2022 TAX CLIENT INTAKE

How did you hear about us?

If someone referred you, please type his or her name here.

Taxpayer's First Name *

Taxpayer's Last Name *

Phone *

Email *

Address *

City *

State *

Zip code *

Are you trying to buy a new home within the next 2 years? *

Taxpayer's SSN *

Taxpayer's Job Title *

Taxpayer's Date of Birth *

Filing Status *

Spouse's Full Name(if applicable)

Spouse's SSN

Spouse's Date of Birth

Spouse's Phone Number

Spouse's Email Address

Spouse's Job Title

Did you and your spouse live apart during the year?

Are you self employed? *

What is your marital status as of December 2022?

Did you support a child or family member for more than 6 months out of the year?

If yes, did you live together at any time after June 30, 2022?

Did you pay over half the expenses of maintaining your residence for the entire year?

How many dependents are you claiming? *

Dependent #1

Dependent #1 Date of Birth

Dependent #1 SSN

What is Dependent #1's Relationship to you (son, daughter, etc.)?

How many months did Dependent #1 live with you in 2022? (If all year, enter 12)

Dependent #2

Dependent #2 SSN

Dependent #2 Date of Birth

How many months did Dependent #2 live with you in 2022? (If all year, enter 12)

Dependent #3

Dependent #3 SSN

Dependent #3's Date of Birth

How many months did Dependent #3 live with you in 2022? (If all year, enter 12)

How would you like to receive your tax refund? *

Name of Bank

Which type of account would you like your refund deposited into?

Routing Number

Account Number

Can someone else claim you as a dependent? *

Was your insurance through the Affordable Care Act (The Marketplace)? *

Upload Taxpayer & Dependent(s) Insurance Documents form 1095A if applicable