Liberty Tax Beaumont

Name
First Name Middle Initial Last Name
Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Phone
Is this a cell phone?
- Yes
- No
Best time to call
Email
Preferred Contact Method
- Phone
- Email
Social Insurance Number (SIN)
Date of Birth (yyyy/mm/dd)*
Date Format: MM slash DD slash YYYY
Province/Territory of Residence on December 31 of tax year being filed
Marital Status on December 31
- Single
- Married
- Common Law
- Widowed
- Divorced
- Separated
Spouse/Common Law Information (if applicable)
First Name Middle Initial Last Name
Social Insurance Number (SIN)
Date of Birth (yyyy/mm/dd)
Date Format: MM slash DD slash YYYY
Net Income: (if not filing together) $
Disabled
- Yes
- No
Dependant Information (if applicable) – living at same address
First Name Last Name SIN DOB (yyyy/mm/dd) Relation Net Income Disabled (Y/N)
For which tax year(s) would you like us to prepare a return?
Did you sell a residence, home or any property during the tax year?
- Yes
- No
Have you claimed bankruptcy in the past two years?
- Yes
- No
Are you self-employed or do you own your own business?
- Yes
- No
Do you have foreign income?
- Yes
- No
Do you have any RRSPs or other investments?
- Yes
- No
Do you own any rental properties?
- Yes
- No
Do you have employment expenses to claim?
- Yes
- No
Do you have any of the following receipts: (receipts must be given with dropped off materials)
- Daycare
- Medical expenses
- Donations
- Political contributions
Do you pay or receive support?
- Pay
- Receive
If yes, what kind of support?
- Child
- Spouse
Please provide any additional information
You may upload any additional required documentation here
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First Name	Last Name	SIN	DOB (yyyy/mm/dd)	Relation	Net Income	Disabled (Y/N)