Individual/LLC Tax Intake Form

Please fill out the form below to complete, and upload, all of your tax information, and documents to us. Should you have any question(s) prior to completing this form, please do not hesitate to contact us via email at [email protected] and someone will reach out to you answer your question(s). Thank you, and have a great remainder of your day!

How did you hear about us or who referred you?

First Name *

Middle Name

Last Name *

Suffix

Date of birth *

Occupation *

TAX ID/SSN# *

Address *

Street Address line 2

City *

State *

Postal code *

Phone *

Email *

Driver's License # *

State Driver's License Was Issued

Date Driver's License Was Issued

Driver's License Expiration Date

Photo of Social Sec. Card & Driver's License *

What is your filing status? *

Are you filing an eligible spouse on your tax return?

Yes

Spouse Name

Social Security Number *

Occupation *

Date of Birth *

Phone Number

Email *

Address Line *

City

State

Zip Code

Driver's License # *

State Driver's License Was Issued *

Date Driver's License Was Issued *

Driver's License Expiration Date

Photo of Driver's License

Choose File - Driver's License ID

Dependents

Should only be listed if you take care of the dependent over half of the year

Image of Dependent's S.S.Card *

1. Dependent Information

Gender of Dependent/ Dependent Relationship

First Name

Middle Name

Last Name

Suffix

Date of Birth *

Social Security Number Dependent

2. Dependent Information

Gender and dependent Relationship

First Name

Middle Name

Last Name

Suffix

Date of Birth

Social Security Number Dependent

3. Dependent Information

Gender and dependent relationship

First Name

Middle Name

Last Name

Suffix

Date of Birth

Social Security Number Dependent

4. Dependent Information

Gender and dependent relationship

First Name

Middle Name

Last Name

Suffix

Date Of Birth

Social Security Number Dependent

Do you have Dependent Daycare Expenses?

Yes

No, all dependents are entered

Child and Dependent Daycare Expenses

If the provider is a person, enter the care provider's SSN

Child Name

Amount Paid *

Provider Phone Number

Provider

Name *

Tax ID# / SSN *

Address

City

State

Zip Code

Do you want to enter another child care provider?

Yes

What type of employee were you in 2023?

W2/Small Business Owner

Self-Employed/Small Business Owner

1099 Contractor

Household Employee (Ex: Babysitter, Gardener, Housekeeper, Maid, etc.)

Upload photos of your W-2,1099,and ALL documents

Attach an image of all documents that can be used to assist your tax preparer with the preparation of your tax return.

Upload *

Enter any additional information or comments that you would like the include for your tax preparer

If you did not file your tax return with us last year, we recommend that you upload a copy of your previous year's tax return

Do you owe from previous year(s)? *

Yes

I have not filed previous years

Do you have a business that you would like to be included on your return? *

Yes

Business Owners Data Sheet

Schedule C

Name of Business

Employer ID Number

What is the legal structure of your business?

Business Address

Amount Paid ($)

Business Income

All income receive during the fiscal year

Total Income

Business Expenses

Complete to the best of your ability. In each field enter the approximate amount you spent in each category.

Advertising

Contract Labor

Insurance

Interest

Legal & Professional Services

Office Expenses

Rent and Lease

Repairs and Maintenance

Supplies

Taxes and Licenses

Travel, Meals, and Entertainment

Utilities

Other Expenses

Is there any other information, questions, or concerns that you want to include to your tax preparer pertaining to your business?

Attach any photos or documents that you want us to have on file.

Choose Files

Consent to Use Of Tax Return Information

“Talley Financial Services, LLC” ("we," "us" and "our")

Federal law requires this consent form be provided to you ("you" refers to each taxpayer, if more than one). Unless authorized by law, we cannot use, without your consent, your tax return information for purposes other than the preparation and filing of your tax return.

You are not required to complete this form. If we obtain your signature on this form by conditioning our services on your consent, your consent will not be valid. Your consent is valid for the amount of time that you specify. If you do not specify the duration of your consent, your consent is valid for one year.

If you do not consent, then you may still have your tax return prepared and electronically filed by us for a fee.

For your convenience, we have entered into arrangements with a bank to provide qualifying taxpayers with the opportunity to apply for a Refund Anticipation Loan (RAL), or a Preferred Electronic Refund Check (PERC) or an Electronic Refund Deposit (ERD). To determine whether these products may be available to you, we will need to use your tax return information by analyzing it and calculating the amount of your anticipated refund.

If you would like us to use your tax return information to determine whether these products may be

available to you while we are preparing your return, please sign and date this consent to the use of

your tax return information.

By signing below, you (including each of you if there is more than one taxpayer) authorize us to use the information you provide to us during the preparation of your 2023/2024 tax return to determine whether to present you with the opportunity to apply for these products and services.

Date *

Joint Taxpayer Signature

Clear

Date

If you believe your tax return information has been disclosed or used improperly in a manner unauthorized by law or without your permission, you may contact the Treasury Inspector General for Tax Administration (TIGTA) by telephone at 1-800-366-4484, or by email at [email protected].

Consent to Disclosure of Tax Return Information

"Talley Financial Services, LLC" ("we," "us" and "our")

Federal law requires this consent form be provided to you ("you" refers to each taxpayer, if more than one). Unless authorized by law, we cannot disclose, without your consent, your tax return information to third parties for purposes other than the preparation and filing of your tax return. If you consent to the disclosure of your tax return information, Federal law may not protect your tax return information from further use or distribution. You are not required to complete this form. If we obtain your signature on this form by conditioning our services on your consent, your consent will not be valid. If you agree to the disclosure of your tax return information, your consent is valid for the amount of time that you specify. If you do not specify the duration of your consent, your consent is valid for one year.

In order to process your return we must disclose all of your 2023/2024 tax return information to Talley Financial Services, LLC that we utilize in order to provide certain services.

If you will allow us to disclose your 2023/2024 tax return information to Talley Financial Services, LLC for this purpose, sign and date your consent to the disclosure of your tax return information.

By signing below, you (including each of you if there is more than one taxpayer) authorize us to disclose to Talley Financial Services, LLC all of your 2023/2024 tax return information. If you are not willing to authorize us to share your tax information with the other firms, you can still choose to have your tax return prepared and filed by us for a fee.

Date *

I agree to terms & conditions

PROMO CODE

E-Signature Below *

Clear