mmahajan@ppmktax.com   /   mmahajan@verizon.net    +1 (732) 452-9381

Personal Tax Information Sheet

    First Name Last Name SSN/IITN Date of Birth Filing Status
  Tax Payer : - -
  Spouse : - -
 
Dependant Information:
 Add Another Dependant
    First Name Last Name Date of Birth SSN/IITN Relationship
  Dependant1 : - -
 
Your Current Address:
 
Address :  
City/town :
State :
ZIP :
Email ID :
Your Contact :
 
County :    
School District :    
State :
And Other :
 
Bank Information:
ABA / Rounting no :    
Account Number :    
Type of Account :    
First time in US : Yes   no
Note :  If Yes, Date of Entry in US :
 
State lived in :  
State Worked in
 Add More State Worked
    State lived in   Date from   Date to   No. of day  
Period Lived in State 1 :        
 
 
If Renting an Apartment      
What was the total rent paid :          
Did you move last year: : Yes   no          
Charity (Pl provide detailed spreadsheet as attachment)
 Add More Charity
Serial no Paid to Insitiute name   Type of Payment Amount  
1    
Expenses
Medical expenses (Out of pocket) :   
If dependant is Student, college fees paid (Attach form 1098T received from school)
Child care expenses              
Child 1 : Provider's Name SSN/ITIN County City/Town
    - -
    Address State ZIP Amount($)
   
Child 2 : Provider's Name SSN/ITIN County City/Town
    - -
    Address State ZIP Amount($)
   
   Note: If you don't have the ITIN no. for dependents, pl. provide the following details to apply for one
   First 2pages of their passport, last 2 pages of the passport and the copy of the Visa and I-94.
Passport details of spouse and children
 Spouse Child1 Child2  
  First Name :  
  Last Name :  
  Date of Birth :  
  Address in India :  
  Country of Birth :  
  Gender :    
  Country of Citizenship :  
  Type of US Visa :  
  Control number and expiration date :  
  Passport Issued by :  
  Passport no. :  
  Expiration Date :  
  Entry date in US :  
Documents Required:
  Copies of W-2 :
  Copies of 1099-INT :
  Copy of the Passport for dependents only :
  Fax # :732-548-1617    

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