Fill - Free fillable STIMULUS PAYMENT President Biden issued a coronavirus stimulus (Flightax) PDF form

PERSONAL DATA

(Please Print)

First Name M.I. Last Name (as on your SS Card) Social Security Number Date of Birth Sex

Taxpayer:

M F

Spouse:

M F

Street Address Apt. # City State Zip Code

Current Tax Address:

Mailing Address:

Tax Address: The current state to which you pay tax and the address we use on your tax return. Note: Must be able to receive mail.

Mailing Address: The address where we mail your documents if diﬀerent from your tax address.

Home Phone Number: Cell Phone Number: Email:

Primary Contact Name: Spouse’s Cell Number: Spouse’s Email:

Best way to contact you:

May we notify you via text messages to your cell phone when your return is complete?

Yes No

If yes, tell us which carrier to use (e.g. Verizon, Sprint, etc.)

Occupation Airline Base Employee # Date of Hire Preferred Name/Nickname

Taxpayer:

Spouse:

Taxpayer: Retired Date: Furlough Date: Leave of Absence Date:

Spouse: Retired Date: Furlough Date: Date:

DEPENDENT INFORMATION

If you have dependents, complete and physically sign the attached dependent worksheet.

FILING STATUS

(Check One)

Single Married Filing Joint Qualifying Widow(er) Spouse’s date of death

Married Filing Separate

If you ﬁle MFS and itemize your deductions, your

spouse must itemize their deductions as well.

Spouse Name: Spouse Soc. Sec. #:

Did you live with your spouse

any time during 2021?

Yes No

If yes, did you live with your

spouse any time after June 30?

Yes No

Head of Household

If you are the custodial parent & someone else is

taking the exemption for your child, complete this

section. Otherwise, list all dependents on the

separate dependent worksheet.

Name: Soc. Sec. #:

Relationship:

Date of Birth:

# of months lived with you:

Who is claiming this person on their tax return?

Victim of Identity Theft?

Yes No

If you, your spouse or any dependents listed have been a victim of Identity Theft, you must provide a

copy of the IRS Letter(s) received with the assigned 6-digit Identity Protection (IP) Pin.

DIVORCE

Yes No Please Answer All Questions Amount

What date was your divorce/separation agreement

ﬁnalized:

Was the original divorce decree or separation

agreement modiﬁed any time after 12/31/18?

If yes, provide a full copy of the modiﬁed agreement.

Yes No Please Answer All Questions Amount

Did you receive any alimony during 2021?

Did you pay any alimony in 2021?

To:

SN:

2021 Tax Year

STIMULUS PAYMENT

President Biden issued a coronavirus stimulus payment after

March 15, 2021 which should have been $1,400 per person

listed on your 2020 tax return.

YES, I received a stimulus payment

Amount of payment

NO, I did not get a stimulus payment

A. INCOME SOURCES

Yes No Please Answer All Questions Amount

Did you receive any unemployment during 2021?

If yes, please provide Form 1099 G.

Did you receive a K-1 from any entities–Corporation,

Estate, Trust, Partnership, etc.? If yes, enclose.

Did you receive any Social Security during 2021?

(Enclose SSA - 1099)

Yes No Please Answer All Questions Amount

Gambling losses may only be used to oﬀset winnings. Losses greater than winnings are

not deductible. You need to have documentation of your gambling losses.

Note: Provide Forms W-2G reporting state where winnings were paid.

Did you have any gambling winnings in 2021?

Did you have any gambling losses in 2021?

Did you receive any type of additional income during 2021? (jury duty pay, training stipends, duty free commissions,

taxable prizes, trustee fees, etc.) Specify type of income and provide amount. Provide 1099-MISC if applicable.

Taxpayer

Spouse

1099 Misc.—income should be reported in Small Business/Self Employment Section.

STATE RESIDENCY INFORMATION FOR 2021

All clients complete this section, even if you only lived in one state or lived in a state with no income tax. If you paid taxes to more than one state, you may receive a separate W-2 for

each state. We must have ALL of these W-2’s.

State Own Rent Other Date Moved In Date Moved Out Still a Resident? County School District

Yes No

If you are required to ﬁle a state return and DO NOT want Flightax to prepare your state return for you, initial here.

(Remember, you should not ﬁle your state return before you ﬁle your federal return.)

DO NOT

File my State

Initial

Here

B. ESTIMATED TAX PAYMENTS

The quarterly payments made to the IRS and/or your state. These payments are usually for tax on self-employment/investment income.

Federal Amount Date of Payment State Amount Date of Payment Local Amount Date of Payment

$ $ $

IMPORTANT QUESTIONS

FOREIGN ACCOUNTS

Yes No Please Answer All Questions Amount

Did you make any out of state purchases without paying

sales tax that you need to claim on your state return?

Do you have any children under age 24 with investment income

over $2,200? If yes, please provide 1099 statements.

Did you adopt a child during 2021? If yes, contact us for additional

information.

Do you owe any back taxes to the IRS or your state?

Do you have any delinquent student loans or owe back child support?

Did the IRS garnish your refund last year?

Yes No Please Answer All Questions

Did you have any debts cancelled or forgiven? If yes, provide explanation

in Comments on pg. 9. Provide Form 1099-A and/or 1099-C.

Do you agree to allow Flightax to discuss this return with

the IRS should questions arise?

What is your maiden name or previous married name?

NEW CLIENTS ONLY

New Clients must provide full copy of prior year Federal and

State Tax Return.

Who referred you to Flightax?

Yes No Please Answer All Questions

At any time during 2021, did you have a ﬁnancial interest in, or a

signature authority over a ﬁnancial account located in a foreign country?

(Foreign Bank, Securities or other ﬁnancial account)

If you live in the U.S. and the balance of your foreign account(s) exceeds $50,000

for Single/MFS or $100,000 for Joint ﬁlers on the last day of the year OR the

balance exceeds $100,000/$150,000 at any point during the year, you are

required to ﬁle form 8938 with your tax return. Taxpayers living outside of the

U.S. have higher thresholds and are only required to ﬁle the form if the foreign

account(s) balance exceeds $200,000 for Single/MFS or $400,000 for Joint ﬁlers on

the last day of the year OR exceeds $300,000/$600,000 at any point during the

year. If you are required to ﬁle form 8938, please visit our website and download

the Foreign Accounts Worksheet.

Did the combined value of these accounts exceed $10,000 at any time

during 2021? If yes, provide the Country(ies) as these must be

reported on your tax return.

Additionally, you are required to submit an FBAR–FinCEN Report

114 electronically via the BSA E-Filing System; a link is available on

our website. Must be ﬁled by April 15, 2022.

FOREIGN BASED FLIGHT ATTENDANTS

If you are based abroad for any part of the tax year, you will need to complete the Foreign Domicile Organizer. Download a copy at www.ﬂightax.com.

D. FORM 1099INT: INTEREST INCOME

Please list the institutions for which 2021 interest income was received for you, your spouse, and any dependents under the age of 24. If your child ﬁles their own tax return and their interest and dividends

are over $2,200, it must be reported on your return or be taxed at your tax rate on their return. Please provide the original Forms 1099-INT or other statements reporting interest income.

Institution

Taxpayer, Spouse or Dependent?

Institution

Taxpayer, Spouse or Dependent?

Institution

Taxpayer, Spouse or Dependent?

T/P S D T/P S D T/P S D

F. FORM 1099B: STOCKS AND BONDS SOLD*

The information below MUST be provided. Provide all broker 1099 Forms. Purchase price (cost basis) must be provided.

Description and Quantity Purchase Date Sale Date Proceeds

Purchase Price

Cost Basis

$ $

G. FORM 1099R: DISTRIBUTIONS FROM PENSIONS, ANNUITIES, RETIREMENT, IRAs, ETC.*

Please list the institutions and provide the following information for which 2021 distributions were received for you and your spouse. Please provide the original Forms 1099-R.

Institution

Taxpayer or

Spouse?

Date of

Distribution

Reason for Distribution

Amount rolled

over, if any

T/P S

Did you repay any of your 2020 Distribution taken due to Covid relief? Date Repaid Amount Repaid

H. IRA & SELF EMPLOYED RETIREMENT CONTRIBUTIONS*

Traditional IRA

Taxpayer Spouse

Have you ever made non-deductible contributions to any Traditional IRA? (If yes, we must have the

amount of non-deductible contributions made.)

Yes No Yes No

2021 contribution already made, if any. (May qualify for tax credit.)

$ $

Roth IRA

2021 Roth contribution already made, if any.

(May qualify for tax credit.)

$ $

Self Employment Retirement Plan

2021 contribution already made, if any.

(May qualify for tax credit.)

$ $

I. EDUCATION DEDUCTION* & STUDENT LOAN INTEREST

Did you pay any student loan interest in 2021? If so, provide Form 1098E.

T/P S D

To claim an Education Credit or Deduction for yourself, your spouse and/or your dependent children: You must provide a copy of the 1098-T and the

Account Transcript showing proof of tuition payment made. This information may be found in the students’ online account.

For the American Opportunity Tax Credit the IRS deﬁnes Qualiﬁed Expenses as: tuition and fees, books and other required materials an individual is required

to pay in order to be enrolled in an eligible institution.

529 Plan Qualiﬁed Expenses and Withdrawals are expanded to include: room and board, computer or peripheral equipment.

Please provide Form 1098T Student #1 Student #2 Student #3 Student #4

Name of Student

Name of Institution

Year in College 1

Grad 1

Grad

Was student at least halftime?

Yes No Yes No Yes No Yes No

Has student ever been convicted of a

Federal or State Felony Drug Oﬀense?

Yes No Yes No Yes No Yes No

Amount of Tuition Paid

$ $ $ $

Amount of 529 Plan Withdrawals

$ $ $ $

Amount of 529 Plan Withdrawals

used for Qualiﬁed Expenses

$ $ $ $

E. FORM 1099DIV: DIVIDENDS AND DISTRIBUTIONS

Please list the institutions for which 2021 dividends and capital gains distributions were received by you, your spouse, and any dependents under the age of 24. If your child ﬁles their

own tax return and their interest and dividends are over $2,200, it must be reported on your return or be taxed at your tax rate on their return. Please provide the original Forms

1099-DIV and all year-end summary statements.

Institution

Taxpayer, Spouse or Dependent?

Institution

Taxpayer, Spouse or Dependent?

Institution

Taxpayer, Spouse or Dependent?

T/P S D T/P S D T/P S D

C. FORM W2: WAGE & TAX STATEMENT

Please list the 2021 employers for you and your spouse, indicate whether the employer is the Taxpayer’s or Spouse’s, and provide the original Forms W-2.

Employer

Taxpayer or Spouse?

Employer

Taxpayer or Spouse?

Employer

Taxpayer or Spouse?

T/P S T/P S T/P S

O. MEDICAL EXPENSES

Do not include amounts paid by insurance or with pre-tax dollars (HSA’s or FSA’s). Out-of-pocket expenses must exceed 7.5% of your income. Your state may allow a medical

deduction. Therefore, please complete this section to enable you to get the maximum federal and state medical deductions. Do not include premiums for Accident or Disability

insurance.

Prescriptions

Physician/Dentist/Chiropractor

Long-Term Care Insurance

Premiums Paid

Taxpayer

Spouse

Long-Term Care Expenses

(not covered by insurance)

Taxpayer

Spouse

Insurance Premiums—Not

Pre-Tax

Contacts/Glasses

Lab Fees

COBRA Premiums

Psychotherapy/Counseling

Laser Eye Surgery/Lasik

Co-Pays

Hospital

Miles Driven for Medical

mi.

Health Care Tax Credit—send us Form 8885 or Form 1099-H. You should receive either of these forms if you are eligible.

N. HEALTH SAVINGS ACCOUNTS HSA

If you or your spouse has a Health Savings Account, please provide the following information. Please provide Forms 5498-SA and/or 1099-SA, as applicable.

What type of high deductible

health plan do you have?

Self Only

Family

Number of months in the

high deductible health plan

in 2021

months

Was high deductible

health plan in eﬀect for the

month of December 2021?

Yes No

Total HSA contributions for 2021 made through

payroll deduction

Form 5498-SA required

Total HSA distributions for 2021

Form 1099-SA required

Total HSA contributions for 2021 made by cash or

check to your account (Do not include payroll

deductions).

How much of this distribution was used for medical

expenses?

P. AFFORDABLE CARE ACT ACA***REQUIRED ANNUAL REPORTING**

If your coverage was Employer-Provided, you must provide Form 1095-C or 1095-B. If your coverage was obtained through the Insurance Marketplace, you

must provide Form 1095-A.

Was your entire family covered for the full year with minimum essential health care coverage?

Yes No

If no, please download and complete the Aﬀordable Care Act Worksheet from our website. Submit with this organizer and other tax information.

If yes, how was your coverage provided? Employer Insurance Marketplace Government

Q. CASUALTY LOSSFEDERALLY DECLARED DISASTERS ONLY

Only net amounts over 10% of your income are deductible. Please provide itemized insurance list.

Type of Property

Reason for

Damage

Date of Event Date Acquired

Value Before

Loss/Damage

Value After

Loss/Damage

Insurance

Reimbursement

$ $ $

M. SALES TAX

For the Sales Tax Deduction—you have the option of taking the standard deduction plus major purchases (auto, boat, RV, aircraft) or providing a total amount of sales tax

paid for all purchases during the year. The IRS requires you keep all receipts used for this deduction—provide total amount below. (Do not send receipts except for major

purchases listed below.)

Sales tax paid on the purchase of an automobile, boat, RV, or aircraft during 2021. (Enclose copy of receipts.)

Sales tax paid on all items purchased during 2021—IRS requires documentation for all items purchased.

J. 529 PLAN WITHDRAWALS FOR K12

If you took a 529 Plan distribution for grades K–12 tuition, provide 1099-Q Statement for each student.

Did you take a 529 Plan distribution for grades K–12?

Yes No

If your 529 withdrawal was for college or grad school tuition, see Section I on page 3.

K. MISCELLANEOUS EXPENSES

Investment Expense is no longer deductible

Margin or Investment Interest Paid

Vehicle Excise/Ad Valorem Tax/Personal Property Tax $

L. K12 EDUCATOR EXPENSESW2 INCOME ONLY*

Educator Expenses Classroom expenses for K thru 12 educators may qualify for a special above the line deduction up to $250.

Total Classroom Expenses (keep receipts)

Grade level taught

R. CHARITABLE CONTRIBUTIONS*

IRS Requirements for Cash Contributions: You cannot deduct a cash contribution, regardless of the amount, unless you keep as a record of the contribution a bank record (such as a

cancelled check, a bank copy of a cancelled check, or a bank statement containing the name of the charity, the date, and the amount) or a written communication from the charity.

The written communication must include the name of the charity, date of the contribution, and amount of the contribution.

Cash

Church

Oﬃcial Charities

Airline Charity

Education Contributions

Charitable Miles Driven

mi.

IRS Requirements for Vehicle Contributions: The IRS requires written acknowledgement (1098-C) received from the charitable organization be attached to the return if you are

taking a deduction over $500. If your donation was valued at less than $500 please complete the following:

Vehicle

Name of Charitable Organization:

Date of Donation

Method to determine value:

Original Purchase Date & Price

Fair Market Value under $500

Make and Model of Vehicle: How acquired?

IRS Requirements for Non-Cash Contributions: The IRS requires an itemized list of all items donated and a receipt from the charitable organization. Name and address are required

for any donation over $500. Please make sure your receipt has a dollar value on it; if over $500, you must submit the receipts. Download additional worksheets at ﬂightax.com

Non-Cash

Charitable Organization receiving donated goods:

Address of this organization:

Do you have an itemized list and the corresponding receipt?

Yes No

Date of Donation Resale Value of Furniture

Original Purchase Date: Resale Value of Clothing

How acquired? (purchase, inheritance, gift): Resale Value of Appliances

Original Purchase Price:

Resale Value of Household Items

T. FIRSTTIME HOMEBUYER FTHB CREDIT RECAPTURE*

If Flightax did not prepare your 2008 return, you must provide a full copy of the 2008 return.

Did you take the FTHB credit of up to $7,500 for a new home purchased in 2008 that must be paid back on a yearly basis?

Yes No

S. HOMEOWNER INFORMATION (Principal Residence and 2nd Home within the U.S.)

Note:

If you own a Principal Residence or 2nd Home outside of the U.S., complete section V. Foreign Residence Information.

Do not include rental property expenses

—

see Section X. Provide 1098 statement from mortgage company. If you purchased, sold, or reﬁnanced, send a copy of the closing statement.

Mortgage Interest on Principal Residence

Real Estate Taxes on Principal Residence

Home Equity Interest or 2nd Mortgage

on your Principal Residence

All other Real Estate taxes paid on personal

residences, including vacant land

Mortgage Interest on 2nd Home

Real Estate Taxes on 2nd Home

Mortgage Interest on Vacant Land

Is this a Construction Loan on Vacant Land?

Yes No

At any time in 2021, did the mortgage balances on your principal and/or second homes exceed $750,000?

Yes No

Interest paid on a boat/RV may qualify as a deduction if it has a lavatory and a range. HOA—Homeowner Association Fees are not deductible for primary residence.

Did you reﬁnance your home in 2021?

Yes No

If yes, please provide number of years you reﬁnanced & closing statement.

Did you use the Home Equity line of credit

for anything other than home improvements?

Yes No

If yes, enter the amount

spent for each

Home Improvements

Other

Did you sell your home in 2021?

Yes No

If yes, provide purchase & sale closing statements.

If yes, what was the sale price?

Sale Date:

What was the original purchase price?

Original Purchase Date:

Was the property you sold your primary

residence for 2 of the past 5 years?

Yes No

Number of years in home before sale:

Was an oﬃce in home deduction ever taken?

Yes No

If yes, please provide tax return from each year taken (new clients).

Was this home ever used as a rental property?

Yes No

If yes, please provide tax return from each year rented (new clients).

Did you purchase your home in 2021?

Yes No

If yes, a copy of your closing statement is required.

U. RESIDENTIAL ENERGY CREDITS*

If you made qualifying energy improvements to your home, you may be eligible for an energy credit.

Did you install alternative energy equipment, such as solar hot water heaters, geothermal heat pumps, or wind turbines?

If yes, you must provide a copy of the manufacturer’s certiﬁcate and a copy of your sales receipt.

Yes No

V. FOREIGN RESIDENCE INFORMATION (Principal and 2nd Home located outside the U.S.)

Provide information below for Mortgage Interest paid in a country other than the U.S. Please list all amounts in U.S. dollars.

Mortgage interest on principal residence

Mortgage interest on 2nd home $

Name of Lender Lenders’ Street Address City State Zip

Are you a Real Estate Agent? Call us for a special RE Professional Worksheet or download one at www.ﬂightax.com

W. SMALL BUSINESSSELF EMPLOYED1099MISC. INCOME*

Includes acting & modeling income. Send last year’s return if you had the business and we did not prepare the return for you.

Name of Business: Type of Business:

Taxpayer Name: Taxpayer SSN: EIN:

Note: If you are incorporated, please download the Corporate Organizer or submit your K-1.

1099 Income

(provide any 1099’s)

Additional Income not reported on 1099

Total Gross Income

Expenses

Advertising

Supplies

Telephone/Internet Services

Business Insurance (not health)

Taxes

(Not Estimated Payments)

Bank Charges

Interest: Mortgage

Travel

Self Employed Health Insurance

Other Interest

Meals

Other (specify)

Legal & Professional Fees

Utilities (outside of home)

Equipment Purchases (complete information below)

Rent (outside of home)

Dues & Publications

Date you started your business

Repairs & Maintenance

Postage & Shipping

Contract Labor

Taxpayer Responsibility: You must ﬁle a 1099-Misc. for

each Contract Laborer paid more than $600. This may

include money paid for repairs or maintenance services.

Did you issue any 1099-Misc. forms for 2021?

If yes, provide copies of all forms issued.

Yes No

List Equipment Purchased in 2021 Date Purchased Placed in Service Cost

Inventory If you purchase goods to have available for resale or you manufacture goods for resale in your business, you may carry an inventory. Beginning inventory should be the

same as ending inventory for the previous tax year. Please include, in the cost of inventory purchased during the year, only the cost of materials and supplies which became a part of

the product which you sell. All other materials and supplies related to your business should be listed separately in the categories above.

Inventory at beginning of year. If diﬀerent from last year’s closing inventory, attach explanation. Provide Cost, not Retail Amount.

Inventory purchased during the year—less the cost of items withdrawn for personal use.

Inventory at the end of the year.

Vehicle Expense Please answer ALL questions below! The IRS requires written evidence of business miles to qualify for the deduction!

Type & Year of Vehicle: Miles Driven for Personal Jan. 1–Dec. 31

mi.

Date First Used for Business Miles Driven for Business Jan. 1–Dec. 31

mi.

Do you have another car for personal use?

Yes No

Miles Driven for Commuting Jan. 1–Dec. 31

mi.

Do you have evidence to support the deduction?

Yes No

Were you reimbursed or paid for any

of your vehicle expenses?

Yes No

Is this evidence written?

Yes No

If yes, what was the amount?

Home Oﬃce Must be used exclusively and regularly for business.

Square Footage of Home

sq./ft

Cost of Utilities during 2021 (excluding water)

Square Footage of Space/Room Used

sq./ft

Amount of Rent Paid per Month

Purchase Price of Home

Insurance—Homeowners/Renters

Months Oﬃce was in Home during 2021 HOA Fees, Security, Other (specify)

Small Business Comments and Other Expenses

Estimated Tax Payments should be included in Section B.

0.00

X. RENTAL INCOME AND EXPENSE*

If you have more than two properties, download additional forms from www.ﬂightax.com. Use yearly totals below! Send last year’s tax return with this organizer if Flightax did not

prepare your return. If you own only a portion of the property or only a portion is rented out, please include only the amounts that apply.

Property 1 Property 2

Date First Used as a Rental

OFFICE USE ONLY OFFICE USE ONLY

Purchase Price of Home

$ $

Ownership %

% %

Type of Property

Property Street Address, City, State

Total Rent Received in 2021

$ $

Annual Expenses Property 1 Property 2

Advertising

$ $

Travel / Hotel Expense

$ $

Cleaning / Maintenance

$ $

Insurance

$ $

Legal / Professional Fees

$ $

Management Fees & Commissions

$ $

Mortgage Interest

$ $

Real Estate Tax

$ $

Supplies

$ $

Repairs

If total exceeds $1,000–please provide

itemized list

$ $

Utilities

$ $

Telephone

$ $

Condo / HOA Fees

$ $

Lawn Care

$ $

Bank Fees

$ $

Other—Specify:

$ $

List Furniture & Equipment Purchased and Major Improvements made in 2021 (not included above)

Description of Purchase/Major

Improvement

Do not include routine maintenance or minor repair items.

Property 1 Property 2

Cost

Purchase/

Improvement Date

Cost

Purchase/

Improvement Date

$ $

Important Questions Property 1 Property 2

Enter the number of months that this property was available for rent this year.

List the number of days each property was used for personal use.

Did you pay anyone a fee to manage this property for you this year?

Yes No Yes No

Do you actively participate in the management of this property?

Yes No Yes No

Is the average rental period/lease for the property 7 days or less?

Yes No Yes No

Sale of Rental Property New clients should send prior year tax returns where the property was claimed as a rental.

If you bought or sold a rental property in 2021 please provide the Closing / Settlement Statement for each transaction.

Vehicle Expense

Must answer ALL questions and have written evidence as required by the IRS to qualify for this deduction.

Type and Year of Vehicle: Date First Used for Rental Activity

Total Miles Driven for Personal

mi.

Do you have evidence to support the deduction?

Yes No

Total Miles Driven for Rental Activity —All Properties

mi.

Is the evidence written?

Yes No

Rental Car Expenses (rental fee & gas), please total them here and do not include the mileage above!

Rental Comments and Other Expenses

OFFICE USE ONLY OFFICE USE ONLY OFFICE USE ONLY

LOCAL ISSUES

Residents of OH Only

ATTENTION OHIO RESIDENTS: We will prepare your Ohio state and school district return, where appropriate; however, we will not prepare

any local or municipality returns (RITA, CCA, COL, CIN, etc.).

LOCAL ISSUES

Residents of DE, MI, MO and PA Only

ATTENTION RESIDENTS OF DE, MI, MO, and PA: Clients with local returns must

be received by March 1st. If you want Flightax to prepare your city return, please

complete the section below and provide the proper form or earnings statement

required by the taxing location. Local tax paid with the ﬁling of your return last year

should be entered under Important Questions on page 2. Please send Instruc-

tions with forms to be completed. (No additional forms for NYC are required.)

Do you want Flightax to prepare your local earnings

or income tax return?

(If yes, provide tax form.)

Yes No

Name of Locality:

Did you pay any estimated tax to your locality during

2021?

(Do not include amounts withheld on your W-2.)

STATE SPECIFIC ISSUESResidence State Only If you are eligible for a state credit or deduction not listed, please let us know.

If you are eligible for a state credit or deduction not listed, please let us know.

Drivers License information required to E-File

Taxpayer DL #: Issue Date: Expiration Date: Issue State:

Spouse DL #: Issue Date: Expiration Date: Issue State:

Residents—Need Date Paid and Amount Paid on Home and Auto Property Tax.

(Maximum total credit is $300)

Property Date Paid Amount Paid Property Date Paid Amount Paid Property Date Paid Amount Paid

Home

Auto 1

Auto 2

ID Cost of insulation installed in primary residence during 2021. (Home must have been built or started prior to 1/1/02.)

IL Property owners provide PIN #. (PIN=Property Index Number on Property Tax Statement)

Provide copy of homeowner’s or property’s insurance declaration page showing the separate line item charges for LA Citizens

assessments not already claimed.

Please provide qualiﬁed commuter expenses

(public transportation only).

Please provide Form 1099-HC. This form is required to claim health coverage exemption and avoid penalty.

MI Provide the property tax statement showing 2021 taxable value of your home.

MN Send statement of property taxes “payable in 2022”. You should receive this statement in March of 2022.

Amount of job training expenses incurred during 12 months after employment layoﬀ.

EDUCATION SAVINGS ACCOUNTS

You must provide the end of the year statement for all plans. Some states may allow carryover of credits for Education Savings Plans. If you are a new client, please provide prior year state return.

Education Savings Plans Only list contributions made on or before 12/31/21

Account Number Beneﬁciary/Student Amount

Contributions to Coverdell Education Savings Plan

Contributions to State College Savings 529 Plan St. Plan Name:

Contributions to State Prepaid Tuition Program St. Plan Name:

RENTER’S CREDIT

If you paid rent at your TAX ADDRESS during year 2021, and it is in IN, MA, MI, MN, NJ, WI, or CA or a state with a renter’s credit, complete the following section.

MN residents send us your Certiﬁcate of Rent Paid (CRP). Note: For NJ residents to qualify for the credit, all roommate information must be provided.

Landlord’s Name: Landlord’s Phone Number:

Landlord’s Address:

Total Monthly Rent

$ # of Months Rented:

Your Portion of Monthly Rent

Apartment Address:

NJ Residents—Do you have a roommate? If yes, roommate’s name: Roommate’s SSN:

NJ Roommate’s Number of Months Rented

mos.

NJ Roommate’s Monthly Rent

K12 EDUCATION CREDITS

K–12 Education Credits for AZ, IL, IN, IA, LA, MN & WI See state speciﬁc qualiﬁed expenses below. Keep all related receipts!

Name of Student

Grade Qualiﬁed Expenses Name of School Address State Zip

Arizona

Only fees or donations to a public or charter school located in Arizona, for

extracurricular activities or character education programs qualify. Expenses in excess

of the $250 maximum credit may be carried forward.

Illinois Fees, book rental, band or lab equipment rental, or tuition paid directly to public,

private or religious schools qualify (must be over $250).

Indiana List children enrolled in non-public private, parochial or home school for grades K–12.

Iowa Fees for tuition and textbooks to an Iowa accredited not-for-proﬁt school. Some

extracurricular expenses qualify, such as activity/club fees or dues, fees to participate

in school sports, etc.

Louisiana Expenses for required school uniforms, tuition, fees, textbooks,

curricula, instructional materials and educational supplies.

Minnesota Tuition & fees paid to public or private schools. Other education

supplies including up to $400 for the purchase of a home

computer & educational software.

Wisconsin Fees for tuition and textbooks paid to a private school. Tuition

does not include amounts paid with a voucher or amounts

paid as a separate charge for other items or fees.

ADDITIONAL COMMENTS

Military Worksheet

Active Duty Military: Professional Deductions are disallowed on Federal for 2021 but may still be allowed on state returns.

Reserve Component & National Guard Members: If located more than 100 miles from post, certain travel deductions are allowed as an

adjustment to income. These deductions are not allowed on the Federal Return for Reservists and National Guard located 100 miles or less from

their post, however, they may still be allowed on state returns.

MOVING EXPENSESACTIVE DUTY MILITARY ONLY*

Moved Primary Residence From: Old Duty Station: Number of Vehicles driven:

Moved Primary Residence To: New Duty Station: Miles driven for move:

Distance (Miles from old home to new home):

mi. Lodging Expense (only while in transit):

Date Moved:

Moving Expense (material, rental, movers, & storage):

Pay Grade: Was this move for change of job for spouse?

Yes No

RESERVE COMPONENT & NATIONAL GUARD MEMBERS

Branch of Military & Rank:

Are you Active Duty?

Reservist? National Guard?

1st Post of Duty: Three Letter Code:

2nd Post of Duty: Three Letter Code:

Number of miles from Home to 1st Post: 2nd Post:

Reservist

Travel expenses related to your Reservist Activities are deductible. This deduction includes

meals, lodging and transportation expense, and is based on the rates applied to federal

employees. If you travel over 100 miles from your post of duty, you are no longer required

to itemize your deductions in order to receive this beneﬁt, as these expenses are now

deducted on the front of the tax return. If you travel 100 miles or less, your deduction will

be taken as itemized deductions.

1st Post 2nd Post

umber of Nights Spent at Post

From: To:

Number of round trips driven to/from Post

Did the military provide housing?

Yes No Yes No

Hotel/Housing Expense Paid by You

$ $

Miles driven while at post in personal car

mi. mi.

Rental Car Expense

$ $

Were you paid a per diem?

Yes No Yes No

What was the total per diem paid?

$ $

General Military Deductions Do not include airline expenses.

Dress Uniform Purchase

Dress Uniform Shoes

Uniform Accompaniments

General Military Deductions Do not include airline expenses.

Subscriptions to Military Related Publications

Professional Dues

Job Related Training

Personal Organizer

Log Book

Foreign Visa

Passport Fee

Passport Photo

Uniform Maintenance:

Home Laundering Expense

Professional Laundering Expense

Dry Cleaning Expense

Shoe Shine/Supplies

Military Business Cards

Military Copy/Fax Expense

Military Mailing Expense

Military Phone Expense

Oﬃce Supplies

Misc. (specify)

—IMPORTANT—

Please Complete each Section Below!

Electronic Filing—No additional fee for this service!

Ye s ! Electronically ﬁle my federal and state returns. No! I do not want to electronically ﬁle my returns.

What you need to do:

(yes…it’s free)

1. Check the above box.

2. Keep the yellow copy of Form 8879 with you.

3. We will contact you with the ﬁnal numbers.

4. Fill in the ﬁnal numbers on the form.

5. Select any 5 digit PIN and sign the form.

See instructions on the back of form.

6. Fax it to us at 800-951-8879.

What you need to do: ($50 additional fee)

1. Check the above box.

2. When you receive your information back from us,

sign the federal & state tax returns.

3. Mail them in the appropriate envelopes (they will be

included with your returns).

Additional Fee of $50.00 for all Mail-In Returns

Direct Deposit—No additional fee for this service!

Ye s ! Have my refund deposited! No! Do not deposit my refund into my account!

What you need to do:

(yes…it’s free)

1. Check the above box.

2. Send a voided check. Take an actual check of the account

you want the deposit to go into and write VOID across it.

What you need to do:

1. Check the above box.

2. The refund will be mailed to your TAX ADDRESS.

Allow an extra 2–4 weeks to receive your refund.

Payment Method—We require all tax preparation fees to be Paid in Full by credit card,

check, or online bill pay before we will Electronically File or Mail a Paper Return. Again, payment

is required before ﬁling of return. We no longer oﬀer “Fee From Refund” as a payment option.

Check or Money Order Make payable to Flightax. ($25.00 charge for all returned checks.)

Credit/Debit Card

Visa MasterCard Discover American Express

(Will appear on your receipt as Specialty Tax Services, Inc.)

Card Number Exp. Date

3 or 4 digit

Security Code*

Cardholder

Name

Signature

of Cardholder

Billing Zip Code

Online Bill Payment via Flightax.com

If you would like to pay by Credit Card online, check the box. Once your return has been completed, we will contact you

with instructions and the ﬁnal invoice amount for you to submit payment. This correct amount must be paid prior to the

processing of your return with the IRS.

*How to ﬁnd your security code:

FREE!

Paper Copy If you would like a paper copy of your tax return, initial here.

Due to printing and shipping costs, $15 will be added to your fee.

All clients will receive a digital copy of their return via our secure online portal. Initial the box above if you do not want a digital copy, and

would prefer a physical copy of your return.

0000 000000 00000

12/09 THRU 12/17

CARDHOLDER NAME

0000

4-DIGIT

SECURITY

CODE

The security code is on the front

of American Express cards.

The security code is on the back of

MasterCard, VISA and Discover cards.

How to ﬁnd your security code:

0000000 0000 0000 0000

3-DIGIT

SECURITY

CODE

Cardholder Signature

0000 000000 00000

12/09 THRU 12/17

CARDHOLDER NAME

0000

4-DIGIT

SECURITY

CODE

The security code is on the front

of American Express cards.

The security code is on the back of

MasterCard, VISA and Discover cards.

How to ﬁnd your security code:

0000000 0000 0000 0000

3-DIGIT

SECURITY

CODE

Cardholder Signature

INITIAL HERE

PRICING INFORMATION

$30 processing fee for all Organizers postmarked after March 1st!

An Extension will be ﬁled for all returns received after March 15th.

*Note on fees:

Most federal returns will be completed for the base fee of $169. This includes the federal long form, itemized deductions, interest

income and various other items. However, more complex returns require additional forms to be ﬁled. The fees for the additional forms are on a per

form basis. An asterisk(*) has been placed next to each section of the Organizer that requires additional forms and an additional fee. Please call if

you have any questions concerning the fee for your return.

Item Form # Price

Federal Long Form—Schedule A 1040 $169

First State Return $40

Joint Return $20

Additional State Return(s) $50 each

State w/Filing Status Change $60 each

Domestic Partner State $80

Premium Tax Credit 8962 $30

Health Coverage Exemptions 8965 $30

Physical Copy of Return

(printing & postage)

$15

Additional Forms

Local Tax Return $50 each

Standard Return

(Non E-File) $50

W-2’s in excess of 2 per Taxpayer $5 each

1099-R Retirement Stmts in excess of 2 per Taxpayer $10 each

1099 Retirement —Tax and Penalty 5329 $30

Additional Child Tax Credit 8812 $10

Alternative Minimum Tax 6251 $50

Alternative Motor Vehicle Credit 8910 $50

Business Use of Home 8829 $30

Capital Gains & Losses

(see note below) Sch. D $30*

Sale of Capital Assets

*see below

Casualty Loss–Federally Declared Disaster 4684 $50

Child Care Credit 2441 $40

Contract & Straddles 6781 $80

First Time Home Buyers Credit/Recapture

5405/8859 $30

Depreciation Worksheet $10 each

Earned Income Credit Sch. EIC $50

Education Credits or Deductions 8863/1040 $40

Energy Credit 5695 $50

Extension of Time to File 4868 NC

Farm Income Sch. F $80

Farm Rental 4835 $80

Item Form # Price

Federal Estimated Payment Vouchers 1040 ES $30

Foreign Income Exclusion/Bona Fide Resident

2555 $70

Foreign Source Income Calculation $70

Foreign Tax Credit 1116 $50

Foreign Financial Asset

(1st Account) 8938 $30

Foreign Financial Asset

(Each Additional) 8938 $10

Health Insurance Credit 8885 $30

Injured Spouse/Innocent Spouse 8379/8857 $50

Installment Gain 6252 $80

Interest & Dividend Income over $1500 Sch. B $30

Investment Interest Expense 4952 $30

Investment Tax—Children Under 18 8615 $40

Mortgage Interest Credit 8396 $20

Military Moving Expense 3903 $30

Net Operating Loss 1045 $100

Non Cash Contributions in excess of $500 8283 $30

Non Deductible IRA 8606 $30

Parents Reporting of Childs Income 8814 $40

Partnerships & S Corporations K-1 $50

K-1 Publicly Traded Partnership multiple $100

Passive Activity Loss 8582 $30

Prior Year Minimum Tax Credit 8801 $30

Reduction of Tax Attributes 982 $50

Rental Property

(price per property) Sch. E $80

Rental Property

(New–ﬁrst time reporting) Sch. E $100

Retirement Savings Credit 8880 $10

Sale of Business Assets 4797 $100

Self Employment Tax Sch. SE $20

1099 Misc. Income Sch. C $50 each

Small Business Sch. C $80 each

Vehicle Credit 8936 $50

Small Business Disclosure Statement

8275 $50

Note: Sale of Stocks and Bonds are calculated at $30 for the ﬁrst three transactions and $3.00 for each additional transaction.

Sale of Capital Assets (Form 8949)—$1.00 per required transaction reported.

U.S. Postal

Mailing Address

PO Box 139

Cicero, IN 46034

317-984-5812 

800-951-8879 

317-984-5841  

FedEx/UPS

Shipping Address

220 W. Jackson St.

Cicero, IN 46034

ﬂightax.com

info@ﬂightax.com

We do not disclose any nonpublic personal information obtained in the course of our practice except as required or permit-

ted by law. Permitted disclosures include, for example, providing information to our employees and those of our aﬃliates,

Pilot-Tax, Specialty Tax Services, Inc. and to our tax return processing center for purposes of preparing and processing your

tax return. In all situations we stress the conﬁdential nature of information being shared. In order to guard your nonpublic

personal information, we maintain physical, electronic, and procedural safeguards that comply with professional standards

and the law.

Under the new tax law, Professional Deductions are no longer allowed for your Federal Return. If you live in AL, AR, CA, HI, MN,

NY or PA, they still take them. You will need to download the “Professional Deduction Organizer” and submit it with this Organizer.

All Clients MUST Sign Below for Return to be Processed!

I certify that the information provided in this organizer is accurate and complete. I understand it is my responsibility to include

any and all information concerning income, deductions and other information necessary for the preparation of my personal tax

return. All returns in house after March 15th will have an extension automatically ﬁled. The forms listed in the Pricing Informa-

tion section are the most common forms used. Additional forms not listed may result in per form fees. Administrative fees will

apply for more complex returns. I will be responsible for any collection fees due to nonpayment. (If ﬁling a joint return, both

you and your spouse must sign.)

Signature Signature of Spouse Date

Final Checklist

Originals of all W-2’s

Copy of Last Pay Stub of 2021

Original Employer-Provided Health Insurance Oﬀer and

Coverage 1095-C or 1095-B

Original Health Insurance Marketplace Statement 1095-A

Originals of Interest Statements 1099 INT

Original Tuition Statement 1098T

Original Dividend Statements 1099 DIV

Copies of Sale of Stock/Bonds 1099B

Copies of Brokerage Statements for All Sales

Original Retirement Statements 1099R

Copies of Mortgage Statements 1098

Copy of Closing Statement if Bought/Sold Home

Copy of Receipt for Sales Tax on Car or Boat

Original Voided Check for Direct Deposit

Copy of Last Year’s Federal and State Tax Return

if you are a New Client

Copy of Any Statement of which you are unsure

Copy of K-1’s for Partnership, S-Corp, or Trusts

Copies of Divorce Decree / Separation Agreement

Copies of Modiﬁed Divorce Decree/Separation Agreement

Payment

Signed Back Page!

Completed Organizer!

Completed and Signed Dependent Worksheet

TAXPAYER AND SPOUSE SIGNATURES (Required)

Under penalties of perjury, the information provided about my dependent(s) is to my (our) knowledge true and accurate.

Taxpayer Must Sign Here Spouse Must Sign Here

Taxpayer’s

Printed Name:

Date

Spouse’s

Printed Name

Date

To comply with the tax law, you must sign and complete this form in its

entirety in order to claim a dependent.

Child Care: Qualifying expense for care which allows you to work, look for work, or go to

school full time. This information must be provided even if you have dependent care beneﬁts.

Dependent

Worksheet

ADVANCE CHILD TAX CREDIT PAYMENTS

(Please Print)

Advanced Child Tax Credit Payments were paid monthly from July 15–Dec 15 and must be reported on the tax return in order to claim additional credit due. Enter the

amount you received each month (enter 0 for months no payment received). In January, the IRS will send you Letter 6419 to provide the total amount of payments they

disbursed to you. Please submit a copy of Letter 6419 with your tax paperwork for veriﬁcation purposes.

July August September October November December

$ $ $ $ $ $

DEPENDENT #1

(Please Print)

First Name M.I. Last Name Social Security Number Date of Birth Relationship

Child lived with taxpayers?

Yes No

Number of months:

Dependent’s Earned Income: $ Full Time Student?

Yes No

Has this dependent ﬁled a tax return?

Yes No

Is there another parent who could claim this child as a dependent?

Yes No

If yes, must provide copy of ﬁrst page of dependent return If yes, who?

Did you provide more than 50% of the ﬁnancial support of this child?

Yes No

Divorced/Separated: Do you alternate claiming in even/odd years?

Yes No

Child Care Provider (if child under age 13)

Provider’s Name: Provider’s ID# or SS#: Amount Paid for Childcare: $

Provider’s Address, City, State:

DEPENDENT #2

(Please Print)

First Name M.I. Last Name Social Security Number Date of Birth Relationship

Child lived with taxpayers?

Yes No

Number of months:

Dependent’s Earned Income: $ Full Time Student?

Yes No

Has this dependent ﬁled a tax return?

Yes No

Is there another parent who could claim this child as a dependent?

Yes No

If yes, must provide copy of ﬁrst page of dependent return If yes, who?

Did you provide more than 50% of the ﬁnancial support of this child?

Yes No

Divorced/Separated: Do you alternate claiming in even/odd years?

Yes No

Child Care Provider (if child under age 13)

Provider’s Name: Provider’s ID# or SS#: Amount Paid for Childcare: $

Provider’s Address, City, State:

DEPENDENT #3

(Please Print)

First Name M.I. Last Name Social Security Number Date of Birth Relationship

Child lived with taxpayers?

Yes No

Number of months:

Dependent’s Earned Income: $ Full Time Student?

Yes No

Has this dependent ﬁled a tax return?

Yes No

Is there another parent who could claim this child as a dependent?

Yes No

If yes, must provide copy of ﬁrst page of dependent return If yes, who?

Did you provide more than 50% of the ﬁnancial support of this child?

Yes No

Divorced/Separated: Do you alternate claiming in even/odd years?

Yes No

Child Care Provider (if child under age 13)

Provider’s Name: Provider’s ID# or SS#: Amount Paid for Childcare: $

Provider’s Address, City, State:

DEPENDENT #4

(Please Print)

First Name M.I. Last Name Social Security Number Date of Birth Relationship

Child lived with taxpayers?

Yes No

Number of months:

Dependent’s Earned Income: $ Full Time Student?

Yes No

Has this dependent ﬁled a tax return?

Yes No

Is there another parent who could claim this child as a dependent?

Yes No

If yes, must provide copy of ﬁrst page of dependent return If yes, who?

Did you provide more than 50% of the ﬁnancial support of this child?

Yes No

Divorced/Separated: Do you alternate claiming in even/odd years?

Yes No

Child Care Provider (if child under age 13)

Provider’s Name: Provider’s ID# or SS#: Amount Paid for Childcare: $

Provider’s Address, City, State:

DEPENDENT #5

(Please Print)

First Name M.I. Last Name Social Security Number Date of Birth Relationship

Child lived with taxpayers?

Yes No

Number of months:

Dependent’s Earned Income: $ Full Time Student?

Yes No

Has this dependent ﬁled a tax return?

Yes No

Is there another parent who could claim this child as a dependent?

Yes No

If yes, must provide copy of ﬁrst page of dependent return If yes, who?

Did you provide more than 50% of the ﬁnancial support of this child?

Yes No

Divorced/Separated: Do you alternate claiming in even/odd years?

Yes No

Child Care Provider (if child under age 13)

Provider’s Name: Provider’s ID# or SS#: Amount Paid for Childcare: $

Provider’s Address, City, State:

DEPENDENT #6

(Please Print)

First Name M.I. Last Name Social Security Number Date of Birth Relationship

Child lived with taxpayers?

Yes No

Number of months:

Dependent’s Earned Income: $ Full Time Student?

Yes No

Has this dependent ﬁled a tax return?

Yes No

Is there another parent who could claim this child as a dependent?

Yes No

If yes, must provide copy of ﬁrst page of dependent return If yes, who?

Did you provide more than 50% of the ﬁnancial support of this child?

Yes No

Divorced/Separated: Do you alternate claiming in even/odd years?

Yes No

Child Care Provider (if child under age 13)

Provider’s Name: Provider’s ID# or SS#: Amount Paid for Childcare: $

Provider’s Address, City, State:

PO Box 139, Cicero, IN 46034  317-984-5812  1-800-951-8879 ﬂightax.com

ELECTRONIC FILING

INSTRUCTIONS

Your Name:_________________________________________________________

For your refund to be electronically ﬁled by

Flightax, you must complete the following:

You must ﬁll in your name on the top portion of the 8879 form. Leave your Social

Security Number blank for security.

Select a personal identiﬁcation number (PIN) as your signature for your electronic

income tax return. This ﬁve digit PIN can be any combination of numbers you

choose. Most of our clients choose to use their zip code. You will not be asked to

remember this number for any future purpose.

Under Part II, You (and spouse if applicable) must SIGN and enter your PIN

number(s) where appropriate.

Return this SIGNED copy of the 8879 Electronic Filing Authorization form to our

office no later than April 18th, 2022.

You may fax the form to us at 800-951-8879

You also may email signed form to: 8879@ﬂightax.com

You can snap a photo with your phone and text it to us at: 317-658-7268

Most important!! Call us at (317) 984-5812 and conﬁrm receipt of your fax/email.

take a pic and

TEXT IT

317-658-7268

8879

Form 8879

(Rev. January 2021)

Department of the Treasury

Internal Revenue Service

IRS e-file Signature Authorization

▶

ERO must obtain and retain completed Form 8879.

▶

Go to www.irs.gov/Form8879 for the latest information.

OMB No. 1545-0074

Submission Identification Number (SID)

▲

Taxpayer’s name Social security number

Spouse’s name

Spouse’s social security number

Part I Tax Return Information — Tax Year Ending December 31, (Enter year you are authorizing.)

Enter whole dollars only on lines 1 through 5.

Note: Form 1040-SS filers use line 4 only. Leave lines 1, 2, 3, and 5 blank.

1 Adjusted gross income . . . . . . . . . . . . . . . . . . . . . . . . . .

2 Total tax . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2

Federal income tax withheld from Form(s) W-2 and Form(s) 1099 . . . . . . . . . . . . .

4 Amount you want refunded to you . . . . . . . . . . . . . . . . . . . . . . 4

5 Amount you owe . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Part II Taxpayer Declaration and Signature Authorization (Be sure you get and keep a copy of your return)

Under penalties of perjury, I declare that I have examined a copy of the income tax return (original or amended) I am now authorizing, and to the best of

my knowledge and belief, it is true, correct, and complete. I further declare that the amounts in Part I above are the amounts from the income tax

return (original or amended) I am now authorizing. I consent to allow my intermediate service provider, transmitter, or electronic return originator (ERO)

to send my return to the IRS and to receive from the IRS (a) an acknowledgement of receipt or reason for rejection of the transmission, (b) the reason

for any delay in processing the return or refund, and (c) the date of any refund. If applicable, I authorize the U.S. Treasury and its designated Financial

Agent to initiate an ACH electronic funds withdrawal (direct debit) entry to the financial institution account indicated in the tax preparation software for

payment of my federal taxes owed on this return and/or a payment of estimated tax, and the financial institution to debit the entry to this account. This

authorization is to remain in full force and effect until I notify the U.S. Treasury Financial Agent to terminate the authorization. To revoke (cancel) a

payment, I must contact the U.S. Treasury Financial Agent at 1-888-353-4537. Payment cancellation requests must be received no later than 2

business days prior to the payment (settlement) date. I also authorize the financial institutions involved in the processing of the electronic payment of

taxes to receive confidential information necessary to answer inquiries and resolve issues related to the payment. I further acknowledge that the

personal identification number (PIN) below is my signature for the income tax return (original or amended) I am now authorizing and, if applicable, my

Electronic Funds Withdrawal Consent.

Taxpayer’s PIN: check one box only

I authorize

ERO firm name

to enter or generate my PIN

Enter five digits, but

don’t enter all zeros

as my

signature on the income tax return (original or amended) I am now authorizing.

I will enter my PIN as my signature on the income tax return (original or amended) I am now authorizing. Check this box only

if you are entering your own PIN and your return is filed using the Practitioner PIN method. The ERO must complete Part III

below.

Your signature

▶

Date

▶

Spouse’s PIN: check one box only

I authorize

ERO firm name

to enter or generate my PIN

Enter five digits, but

don’t enter all zeros

as my

signature on the income tax return (original or amended) I am now authorizing.

I will enter my PIN as my signature on the income tax return (original or amended) I am now authorizing. Check this box only

if you are entering your own PIN and your return is filed using the Practitioner PIN method. The ERO must complete Part III

below.

Spouse’s signature

▶

Date

▶

Practitioner PIN Method Returns Only—continue below

Part III Certification and Authentication — Practitioner PIN Method Only

ERO’s EFIN/PIN. Enter your six-digit EFIN followed by your five-digit self-selected PIN.

Don’t enter all zeros

I certify that the above numeric entry is my PIN, which is my signature for the electronic individual income tax return (original or amended) I am now

authorized to file for tax year indicated above for the taxpayer(s) indicated above. I confirm that I am submitting this return in accordance with the

requirements of the Practitioner PIN method and Pub. 1345, Handbook for Authorized IRS e-file Providers of Individual Income Tax Returns.

ERO’s signature

▶

Date

▶

ERO Must Retain This Form — See Instructions

Don’t Submit This Form to the IRS Unless Requested To Do So

For Paperwork Reduction Act Notice, see your tax return instructions.

Cat. No. 32778X

Form 8879 (Rev. 01-2021)

Leave Blank

Assigned at E-File

Flightax/Specialty Tax Services

Download
Save PDF to desktop

Email
Email completed PDF

Send for Signing
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Print
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