Full Legal Name
*
Date of birth
*
Social Security Number
*
Phone
*
Email
*
Address
*
Residential Address
City
State
Country
Country
Postal Code
Mailing Address if Different
Citizenship Status
*
Marital Status
*
Spouse Full Legal Name
Spouse Date of Birth
Spouse Social Security Number
Spouse Phone Number
Spouse Email Address
Taxpayer Government Issued ID
*
Spouse Government Issued ID
Social Security Cards for Everyone on Return
*
Prior Year Tax Return (Optional)
How many dependents do you have?
*
0 Dependents
1 Dependent
2 Dependents
3 Dependents
4 Dependents
5 Dependents
Dependent 1 Full Name
Dependent 1 Date of Birth
Dependent 1 Social Security Number
Dependent 1’s Relationship to You
Months Dependent 1 Lived With You This Year ✅
Is Dependent 1 a full-time student?
Yes
No
Is Dependent 1 disabled?
Yes
No
Dependent 1 Birth Certificate
Dependent 1 Social Security Card
Dependent 1 School or Medical Residency Documents
Dependent 1 Court or Guardianship Documents (if applicable)
Dependent 2 Full Name
Dependent 2 Date of Birth
Dependent 2 Social Security Number
Dependent 2’s Relationship to You
Months Dependent 2 Lived With You This Year
Is Dependent 2 a full-time student?
Yes
No
Is Dependent 2 disabled?
Yes
No
Dependent 2 Birth Certificate
Dependent 2 Social Security Card
Dependent 2 School or Medical Residency Documents
Dependent 2 Court or Guardianship Documents (if applicable)
Dependent 3 Full Name
Dependent 3 Date of Birth
Dependent 3 Social Security Number
Dependent 3’s Relationship to You
Months Dependent 3 Lived With You This Year
Is Dependent 3 a full-time student?
Yes
No
Is Dependent 3 disabled?
Yes
No
Dependent 3 Birth Certificate
Dependent 3 Social Security Card
Dependent 3 School or Medical Residency Documents
Dependent 3 Court or Guardianship Documents (if applicable)
Dependent 4 Full Name
Dependent 4 Date of Birth
Dependent 4 Social Security Number
Dependent 4’s Relationship to You
Months Dependent 4 Lived With You This Year
Is Dependent 4 a full-time student?
Yes
No
Is Dependent 4 disabled?
Yes
No
Dependent 4 Birth Certificate
Dependent 4 Social Security Card
Dependent 4 School or Medical Residency Documents
Dependent 4 Court or Guardianship Documents (if applicable)
Dependent 5 Full Name
Dependent 5 Date of Birth
Dependent 5 Social Security Number
Dependent 5’s Relationship to You
Months Dependent 5 Lived With You This Year
Is Dependent 5 a full-time student?
Yes
No
Is Dependent 5 disabled?
Yes
No
Dependent 5 Birth Certificate
Dependent 5 Social Security Card
Dependent 5 School or Medical Residency Documents
Dependent 5 Court or Guardianship Documents (if applicable)
Number of W2 Forms Received
Upload multiple W-2 forms
Describe Your Self Employment or Side Business
Business Name
Employer Identification Number (EIN)
Business Address
Type of Business
Total Gross Income
Total Expenses
Bookkeeping Method or Notes
Upload all Form 1099-NEC and Form 1099-MISC documents
Upload your 1099-NEC and 1099-MISC forms here
1099 Forms Upload
Upload Income Log or Bookkeeping Records
Upload Profit and Loss Statement
Gig Work Income
*
Uber
Lyft
DoorDash
Instacart
Amazon Flex
Airbnb
Turo
Upwork
Fiverr
Other
Upload Gig Work 1099 or Year-End Statements
Other Income Types
Unemployment (1099 G)
Social Security (SSA 1099)
Disability
Pension or Retirement (1099 R)
Interest or Dividends (1099 INT / DIV)
Stock Sales (1099 B)
Cryptocurrency
Rental Income
Child Support Received
Alimony Received
Gambling Winnings (W2 G)
Foreign Income
Upload Other Income Supporting Documents
Upload 1098 T Form
Upload Tuition Receipts
Upload Student Loan Interest (1098 E)
What is the child care provider’s name?
What is the child care provider’s phone number?
What is the child care provider’s address?
What is the child care provider’s Tax ID?
What is the total amount paid for child care?
Summary of Medical Dental and Prescription Expenses
Upload 1098 Mortgage Interest
Upload Property Tax Statement
Upload Closing Documents
List Cash and Non Cash Donations
1
2
3
4
5
6
Upload Donation Receipts
IRA and Additional Retirement Contributions
Upload Solar or Energy Credit Documentation
Are you self-employed or a business owner?
Yes
No
Entity Type
LLC
S Corp
Partnership
Sole Proprietor
Date Business Was Formed
Upload Articles of Organization
Upload Prior Year Business Tax Return
Upload Operating Agreement
Profit and Loss Statement
Balance Sheet
Business Bank Statements
Payroll Reports
1099s You Issued
Inventory or Asset Purchase Receipts
Total Home Square Footage
Square Footage Used for Business
List Home Expenses (rent mortgage utilities internet repairs etc.)
Did you obtain health insurance coverage from any of the health exchanges Marketplace? (1095A)
Yes
No
Upload 1095-A Form
Did You Have Marketplace Health Insurance
Yes
No
Refund Method
Direct Deposit
Paper Check
Bank Name
Routing Number
Account Number
Account Type (Checking/Savings)
Upload Voided Check or Bank Letter
Did your address change this year?
Yes
No
Did you receive any IRS or state letters?
Yes
No
Have you been a victim of identity theft?
Yes
No
Did you make estimated tax payments?
Yes
No
Do you owe back taxes child support or student loans?
Yes
No
Does someone else claim you?
Yes
No
Did you buy sell or trade cryptocurrency?
Yes
No
Did you win or lose gambling?
Yes
No
Did you buy or sell a home?
Yes
No
Upload IRS or State Notices
Additional Notes or Information
Client Acknowledgements
*
I confirm all information I provided is accurate
I understand Financial Dominance does not audit or verify information
I am responsible for reviewing my tax return before filing
I understand fees must be paid before filing
I understand incomplete information may cause delays penalties or interest
I agree to upload all required documents to the secure portal
I consent to communication by phone email text message and portal
Required Checkbox
*
I certify that all information and documents I have provided are true correct and complete to the best of my knowledge and belief
Taxpayer Digital Signature
*
Clear
Spouse Digital Signature (If Applicable)
Clear
Date Signed
*
Submit My Intake & Agreement”