1
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: Spouses Cell Number: Spouses 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:
S
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
2
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
Yes No
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.
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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
T/P S D T/P S D T/P S D
F. FORM 1099B: 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
$
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
ST
2
ND
3
RD
4
TH
Grad 1
ST
2
ND
3
RD
4
TH
Grad 1
ST
2
ND
3
RD
4
TH
Grad 1
ST
2
ND
3
RD
4
TH
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
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
T/P S T/P S T/P S
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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 Creditsend 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 EXPENSESW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
5
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. FIRSTTIME 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 manufacturers 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
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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 years closing inventory, attach explanation. Provide Cost, not Retail Amount.
$
Inventory purchased during the yearless 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. 1Dec. 31
mi.
Date First Used for Business Miles Driven for Business Jan. 1Dec. 31
mi.
Do you have another car for personal use?
Yes No
Miles Driven for Commuting Jan. 1Dec. 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
7
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
OFFICE USE ONLY OFFICE USE ONLY OFFICE USE ONLY
8
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.
AL
Drivers License information required to E-File
Taxpayer DL #: Issue Date: Expiration Date: Issue State:
Spouse DL #: Issue Date: Expiration Date: Issue State:
CT
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)
LA
Provide copy of homeowner’s or property’s insurance declaration page showing the separate line item charges for LA Citizens
assessments not already claimed.
$
MA
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.
OH
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 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 ResidentsDo 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
$
K12 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.
9
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
N
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)
$
10
IMPORTANT
Please Complete each Section Below!
Electronic FilingNo 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 DepositNo 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 MethodWe 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
94
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
94
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
11
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 LossFederally 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 TaxChildren 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.
12
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
Privacy Policy
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 Years 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
Taxpayers
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:
Dependents 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:
Dependents 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:
Dependents 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:
Dependents 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:
Dependents 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:
Dependents 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 . . . . . . . . . . . . . . . . . . . . . . . . . .
1
2 Total tax . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2
3
Federal income tax withheld from Form(s) W-2 and Form(s) 1099 . . . . . . . . . . . . .
3
4 Amount you want refunded to you . . . . . . . . . . . . . . . . . . . . . . 4
5 Amount you owe . . . . . . . . . . . . . . . . . . . . . . . . . . . .
5
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
Leave Blank
Assigned at E-File
Flightax/Specialty Tax Services
Flightax/Specialty Tax Services