Nvisionit | Financial Solution - Reduce Taxes, Eliminate Debt and Build Wealth like no other

Name:

Occupation:

Social Security:

- -

Birth Date:

/ / mm/dd/yyyy

Spouse Name:

Occupation:

Social Security:

- -

Birth Date:

/ / mm/dd/yyyy

Address:

City:

State:

--
Other

Zip Code:

Filing Status:

Single Married Married/Separate Head of House-Hold

Email:

Spouse Email:

Telephone:

- - (area code - xxx - xxxx)

Evening Telephone:

- - (area code - xxx - xxxx)

Cell:

- - (area code - xxx - xxxx)

DEPENDENTS First, Middle, Last	BIRTH DATE (Month, Day, Year)	SSN#	RELATIONSHIP	MONTHS LIVED With You
	/ / mm/dd/yyyy	--
	/ / mm/dd/yyyy	--
	/ / mm/dd/yyyy	--
	/ / mm/dd/yyyy	--

Can Someone else claim you as a dependent? Yes No

IRA / Roth Contributions:

Alimony Paid:

Moving Expenses:

Lodging Expenses

Do You Itemize?

Yes No

Did You Pay State Tax?

Yes No

Which State:

DID YOU PAY SOMEONE TO CARE FOR YOUR CHILD/CHILDREN?

Provider's Name:

SSN/EIN:

--

Address:

Amt. Paid: $

Provider's Name:

SSN/EIN:

--

Address:

Amt. Paid: $

Additional Comments: