Tax Preparation Client Intake Form

Please complete all sections as accurately as possible. Your information is used solely to prepare your tax return and is kept stricly confidential

Personal Information

First Name *

Last Name *

Date of birth *

Social Security Number (SSN) or ITIN *

Filing Status *

Single

Married Filing Seperate

Married Filing Joint

Qualifying Windower

Head of Household

Street Address

City

State

Country

Enter your country

Postal Code

Phone *

Email *

Spouse Information

Section instruction text: Complete this section only if filing Married Filing Jointly.

Spouse Full Name *

Spouse Date Of Birth

Spouse SSN *

Dependent Information

Section instruction text: Complete this section only if filing Married Filing Jointly.

Depedent 1

Dependent 1 Fullname *

Dependent 1 Relationship to Taxpayer *

Select an option

Dependent 1 Birthdate *

Dependent 1 SSN *

Dependent 1 Months lived in your home this year *

Select an option

Dependent 1 Did this dependent have income over $4,700 this year? *

Yes

No

Depedent 2

Dependent 2 Fullname *

Dependent 2 Relationship to Taxpayer *

Select an option

Dependent 2 Birthdate *

Dependent 2 SSN *

Dependent 2 Months lived in your home this year *

Select an option

Dependent 2 Did this dependent have income over $4,700 this year? *

Yes

No

Depedent 3

Dependent 3 Fullname *

Dependent 3 Relationship to Taxpayer *

Select an option

Dependent 3 Birthdate *

Dependent 3 SSN *

Dependent 3 Months lived in your home this year? *

Select an option

Dependent 3 Did this dependent have income over $4,700 this year? *

Yes

No

Depedent 4

Dependent 4 Fullname *

Dependent 4 Relationship to Taxpayer *

Select an option

Dependent 4 Birthdate *

Dependent 4 SSN *

Dependent 4 Months lived in your home this year? *

Select an option

Dependent 4 Did this dependent have income over $4,700 this year? *

Yes

No

Income Sources

Section instruction text: Check all income sources that apply to you this tax year. Attach the corresponding documents when you meet with your preparer.

W-2 Form(Attach W-2)

PDF, DOC/DOCX, XLS/CSV, JPG/JPEG, PNG, GIF

1099-NEC

Self-employment

Freelance income

1099-MISC *

Click to upload

PDF, DOC/DOCX, XLS/CSV, JPG/JPEG, PNG, GIF

1099-G *

Click to upload

PDF, DOC/DOCX, XLS/CSV, JPG/JPEG, PNG, GIF

1099-R

Retirement

Pension income

SSA-1099 *

Click to upload

PDF, DOC/DOCX, XLS/CSV, JPG/JPEG, PNG, GIF

1099-INT or 1099-DIV

Interest

dividend income

Schedule K-1

Partnership

S-corp income

Other income not listed *

Click to upload

PDF, DOC/DOCX, XLS/CSV, JPG/JPEG, PNG, GIF

Deductions and Credits

Section instruction text: Check all items that may apply to your tax situation.

Homeowner

mortgage interest

property taxes

Charitable donations

cash

non-cash items

Tuition or education expenses (attach Form 1098-T)

Click to upload

PDF, DOC/DOCX, XLS/CSV, JPG/JPEG, PNG, GIF

Earned Income Tax Credit — I have qualifying children

Yes

No

Self-employed — I have business expenses to deduct

Yes

No

Home office — I work from home for my business

Yes

No

Vehicle used for business — Miles driven this year:

Medical expenses that exceeded 7.5% of my income

Yes

No

Prior Year Information

Did you file a federal tax return last year?

Yes

No

If yes — outcome: Dropdown: Received a refund

Owed taxes

Broke even

Not sure

Approximate refund received or tax owed

"Estimate is fine. Leave blank if you do not know."

Prior year Adjusted Gross Income (AGI)

"Estimate is fine. Leave blank if you do not know."

Who prepared your return last year?

I prepared it myself / TurboTax or similar software / H&R Block / Jackson Hewitt / Another paid preparer / Taxes As Usual / This is my first time filing

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