Please complete the following information Lopeza Services Impuestos / Taxes: Tax payer name: * Tax payer name: Name Name Apellidos Apellidos LOPEZA customer number: Address * Address Address Address City City Estate AlabamaAlaskaArkansasArizonaCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyoming Estate Zip-code Zip-code Phone: * Email Confirm Email Fecha de nacimiento: Spouse: * Yes No Spouse Date of Birth: Form of presentation: * Single Married reporting together Married Reporting Separated Head of household Other Has dependents: * Yes No How many dependents do you have: Dependents Name * Name Name Name Middle name or initial Middle name or initial Apellidos Apellidos Relationship: * Children Siblings wife or Husband Father or Mother Other Has lived with you during the reporting period: * Yes No Añadir dependiente Eliminar dependiente Ingresos Presentation documents: * Social Security MASS ID ITIN Aplicar o renovar ITIN Date of entry to the United States: * Adjuntar copia de pasaporte: * Drag a file here or click to upload Select File Maximum file size: 5MB Select one or more options (according to your case): * W2/W2G 1099R 1099G 1099B 1099R 1099 INT/DIV SSA-1099 1098T Tuition Adjuntar documentación: * Drag a file here or click to upload Select File Maximum file size: 5MB Impuestos de Negocio o Contratista Reporta Negocio o Contratista * Yes No Impuestos de negocio o contratista (continuación)… Ingreso 1099 Misc 1099K 1099NEC Cash Adjuntar formularios de negocios: * Drag a file or take a photo here: Select File Maximum file size: 5MB cash income: * Material expenses: * Gastos Contratistas: * Rent expenses: * Mobile Phone Expense: * Cost of work clothes: * Gas expense: * Electrical energy expense: * Reporta vehículo: * Yes No Modelo * Precio * Fecha de compra * Millaje a fecha de compra * Millaje a finalizar * house taxes 1098 INT (Mortgage Company) * Yes No Adjuntar documentación: * Drag a file here or click to upload Select File Maximum file size: 5MB Home taxes (continued) Date of purchase (provide package delivered at purchase): * Rental Income: * Loan interest: * Real estate Tax: * Hazard Insurance: * Water: * Repairs: * Expenses / Gastos Rent expenses: * Transportation: * E-ZPass: * Donations: * Other expenses: * Gastos estudiantiles: * Yes No Gastos estudiantiles (monto anual): * Adjuntar 1098T (Gastos estudiantiles): * Drag a file here or click to upload Select File Maximum file size: 5MB 1098E: * Yes No 1098E (annual amount): * Attach 1098E: * Drag a file here or click to upload Select File Maximum file size: 5MB Daycare: * Yes No Daycare (annual amount): * Attach Daycare vouchers: * Drag a file here or click to upload Select File Maximum file size: 5MB Medical Form 1095 A Yes No Adjuntar documento: * Drag a file here or click to upload Select File Maximum file size: 5MB 1095 B Yes No Adjuntar documento: * Drag a file here or click to upload Select File Maximum file size: 5MB 1095 «C» Yes No Adjuntar documento: * Drag a file here or click to upload Select File Maximum file size: 5MB Masshealth * Yes No Gastos de dentista: * Yes No Deposito Directo Desea deposito directo: * Yes No Datos Banco: Nombre del banco: * Nombre de la cuenta: * Número de cuenta: Routing number: If you are human, leave this field blank. Send
