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ABOUT YOU Patients Name : LastFirstMiddleMr/Ms/DRI prefer to be called: Email: SingleMarriedDivorcedWidowedSeparatedOther MaleFemaleSocial Security No: Date of Birth: Driving License No: Home Address:
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I prefer to be a document used to indicate preference for tax filing status.
Individuals or entities that need to show their preferred tax status or classification may be required to file it.
Fill out the form by providing personal identification information, selecting the preferred filing status, and signing where indicated.
The purpose is to communicate an individual's or entity's preferred tax filing status to the tax authorities.
Information such as name, address, taxpayer identification number, and the chosen filing status must be reported.
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