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First Name

Last Name

Date of Birth

Social Security Number

Spouse First Name

Spouse Last Name

Spouse Date of Birth

Spouse Social Security Number

Address Line 1

Address Line 2

City

State

Zip Code

Phone

Filling Status

TAX Declaration:

Did you receive Advance Child Tax Credit (ACTC) in 2021?

Yes No

Did you receive EIP (Stimulus) Payment #3

Yes No

Did you receive a loan from Payroll Protection Program?

Yes No

Did you, spouse and/or dependent(s) receive social security?

Yes No

Did you, spouse and/or dependent(s) receive unemployment?

Yes No

Did you, spouse and /or dependent (19-24 years old) attend school for at least 6 months?

Yes No

Are you and/or your spouse a BUSINESS OWNER, SELF EMPLOYED or have unreported income?

Yes No

Do you have health insurance coverage?

Yes No

Do you have any debts with the IRS, US Treasure, child support, student loans, FEMA or any govt. entity?

Yes No

Are you legally married based on your state's definition of marriage?

Yes No

Can someone else claim you/spouse as a dependent?

Yes No

Did you/spouse receive any kind of military pay earnings?

Yes No

Did you/spouse live with anyone with a higher adjusted gross income?

Yes No

DEPENDENTS AND/OR QUALIFYING CHILDREN:

Did you/spouse provide over 50% of total support for each dependent?

Yes No

Did your EIC qualifying children live with you in the same main home in the US?

Yes No

Do your EIC qualifying children meet any one of these requirements:

Under age 19 and lived in taxpayer's home more than one half of the year? Under age 19, foster child of taxpayer and lived in taxpayers home for a full year? Full time student age 19 to 23? Totally disabled and can provide proof?

Documents:

Please ATTACH necessary documents. Attachments must be clear and LEGIBLE. Take pictures with the least amount of background as possible

Please upload Driver’s License (for ALL taxpayers)

Please upload Social security cards (for everyone on tax return)

Please upload Proof of residency

Please upload W2

Please upload 1099-R (Retirement)

Please upload childcare/daycare letter

Please upload 1098 (Mortgage Interest Statement)

Please upload tithes letter

Please upload additional documents

Would you like direct deposit or a check?

Direct Deposit Check

Routing (If direct deposit)

Account number(If direct deposit)

Security Question:

Your Answer

Gossip Financial Services will prepare your 2021 individual tax return from the information you have provided. We will not audit or verify the information you furnished to us. You, the taxpayer, are ultimately responsible for the preparation and filing of your tax return. Please read and verify the information you furnish and the information on your tax return are the same and accurate before signing. I, the taxpayer named above, have provided to Gossip Financial Services the attached tax information and to the best of my knowledge this information is true, correct and complete. I declare that I understand the above questions and have answered them truthfully to the best of my ability.

Taxpayer's Signature

Spouse's Signature

KNOW THE BASICS EITC ELIGIBIITY RULES FOR ALL EITC CLAIMANTS
ALL TAXPAYERS CLAIMING EITC MUST MEET THESE RULES:
Rule 1- Adjusted gross income (AGI) limits Your adjusted gross income (AGI) must be less than: $51,464 ($57,414 for married filing jointly) if you have three or more qualifying children, $47,915 ($53,865 for married filing jointly) if you have two qualifying children, $42,158 ($48,108 for married filing jointly) if you have one qualifying child, or $21,430 ($27,380 for married filing jointly) if you do not have a qualifying child. Rule 2- you must have a valid social security number (SSN)
Rule 3- your filing status cannot be married filing separately
Rule 4- you must be a United States citizen or resident alien all year
Rule 5-you cannot file form 2555 or form 2555-ez
Rule 6- your investment income must be $10,000 or less
Rule 7-you must have earned income of at least $1
Rule 8-your child must meet the relationship, age, residency, and joint return tests
Rule 9-your qualifying child cannot be used by more than one person to claim the EIC
Rule 10- you cannot be a qualifying child of another taxpayer
Rule 11-you must be at least 25, but under age 65 (if no qualifying child)
Rule12-you cannot be the dependent of another person
Rule 13-you must have lived in the United States more than half of the year

The maximum amount of credit for Tax Year 2021 is:

$6,728 with three or more qualifying children
$5,980 with two qualifying children
$3,618 with one qualifying child
$1,502 with no qualifying children

When Can I Expect My Refund?
If you claim the earned income tax credit (EITC) or the additional child tax credit (ACTC) on your tax return, by law the IRS can't issue your refund before mid-February — even the portion not associated with EITC or ACTC

Disclosure: I understand the rules to claim EITC. I understand that the information I provided meets the IRS guidelines to receive the EITC. I found to be perjury, I, the taxpayer could be fined for misrepresentation of the Earned Income Credit Tax Laws.

Date