The US Government is giving out stimulus payments during the COVID-19 pandemic. Please fill out the form completely. The information will be used to file a simple tax return for you so that you will be able to receive stimulus funds.

File a 2019 tax return with simple, but necessary, information including your filing status, number of dependents and direct deposit bank account information if available.

People who typically do not file a tax return will need to file a simple tax return to receive an economic impact payment. Low-income taxpayers, senior citizens, Social Security recipients, some veterans and individuals with disabilities who are otherwise not required to file a tax return will not owe tax.

The cost of processing your tax return will also be based on the answers on this form. The cost can be from $0.00 to $50.00 and payment will be required prior to your return being processed.
  • This needs to be your name as it would appear on your social security card
  • Month/Day/Year
  • Your check will be mailed to the address above if you choose the check option. PO Boxes are not allowed
  • If you do not have an email put N/A
  • - -
    If you do not have a phone use
    555-555-5555 as your phone number.
  • IMPORTANT** Choose one. If you choose direct deposit provide your routing number and account number below. The account must be in your name to receive the stimulus.
  • If you do not have an account mark the box N/A
  • If you do not have an account mark the box N/A

  • Choose a filing status.

  • **Earned Income includes salaries, wages, tips, professional fees, taxable scholarships, and fellowship grants

    **Unearned Income includes unemployment compensation, taxable Social Security benefits, taxable pensions, annuity income, canceled debts, unearned income from a trust, taxable interest, dividends, and capital gains.
  • List the total amount of income you made.
  • dependent 1
    dependent 2
    dependent 3
    dependent 4
    dependent 5
  • Upload a copy of your valid ID. You may use a driver's license, state ID military ID, or passport.

  • Privacy Policy. The nature of our work requires us to collect certain nonpublic personal information about you from various sources. We collect financial and personal information from applications, worksheets, reporting statements, and other forms, as well as interviews and conversations with our clients and affiliates. We may also review banking and credit card information about our clients in the performance of receipt of payment. Under our policy, all information we obtain about you will be provided by you or obtained with your permission. Our firm has procedures and policies in place to protect your confidential information. We restrict access to your confidential information to those within our firm who need to know in order to provide you with services. We will not disclose your personal information to any third party without your express permission, except where required by law. We maintain physical, electronic, and procedural safeguards in compliance with federal regulations that protect your personal information from unauthorized access. Please contact us with any questions regarding our privacy policy. I declare under penalty of perjury under the laws of the State Indiana that the foregoing is true and correct.
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