Tax Year 2025 Client Intake Form

This questionnaire may take you up to 20 minutes to complete. If a section or question does not apply to you please skip that question/section and answer the remainder of the questions

Date Form Completed

Thank You For Choosing Us For Your Tax Preparation

How Were You Referred?

This is a Paid Preparer / Client (Taxpayer) Interview. As a Paid Preparer, it is a requirement by the IRS that I conduct a Due Diligence Interview when you, the taxpayer, are claiming Earned Income Tax Credits, Child Tax Credits, other Dependent Credits, are self-employed, operate a Schedule C Business, and are filing as Head of Household. Your responses may lead to additional questions to ensure clarity regarding your personal situation. Please be aware that not all questions may be relevant to your circumstances; in such cases, kindly indicate with a "NO" or type "N/A." However, your signature is mandatory in all designated areas.

Are You NEW To Our Firm?

Interview Location

PERSONAL INFORMATION

First Name

Last Name

Phone

What is Your IPPIN (if appliciable)

Tax Payer Social Security Number

What Is Your Occupation?

Tax Payer Date of birth

Were You A Student in 2025?

Are You A Full-Time Student

Would you like to donate $3 tothe Presidential Election Campaign Fund ?

Would you like to donate $3 tothe Presidential Election Campaign Fund?

Drivers License Number

Taxpayer ID/DL Expiration Date

Taxpayer DL/ID State Issued

ID/License Issue Date

Address

Street Address

City

State

Country

Zip code

Did You Move During 2025?

Did You Move in 2025?

What Date Did You Move Last Year?

If you moved last year or this year, What is your old address?

Did you live or work in 2 or more States in 2025?

Are You or Spouse Legally Blind

Legally Blind

Were You Totally and Permanently Disabled in 2025?

Totally and Permanently Disabled?

Has a licensed medical practitioner determined that this individual has a disability? What is the nature of the disability? How long will disability last?

What School Tax District Do You Live In?

What County Do You Live In?

Did You Pay More Than Half Of the Cost To Maintain The Home/Apartment in 2025

Tax Payer State ID/DL

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

Taxpayer SS Card

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

Tax Payer Marital Status As Of December 2025

SPOUSE INFORMATION

Spouse First Name

Spouse Last Name

Spouse Email Address

Spouse Phone Number

Were You Permanently and Totally Disabled In 2025?

Are You Disabled?

Do you have the same address as your spouse?

Has a licensed medical practitioner determined that this individual has a disability? What is the nature of the disability? How long will disability last?

If You DO NOT Live At The Same Address As Your Spouse, What Is Your Full Address?

Spouse Date Of Birth

Spouse SSN Number

Spouse's Occupation

Spouse DL/State ID Number

Spouse-DL/State ID Issued State

DL/State ID Issue Date

DL/State ID EXPIRATION Date

Spouse IPPIN (if applicable)

Spouse ID

Spouse ID and SS Card (If Filing Married Return)

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

Spouse SS Card

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

Direct Deposit Information:

Deposit Method

Deposit Type

Bank Name (Direct Deposit Info)

Bank Account Number For Direct Deposit

Account Type

Routing Number

How Did You File Taxes Last Year?

Did you receive a refund in 2025

Yes

Do You Want To Apply For A Cash Advance up to $7,500? (Offer Ends March 15)

Have you ever been DISALLOWED EITC and was informed by the IRS to complete form 8862?

Have you ever been DISALLOWED EIC and was informed by the IRS to complete form 8862?

Do You have a copy of last year's Tax return?

Are You Self-Employed

Did You Receive 1099 Income In 2025?

Did You Receive W2 Income in 2025?

Do you have daycare expenses any child or adult dependent?

Yes

Are You Claiming Dependents

Did You (or Spouse) Receive State Unemployment Benefits in 2025?

Are You Disabled?

How Many Dependents Are You Claiming?

Dependent Info

Dependent #1 Relationship To You

Dependent #1 First Name

Dependent #1 Last Name

Dependent #1 Social Security Number

Dependent #1 Date of Birth

Did The Dependent Live With You For at least 6 months and a day or More?

Was dependent #1 A College Student in 2025?

Dependent #1 IPPIN (if applicable)

If this is not your biological child, Why isn't the parents claiming this dependent? Where is the child's other parent?

What School Did the Dependent Attend last year?

Who Watches The Child While You work and/or go to school?

Dependent #1 Birth Certificate Or a Legal Document showing Date of birth

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

Dependent #1 Social Security Card

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

Is This Dependent Disabled?

YES

Has a licensed medical practitioner determined that this individual has a disability? What is the nature of the disability? How long will disability last?

Do You Have Any Additional Dependents To Claim?

Dependent #2

If you are only claiming one dependent please skip this section

Dependent #2 Relationship To You

Dependent #2 First and Last Name

Dependent #2 Social Security Number

Dependent #2 Date of Birth

Did The Dependent that you are claiming Live With You For at least 6 months and a Day or More?

Dependent #2 Birth Certificate Or a Legal Document showing Date of birth

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

Who Watches The Child While You Work and or Go To School?

What school did your dependent attend last year?

If this isn't your biological child, Why isn't the parents claiming this dependent? Where does the parent(s) live?

Is This Dependent Disabled?

YES

Dependent #2 Social Security Card

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

If your name is not listed on the child's birth certificate please upload a document proving the relationship to the child. i.e. letter from social security, payee letter, medical card, letter from school, court document etc.

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

Are You Claiming A 3rd Dependent?

Dependent #3

Dependent #3 First and Last Name

Dependent #3 Date of Birth

Dependent #3 Relationship to You

Dependent #3 Social Security Number

Did Your Dependent Live With You For At Least 6 months And A Day Or More?

Is This Dependent Disabled?

YES

Who watches the child while you work/school?

What School did your dependent attend last year?

If this is not your biological child, Why isn't the real parent's claiming the dependent? Does the parent live with the dependent?

Dependent #3 Birth Certificate Or a Legal Document showing Date of birth

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

Dependent #3 Social Security Card

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

If your name is not printed on the child's birth certificate please upload a document proving the relationship to the child. i.e. letter from social security, payee letter, medical card, letter from school, court document etc.

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

Did any of your dependents live with anyone else for a total of 6 months and a day or more in last year?

Did the child or adult dependent receive any income last year, including but not limited to scholarships or grants, student loans, wages, child support, alimony, public assistance, Social Security, or disability benefits?

INCOME QUESTIONS

How Many Jobs Did You Have In 2025?

Do you (and/or spouse) have any Retirement, Pension or AnnuityProceeds? (1099R)

DO You have any Retirement Income?

Disability Benefits (payments from insurance and workers comp)

Disability Benefits (Payments from insurance and workmas comp)

Social Security or RailRoad Benefits (SSA-1099, RBR-1099)

If Requested by the IRS, Can you provide documentation of the extent and nature of the disability?

Is there a written custody, divorce or separation agreement or court order regarding the child(ren)?

Is there an active Form 8332 – Release/Revocation of Exemption to Claim Child by Custodial Parent, or similar document, in place which states who can claim any of the children listed above?

Did you or your dependents receive financial aid or make payments on a student loan in 2025?

Did You or any of Your Dependents Attend College or Pay Tuition (any grade) Tuition Out of Pocket in 2025?

Did You Receive 1099 Income In 2025?

Were You or Spouse 65 or older by December 31, 2025?

Did You receive Cash or charged tips in an occupation customarily receiving tips?

Is Your Total Income Below $75,000 Single or $150,000 for couples?

Did You Receive Cash or Charged tips in an Occupation Receiving Tips?

Did You Receive Overtime Compensation?

Did You Purchase a New Vehicle For Personal Use in 2025 with a car note?

Did You Receive Overtime Compensation?

Did You Make Any Cash Contributions To Qualifed Charities?

Did You Pay More Than $10,000 In Property, Income or Sales Tax (SALT)?

Did You Purchase and Electric Vehicle or Install Solar/Energy Efficient Home Items Before The September/December Deadlines?

Are You Self Employed or a Small Business Owner?

What type of business do you have? How Long Have You been in business?

How do you receive payments from clients/customers?

Do you have a license or certificate for your business type?

Do you have a Business Bank Account?

If Your Business is not incorporated or an LLC, Do you need help with incorporating it?

Is your business registered with your State? Is your business an INC, LLC, S-Corp etc.

Do You have an EIN, if so what's the number? (if you are a sole proprietor leave this blank)

How much did your business make in sales last year?

Do you have business expenses?

Do you need to give any 1099 NEC's to contractors that did work for your business? (This usually occurs when you paid a contractor more than $600 to work for your company)

If your business is not registered, would you like to add the service to establish your business and get it registered?

Do You Use Any Vehicles for Business use?

If yes, What is the make and model (s)?

How many miles are currently on you vehicle?

How many miles did you drive for business purposes in 2025?

Did you keep track of the mileage driven for business purposes?

Is Your Proof Of Miles Driven Written Down?

Do you have receipts for car maintenance for vehicles that was used for business purposes?

Business Related Documents (Upload Up to 10 Documents)

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

Spouse Business Related Documents(Upload Up to 10 Documents)

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

Trouble Uploading....Additional documents can be sent to:

[email protected]

**Please only send email from the email you listed above

**Please put your first and last name in the subject line

Please only upload the documents that you have.

Voided Check OR Direct Deposit Letter

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

School Forms (1098T and 1098E)

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

2025 W2's (Upload up to 10)

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

Other Uploads(Up to 15 documents can be uploaded)

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

1099 G (State Unemployment)

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

Miscellaneous Documents

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

Trouble Uploading....Additional documents can be sent to: [email protected]

**Please only send email from the email you listed above

**Please put your first and last name in the subject line

Letter Of Engagement

I confirm that I have read and understand the information above

Taxpayer Sign Here:

Clear

Spouse Sign Here:

Clear

Consent For Payment

I confirm that I have read and understand the information above

Taxpayer Signature

Clear

Spouse Signature

Clear

I confirm that I have read and understand the information above

Your Signature

Clear

Your Spouse Signature

Clear

I confirm that I have read and understand the information above

Today's Date

Thank you for taking time to complete your Tax Year 2025 Client Questionnaire. For new clients, this information is critical to ensure we accurately file your tax return. For existing clients, we kindly request you provide this information again to ensure our records are 100% accurate and up to date.

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