Tax Year 2025 Client Intake Form

Date Form Completed

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/ or 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?

YES
NO
It's Been A While
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Interview Location

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

Do You Want To Apply For A Cash Advance up to $7,000? (Offer Ends March 15)

yes
no
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PERSONAL INFORMATION

First Name

Last Name

Phone *

Email *

Tax Payer Marital Status As Of December 2025

Tax Payer Marital Status As Of December 2024

Single
Married
Divorced in 2025
Surviving Spouse
Registered Domestic Partnership
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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?

YES
NO
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Would you like to donate $3 tothe Presidential Election Campaign Fund ?

YES
NO
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Drivers License Number

Applicant #1 ID/DL Expiration Date

Applicant #1 DL/ID State Issued

Address

Street Address

City

State

Country

Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antarctica
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
Bouvet Island
Brazil
British Indian Ocean Territory
Brunei Darussalam
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos (Keeling) Islands
Colombia
Comoros
Congo
Congo, The Democratic Republic of the
Cook Islands
Costa Rica
Cote D"Ivoire
Croatia
Cuba
Cyprus
Czech Republic
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Falkland Islands (Malvinas)
Faroe Islands
Fiji
Finland
France
French Guiana
French Polynesia
French Southern Territories
Gabon
Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Heard Island and McDonald Islands
Holy See (Vatican City State)
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran, Islamic Republic Of
Iraq
Ireland
Isle of Man
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
Korea People's Democratic Republic
Republic of Korea
Kuwait
Kyrgyzstan
Land Islands
Lao People's Democratic Republic
Latvia
Lebanon
Lesotho
Liberia
Libyan Arab Jamahiriya
Liechtenstein
Lithuania
Luxembourg
Macao
North Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Federated States of Micronesia
Moldova, Republic of
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Namibia
Nauru
Nepal
Netherlands
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
Northern Mariana Islands
Norway
Oman
Pakistan
Palau
Palestinian Territory, Occupied
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn
Poland
Portugal
Puerto Rico
Qatar
Reunion
Romania
Russian Federation
Rwanda
Saint Helena
Saint Kitts and Nevis
Saint Lucia
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
South Africa
South Georgia and the South Sandwich Islands
Spain
Sri Lanka
Sudan
Suriname
Svalbard and Jan Mayen
Eswatini
Sweden
Switzerland
Syrian Arab Republic
Taiwan
Tajikistan
Tanzania, United Republic of
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Trinidad and Tobago
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
Uganda
UK
Ukraine
United Arab Emirates
United States
United States Minor Outlying Islands
Uruguay
Uzbekistan
Vanuatu
Venezuela
Vietnam
Virgin Islands, British
Virgin Islands, U.S.
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
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Zip code

Did You Move During 2025?

YES
NO
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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 State in 2025?

Are You or Spouse Legally Blind

YOU
SPOUSE
Both
NONE
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Were You Totally and Permanently Disabled in 2025?

YES
NO
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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

Did You Pay More Than Half Of the Cost To Maintain The Home/Apartment in 2024?

YES
NO
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DL/State ID Issue State

ID/License Expire Date

Tax Payer State ID/DL

ID/License Issue Date

Taxpayer SS Card

SPOUSE INFORMATION

Spouse First Name

Spouse Last Name

Spouse Email Address

Spouse Phone Number

Were You Permanently and Totally Disabled In 2025?

YES
NO
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Do you have the same address as your spouse?

Option 1
Option 2
Option 3
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Has a licensed medical practitioner determined that this individual has a disability? What is the nature of the disability? How long will disability last? (copy)

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 EXPIRE Date

Spouse IPPIN (if applicable)

Spouse ID

Spouse SS Card

Direct Deposit Information:

Deposit Method

Your Bank Account
Debit Card Form Us
Printed Office Check
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Bank Name (Direct Deposit Info)

Bank Account Number For Direct Deposit

Account Type

Checking Account
Savings Account
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Routing Number

How Did You File Taxes Last Year?

Paid Professional
Self-Prepared
Other
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Did you receive a refund in 2024

Yes

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

Yes
NO
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Do You have a copy of last year's Tax return?

Yes
No
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Are You Self-Employed

YES
NO
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Did You Receive 1099 Income In 2025?

Did You Receive 1099 Income In 2024?

YES
NO
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Did You Receive W2 Income in 2024?

yes
no
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Do you have daycare expenses any child or adult dependent?

Yes

Are You Claiming Dependents

YES
NO
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Did You (or Spouse) Receive State Unemployment Benefits in 2025?

Did You (or Spouse) Receive State Unemployment Benefits in 2024?

yes
no
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Are You Disabled?

Dependent Info

Dependent #1 Relationship To You

Dependent #1 First Name

Dependent #1 Last Name

How Many Dependents Are You Claiming?

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?

YES
NO
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Was dependent #1 A College Student in 2025?

YES
NO
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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

Dependent Birth Certificate

Dependent #1 Social Security Card

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?

YES
NO
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Dependent #2

If you are only claiming one dependent please skip this section

Dependent #2 Relationship To You

Are You Or Any Of Your Dependents Disabled?

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?

YES
NO
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Dependent #2 Birth Certificate Or a Legal Document showing Date of birth

Dependent #2 Birth Certificate

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

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.

Are You Claiming A 3rd Dependent?

YES
NO
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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?

YES
NO
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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

Dependent #3 Birth Certificate

Dependent #3 Social Security Card

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.

If your name is 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.

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?

Yes
No
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INCOME QUESTIONS

How Many Jobs Did You Have In 2025?

Option 1
Option 2
Option 3
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Do you (and/or spouse) have any Retirement, Pension or AnnuityProceeds? (1099R)

YES
NO
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Disability Benefits (Payments from insurance and workmas comp)

YES
NO
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Social Security or RailRoad Benefits (SSA-1099, RBR-1099)

YES
NO
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If Requested by the IRS, Can you provide documentation of the extent and nature of the disability?

Yes
No
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Is there a written custody, divorce or separation agreement or court order regarding the child(ren)?

Yes
No
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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?

Yes
No
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Did you or your dependents receive financial aid or make payments on a student loan in 2024?

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 2023?

YES
NO
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2026 Tax Credits

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

YES
NO
Unsure
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Is Your Total Income Below $75,000 Single or $150,000 for couples?

YES
NO
Unsure
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Did You Receive Cash or Charged tips in an Occupation Receiving Tips?

YES
NO
Unsure
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Did You Receive Overtime Compensation?

YES
NO
Unsure
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Did You Purchase a New Vehicle For Personal Use in 2025 with a car note?

YES
NO
Unsure
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Did You Make Any Cash Contributions To Qualifed Charities?

YES
NO
Unsure
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Did You Pay More Than $10,000 In Property, Income or Sales Tax (SALT)?

YES
NO
Unsure
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Did You Purchase and Electric Vehicle or Install Solar/Energy Efficient Home Items Before The September/December Deadlines?

YES
NO
Unsure
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Small Business/Self Employed

Are You Self Employed or a Small Business Owner?

Yes
No
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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?

Yes
No
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Do you have a Business Bank Account?

Yes
No
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If Your Business is not incorporated or an LLC, Do you need help with incorporating it?

YES
NO
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Is your business registered with your State? Is your business an INC, LLC, S-Corp etc.

Yes
No
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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?

Yes
No
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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)

Yes
No
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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?

Yes 1-2
Yes 2 or more
No
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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 2024?

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

Is Your Proof Of Miles Driven Written Down?

YES
NO
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Do you have receipts for car maintenance for vehicles that was used for business purposes?

Yes
No
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Additional Services:

Are You Interested In Credit Repair

YES

How Do I Sign Up?

Business Related Documents (Upload Up to 10 Documents)

Spouse Business Related Documents(Upload Up to 10 Documents)

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

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

"[email protected]"

**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

School Forms (1098T and 1098E)

2024 W2's (Upload up to 10)

Other Uploads(Up to 15 documents can be uploaded)

1099 G (State Unemployment)

Miscellaneous Documents

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

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

"ENTER YOU TAX COMPANY EMAIL HERE"

**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 *

Check

Taxpayer Sign Here: *

Clear

Spouse Sign Here:

Clear

Consent For Payment

I confirm that I have read and understand the information above *

check

Taxpayer Signature *

Clear

Spouse Signature

Clear

I confirm that I have read and understand the information above *

check

Your Signature *

Clear

Your Spouse Signature

Clear

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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