Dear Taxpayer,

As part of our commitment to accuracy and our due diligence in preparing your taxes in ensuring compliance with IRS regulations, we kindly request your cooperation in answering the following questions. Your responses will help us accurately assess your eligibility for various tax credits and filing statuses.

Your responses will help ensure that your tax return is prepared correctly and in accordance with the law. Please answer each question to the best of your knowledge. Thank you for your cooperation.

Personal Information:

F2WTAX CLIENT INTAKE SHEET

Drivers License / ID

Social Security Card

FILING STATUS (PLACE AN X IN THE BOX THAT APPLIES)

SINGLE
MARRIED FILING JOINT
MARRIED FILING SEPERATE
HEAD OF HOUSHOLD
WIDOWED/SURVIVNG SPOUSE

Spouse Date Of Birth

Social Security Number:

Social Security Card

Dependent #1 Full Name

Social Security Card

School or Medical Record

Dependent #2 Full Name

Social Security Card

School or Medical records

Dependent #3 Full Name

Social Security Card

School or Medical records

Are you Filing as Head of Household ?

YES

If yes, please confirm the qualifying criteria you meet for the Head of Household filing status.

Could you, or your spouse if filing jointly, be considered a "Qualifying Child" on another persons tax

YES

Did all of your dependents live with you in the United States for over half of the year, OR The full year if any of the dependents is an eligible foster child?

YES

Were any of your dependents at the end of the year: Under age 19 OR Under age 24 and a full-time student OR Any age and permanently and totally disabled?

YES

Could any other person claim credit for providing for any of the dependents on this this tax return?

YES

If the child is married, are you claiming this child as a dependent?

YES

Is the Child or any of the dependents: (The Taxpayer's Son, Daughter, or adopted child OR A child of the Taxpayer's son, daughter or adopted child OR The Taxpayer's stepchild OR The Taxpayer's eligible foster child?

YES

Child Tax Credit (CTC), Additional Child Tax Credit (ACTC), and Other Dependent Credit (ODC): Are you claiming any children or dependents for the Child Tax Credit, Additional Child Tax Credit, or Other Dependent Credit? (copy)

YES

If yes, have you obtained Form 8332 or an equivalent written declaration from the custodial parent?

YES

Form 8862 (Information to Claim Earned Income Credit After Disallowance): Have you ever been denied the Earned Income Credit (EIC) in the past, and are you currently claiming it?

YES

American Opportunity Tax Credit (AOTC): Are you or a dependent enrolled in higher education?

YES

Are you or one of your dependents a full-time student?

Yes

Upload your 1098T form

SOURCE OF INCOME (CHECK ALL THAT APPLY)

LENGTH OF TIME EMPLOYED

W2 ,1099,1099K ETC,INCOME STATEMENT

W2 ,1099,1099K ETC ,INCOME STATEMENT

W2 ,1099,1099K ETC,INCOME STATEMENT

W2 ,1099,1099K ETC ,INCOME STATEMENT

IF YOU ARE SELF EMPLOYED OR OWN A BUSINESS PLEASE WRITE A BREIF DESCRIPTION OF YOUR JOB OR BUSINESS.

Do you own a business, and will you be filing a Schedule C (Profit or Loss from Business) on this return

YES

Do you operate any business as a sole proprietor or independent contractor?

YES

Business License ,Business Card ,Flyer, Proof of business

Business phone number:

How long have you had the business?

Did you file your business taxes?

Upload your current tax documents

Are you contributing to 401k or other pre-tax account?

Yes

At least one family member (including taxpayer) did not have health care coverage at anytime during the year?

YES

Received health care coverage through employer for entire year (including COBRA Coverage)? (copy)

YES

Received heallth care coverage from the government such as Medicaid, Medicare or Veterans Benefits?

YES

Received heallth care coverage from the government such as Medicaid, Medicare or Veterans Benefits? (copy)

YES

Purchased private health insurance (NOT through the Marketplace") for the entire year?

YES

Purchased private health insurance (NOT through the Marketplace") for the entire year? (copy)

YES

Received health care coverage through ACA Health Insurance Marketplace ?

YES

Upload your 1095A FORM

Taxpayer Signature

Clear

Taxpayer Spouse Signature

Clear

Additional Information: Are there any other tax-related matters or circumstances that you believe we should be aware of during the preparation of your return?

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