TAX PREP CLIENT INTAKE FORM

Filing Status *

TAXPAYER INFORMATION:

Full Name *

Date of birth

Phone *

Email *

Address *

City *

State *

Postal code *

Occupation *

Are you a full-time student?

Yes

No

Are you totally and permanently disabled?

Yes

No

Are you legally blind?

Yes

No

SPOUSAL INFORMATION

Spouse Full Name *

Spouse Date Of Birth *

Phone Number *

Email Address *

Address *

Street Address
City
State/Province
Postal/Zip Code

Spouse Occupation

Are they a full-time student?

Yes

No

Are they totally and permanently disabled?

Yes

No

Are they legally blind?

Yes

No

Are they your dependent?

Yes

No

DEPENDANTS:

Enter your dependents here

Name
Name
Name
Name
Name

TAX RELATED QUESTIONS:

Employment Status

Are you contributing to 401k or other pre-tax account?

Yes

No

Is this your first time opening a pre-tax account?

Yes

No

Are you currently renting?

Yes

No

What is the monthly rental amount?

GENERAL EXPENSES:

Enter the following expenses total amount

Medical Expenses
Dental Expenses
Insurance Premiums paid
Long Term Care Premiums
Prescription Drugs and Medications
Home Mortgage
Investment Interest
Cash Contributions
Non-Cash Contributions
Unreimbursed Business Expenses
Union Dues
Tax Preparation Fees
Investment Expenses

Total Expenses

ACKNOWLEDGMENT & SIGNATURE

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I have read the terms and conditions and privacy policy of Solutions Income Tax .
By signing below, you acknowledge that you have read and understood your responsibilities and our responsibilities in doing this tax return.

Date Signed

Taxpayer Signature

Clear

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