TAX PREP CLIENT INTAKE FORM

What tax year is this submission for? (Please do not attach documents that are not for the tax year you selected. If you need more than 1 year filed it needs to be submitted as a separate submission for each year. *

TAX RELATED QUESTIONS:

Taxpayer Filing Status *

Single

Married Filing Seperate

Married Filing Joint

Qualifying Widower

Head of Household

Is this an amendment? *

Yes

No

*

Are you contributing to 401k or other pre-tax account?
Is this your first time opening a pre-tax account?
Are you currently renting?
What is the monthly rental amount?
Do you owe debt to any Government Agency; such as IRS, Student Loans, Child Support etc?
Are you self employed or a business owner?
Do you have an IRS IP PIN?
IRS IP PIN (If applicable)
Do you have a copy of your tax return from last year?
Taxpayer Occupation
Are You A Full Time Student?
Are you totally and permanently disabled?
Are you legally blind?
Did you receive health insurance through the Market Place?
Did You Receive Unemployment Benefits?

TAXPAYER INFORMATION:

First Name *

Last Name *

Phone *

Email *

Address

Postal code

Date of birth *

Taxpayer's Social Security # *

Upload your Profit & Loss (P&L) or Income & Expense Statement (If applicable)

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

IDENTIFICATION DOCUMENTS

Driver License/ State ID *

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

Taxpayer Social Security Card *

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

Secondary Identification Documentation *

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

SPOUSAL INFORMATION (If Applicable)

Full Name
Full Address
Date Of Birth
Is Spouse Totally and Permanently Disabled?
Is Spouse Legally Blind?
Is Spouse a Dependent?
Did Spouse Receive Unemployment Benefits?
Spouse Occupation

DEPENDENTS (If Applicable)

How many Dependents are you claiming?

Do you pay child care expenses for any of the dependents?

Yes

No

Dependent 1

Full Name
Date Of Birth
Social Security Number
Number Of Months Lived in Home of (Tax Filing Year)
Relationship Between You and Dependent

Dependent 1: Social Security Card

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

Dependent 2

Full Name
Date Of Birth
Social Security Number
Number Of Months Lived in Home of (Tax Filing Year)
Relationship Between You and Dependent

Dependent 2: Social Security Card

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

Dependent 3

Full Name
Date Of Birth
Social Security Number
Number Of Months Lived in Home of (Tax Filing Year)
Relationship Between You and Dependent

Dependent 3: Social Security Card

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

Dependent 4

Full Name
Date Of Birth
Social Security Number
Number Of Months Lived in Home of (Tax Filing Year)
Relationship Between You and Dependent

Dependent 4: Social Security Card

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

Dependent 5

Full Name
Date Of Birth
Social Security Number
Number Of Months Lived in Home of (Tax Filing Year)
Relationship Between You and Dependent

Dependent 5: Social Security Card

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

Dependent 6

Full Name
Date Of Birth
Social Security Number
Number Of Months Lived in Home of (Tax Filing Year)
Relationship Between You and Dependent

Dependent 6: Social Security Card

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

Dependent 7

Full Name
Date Of birth
Social Security Number
Number Of Months Lived in Home of (Tax Filing Year)
Relationship Between You and Dependent

Dependent 7: Social Security Card

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

Dependent 8

Full Name
Date Of Birth
Social Security Number
Number Of Months Lived in Home of (Tax Filing Year)
Relationship Between You and Dependent

Dependent 8: Social Security Card

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

Dependent 9

Full Name
Date Of Birth
Social Security Card
Number Of Months Lived in Home of (Tax Filing Year)
Relationship Between You and Dependent

Dependent 9: Social Security Card

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

Dependent 10

Full Name
Date Of Birth
Social Security Number
Number Of Months Lived in Home of (Tax Filing Year)
Relationship Between You and Dependent

Dependent 10: Social Security Card

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

Who Referred You to Me?

Anything you'd like us to know when preparing your return?

Spouse Signature

Clear

Signature *

Clear

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