Client Intake Form

Select Tax Preparer *

Amaryllis Vargas
Alessandra Vargas
Tasha Almodovar
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Client Status *

New Client
Returning Client
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Taxpayer Full Name *

Street Address *

City *

State *

Postal Code *

Email *

Phone *

Date of birth *

Social Security Number *

Filing Status *

Single
Head of Household
Married Filing Jointly
Married Filing Separately
Widow or Surviving Spouse
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PIN Number - Identity Protection PIN

Fill this out only if you were provided one by the IRS

ID Type *

Driver License
State ID
Other
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License / ID Number *

License / ID Issuing State *

License / ID Expiration Date *

Job Occupation *

Are you or your spouse permanently disabled? *

No
Yes, Taxpayer
Yes, Spouse
Both
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Do you have Marketplace Health Insurance? *

Yes

No

If yes, upload 1095-A

Spouse Information

Spouse Full Name

Please write N/A if not applicable.

Spouse Email

Please write N/A if not applicable.

Spouse Phone

Please write N/A if not applicable.

Spouse Date of Birth

Please write N/A if not applicable.

Spouse ID Type

Driver License
State ID
Other
N/A
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Spouse Job Occupation

Please write N/A if not applicable.

Upload ID's and Social Security Cards. If you are filing HOH, please upload the necessary forms (see more information below). *

If you are filing as Head of Household, please upload documents showing your dependent’s residency and support. Upload at least one of the following: utility bill, lease agreement, mortgage statement, bank statement, divorce decree, separation agreement, or rent statement.

Will you be claiming any dependents for this tax year? *

Yes
No
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Dependent 1

Full Name

Date of Birth

Social Security Number

Relationship

Disabled

Yes
No
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Provided more than 50% support

Yes
No
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Has this dependent lived with you more than half the year in 2025?

Yes
No
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Is anyone else claiming the child or allowed to claim the child?

Yes
No
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Do you want to add another dependent?

Yes
No
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Dependent 2

Full Name

Date of Birth

Social Security Number

Relationship

Disabled

Yes
No
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Provided more than 50% support

Yes
No
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Has this dependent lived with you more than half the year in 2025?

Yes
No
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Is anyone else claiming the child or allowed to claim the child?

Yes
No
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Do you want to add another dependent?

Yes
No
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Dependent 3

Full Name

Date of Birth

Social Security Number

Relationship

Disabled

Yes
No
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Provided more than 50% support

Yes
No
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Has this dependent lived with you more than half the year in 2025?

Yes
No
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Is anyone else claiming the child or allowed to claim the child

Yes
No
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Do you want to add another dependent?

Yes
No
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Dependent 4

Full Name

Date of Birth

Social Security Number

Relationship

Disabled

Yes
No
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Provided more than 50% support

Yes
No
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Has this dependent lived with you more than half the year in 2025?

Yes
No
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Is anyone else claiming the child or allowed to claim the child?

Yes
No
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Do you want to add another dependent?

Yes
No
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Dependent 5

Full Name

Date of Birth

Social Security Number

Relationship

Disabled

Yes
No
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Provided more than 50% support

Yes
No
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Has this dependent lived with you more than half the year in 2025?

Yes
No
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Is anyone else claiming the child or allowed to claim the child?

Yes
No
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Do you want to add another dependent?

Yes
No
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Dependent 6

Full Name

Date of Birth

Social Security Number

Relationship

Disabled

Yes
No
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Provided more than 50% support

Yes
No
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Has this dependent lived with you more than half the year in 2025?

Yes
No
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Is anyone else claiming the child or allowed to claim the child?

Yes
No
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File Upload

Upload proof of relationship and residency for each dependent.

Accepted files: Birth certificate, school record, medical record, lease, or court document.

Income – Check all that apply: *

W-2 (Wage / Salary)

1099-NEC (Self-Employed / Contractor Income)

1099-MISC (Other Miscellaneous Income)

1099-INT (Interest Income)

1099-DIV (Dividend Income)

1099-B (Investment or Stock Sales)

1099-G (Unemployment / Government Payments)

1099-R (Retirement / Pension / Annuity)

SSA-1099 (Social Security Benefits)

K-1 (Partnership / S-Corp / Trust Income)

Rental Income

Business Income (Self-Employment)

Cash Income (Not Reported on 1099)

Child Support Received

Alimony Received

Disability Benefits

Gambling / Lottery Winnings

Tips or Gratuities

Farm Income

Foreign Income

Household Income

N/A

Government assistance? Check all that apply *

SNAP/TANF

Section 8

Childcare Assistance

Child Support

N/A

Upload all Income Tax forms that you selected

Deductions - Check all that apply:

Mortgage Interest (Form 1098)

Property Taxes Paid

Charitable Donations / Tithes

Student Loan Interest (Form 1098-E)

Medical or Dental Expenses

Health Insurance Premiums (Self-Paid)

Educator Expenses (Teachers / School Staff)

IRA or Retirement Contributions

Childcare Expenses (Dependent Care)

Job-Related Expenses (Union Dues, Uniforms, Mileage)

Moving Expenses (Active Duty Military)

Tuition / Education Expenses (Form 1098-T)

State or Local Taxes Paid

Vehicle Registration Fees

Casualty or Theft Losses

Investment Interest Expenses

Self-Employed Health Insurance

Alimony Paid

N/A

Upload all Deductions tax forms.

Are you filing Self-Employed? *

Yes

No

Business Name/Address

If no business name, leave blank.

Home or Apartment Business Use

If you operated your business from your home or apartment, please provide the following information to determine your business-use-of-home deduction.

Total Square Footage of Home or Apartment
Square Footage Used Exclusively for Business (300sq ft is the max)

Job Description

EIN Number or Social Security Number

Self-Employed Reconstruction of Income

Grand Total of Income your business or job made?

Income Per Month

January

February

March

April

May

June

July

August

September

October

November

December

Self-Employed Reconstruction of Expenses

Grand Total of Expenses your business or job occur?

Type of Expenses

January

February

March

April

May

June

July

August

September

October

November

December

I agree that I have uploaded accurate receipts and/or a valid profit and loss statement reflecting my business income and expenses. I confirm that I have materially participated in my business during the tax year.

I certify that all of the information and documents that I have provided to KTA CONSULTING GROUP LLC in preparing this tax return for my business is true to the best of my knowledge. KTA CONSULTING GROUP LLC will not be held liable for any discrepancies that arise due to these verbal statements or documents that I have provided. I agree to all of these statements and do hereby grant KTA CONSULTING GROUP LLC and the Tax Preparer permission to complete and submit my tax docs electronically.

Upload Your Business Documents Here

You can only upload 50 files. If it is more, please email me. See email above.

Signature

Household Income Worksheet

Only fill out this section if you were paid cash and worked inside the home

Household Income 1

Full Name of the Person You Worked For

Type of Service

Address

Total Work Time

Amount

Household Income 2

Full Name of the Person You Worked For

Type of Service

Address

Total Work time

Amount

Household Income 3

Full Name of the Person You Worked For

Type of Service

Address

Total Work Time

Amount

Household Income 4

Full Name of the Person You Worked For

Type of Service

Address

Total Work Time

Amount

Household Income 5

Full Name of the Person You Worked For

Type of Service

Address

Total Work Time

Amount

Household Income 6

Full Name of the Person You Worked For

Type of Service

Address

Total Work Time

Amount

Due Diligence

*To be completed by all taxpayers with dependents

Are you married?

Yes

No

Have you ever been disallowed the EITC/AOTC/CTC? *

Yes

No

If so, when?

What is the name of the other parent?

Why is the other parent of the child/children not claiming the child?

Explain why (IF) the dependent(s) have different last names than taxpayer?

If you are separated or divorced, when did you last live in the home?

Do you have Joint Custody of your child? *

Yes

No

Does not apply to me

If so, how many months did your child/children live in the other parent's home during 2025?

Can anyone else claim your dependent on their return?

Yes

No

Do you have a signed Form 8332? (Custodial Parent Release of Claim of Dependent(s) on tax return)

Yes

No

Did anyone else live in the home that provides financial support for your child/dependents?

Yes

No

If so, who lives there, and how much do they pay?

Is this your biological dependent(s)?

Yes

No

If NO, what is your relationship to the dependent(s)?

What were the circumstances leading to the dependent(s) being placed in your home?

Do you or anyone else receive financial aid for this dependent?

Yes

No

If yes, which dependent(s)?

Are you applying for a loan advance? *

Yes

No

How would you like to receive your refund? *

Direct Deposit, checking

Direct Deposit, saving

Direct Deposit, other

Faster Moneycard

Name of the Bank

Routing Number

Checking Account Number

Do you need help with the following: check all that apply *

Tax Preparation

Credit Repair

Insurance

Funding

Bookkeeping

Payroll

N/A

How did you hear about us? *

If someone referred you, please type his/her name above.

IRS Form 7216 – Consent to Use or Disclose Tax Return Information

In accordance with Internal Revenue Code §7216, KTA Consulting Group LLC must obtain your consent before using or disclosing your tax return information for purposes other than preparing or filing your tax return.

By signing below, you authorize KTA Consulting Group LLC and its representatives to use and/or disclose your tax return information for the following services (check all that apply below):

Tax preparation and e-filing

IRS correspondence or audit support

Tax planning and consulting

Bookkeeping, payroll, or financial services

Marketing and promotional offers for related financial products

Tax business education, training, or mentorship programs

This consent is valid for one (1) year from the date signed unless revoked in writing. You are not required to sign this form; however, KTA Consulting Group LLC may not use or disclose your information for other purposes without it.

Qualifying Children for Earned Income Credit (EIC) Acknowledgment

Based on the information you provided regarding your dependent(s), you confirm that each dependent listed is your biological child, grandchild, niece, nephew, or other qualifying relative.

I have explained that a qualifying child can only be claimed by one taxpayer per tax year. In cases where both parents are eligible, only one parent (or both if filing jointly) may claim the dependent.

If you are filing as Head of Household, you affirm that you can provide proof of residency such as a lease agreement or utility bill showing your name and current address.

By signing below, you acknowledge and affirm that:

You provide more than 50% of the total care and financial support for each dependent listed.
The dependent(s) live with you for more than half of the year.
No other person is eligible to claim the same dependent(s).
All information provided to KTA Consulting Group LLC is true, accurate, and complete to the best of your knowledge.
You have not provided, and will not provide, false or fraudulent information to your preparer.

By signing this document, you authorize KTA Consulting Group LLC to use the information you have provided for the purpose of preparing and filing your tax return.

Signature *