Please Fill Out The Following Personal Taxes Form Taxpayer Questionnaire PERSONAL INFORMATION Primary Taxpayer Dependant on another return? Yes No Text Message Yes No Filing Status (Circle which Status number applies) 1 = Single If You Were NOT married on or before December 31, 2013. Your dependents lived with you less than 6 months during the year. 2 = Married Filing Joint If You were married as of December 31, 2013 or your spouse died during 2013 3 = Married Filing Separate If You were married on or before December 31, 2013 and your spouse is filing a tax return using this filing status. * If MFS, did you live together at ANY time during the tax year? If yes, did you live together during the final 6 months? * If MFS, did your spouse itemize his/her deductions? NOTE: If spouse itemized deductions, taxpayer must also Itemize deductions. 4 = Head of Household If: You were NOT married as of December 31, 2013. Your child, foster child, or grandchild lived with your more than 6 months. 5 = Qualified Widow(er) If: Your spouse died during either 2011 or 2012, and Your child, stepchild or foster child lived with you for 12 months in 2013. Spouse Dependant on another return? No Yes Adress Bank Information (for Direct Deposit intoTaxpayers Personal Acc.) Account Type: Saving Checking This refund go to an account outside of the US? Yes No Bank Information (for Direct Deposit intoTaxpayers Personal Acc.) Children who lived with you and are being claimed on another return Non Depdents claimed for EIC and Disabled person's dependent care expenses FINANCIAL PRODUCTS Complete the following if refund type is a RAC/RT Identification Information: Bank Products require at least 1 of the following forms of ID Driver License DMV/BMV State ID Military ID US Passport/Resident Alien ID Matricular Consular Foreign Passport Taxpayer Taxpayer Taxpayer Spouse Spouse Spouse Application Information: If filing a joint return, who is borrower? T = Taxpayer Only S = Spouse Only B = Both Taxpayer & Spouse With the IRS removing the Debit Indicator (D1), there is a chance that a RAC/RT will not be refunded in full. Some reasons for not getting a complete RT refund: 1. IRS says you owe back taxes 2. IRS says you have a current garnishment 3. IRS is auditing your Earned Income Credit 4. Earned Income Tax Credit (EITC) is claimed and an EITC qualifying child is a foster child 5. You have an outstanding debt with any bank that provides RAC/RT PLEASE NOTE - WE DO NOT HAVE ANY CONTROL OVER THE ABOVE REASON I understand that all information I have provided on this form is true. If any of this information is incorrect, I understand that a formal letter will be sent if the refund is not paid in full. In addtion, I understand that my refund may be provided to me in more than 1 check. Send
