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L W-2's and 1099's for you, your spouse and all dependents 4) Any other income for you, your spouse and all dependents 5) All other pertinent tax documents 2 1. Taxpayer Information Last Name Taxpayer: First Name & M.I. Social Security Number c. Totally & Permanently Disabled? b. Legally Blind? Yes No Yes No d. US Citizen or Resident Alien? a. Date of Birth: Yes No e. Your Occupation: 2. Spouse Information Last Name Spouse: First Name & M.I. Social Security Number c. Totally & Pe.

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