Tax Client Intake Form

Tax Client Intake Form
Tax Payer Information
Client's Name *

First Name Middle Name Last Name Suffix
Spouse's Name (if applicaple)

First Name Middle Name Last Name Suffix
Filing Status *
Address *

Street Address

Street Address Line 2

City State

Zip Code
County *
School District *
Email *
example@example.com
Phone Number *

Area Code Phone Number
Date of Birth *

Month Day Year
Date
Spouse Date of Birth (if applicable) *

Month Day Year
Date
Social Security Number (last 4 digits only) *
Spouse's Social Security Number (if applicable - last 4 digits only)
Occupation *
Spouse's Occupation (if applicable)
Has your name or address changed since last year? *

Yes No
Have you worked with us before

Website‎ Google Social Media Referral Other
If referral, please provide name. *
Have you ever worked with a similar service before? *

Yes No
What is the name of the service you have previously worked with? *
Were your taxes filed last year? *

Yes No
If your taxes were filed last year, did you receive a refund? *

Yes No
If you received a tax Refund, what was the Federal refund amount? *
Briefly explain what you may need assistance with: *
Are there any issues that may impact your tax return filing? *
Have you experienced any changes in your household, income, expenses, education, investment status or other? Please provide details below. We'll need to review documentation to determine any impact to tax filing. *
Dependents Information
How many dependents do you have? *
Name (Dependent 1) *

First Name Middle Name Last Name Suffix
Male or Female *

Female Male
Relationship *
Date of Birth *

Month Day Year
Date
Social Security Number (last 4 digits only) *
Name (Dependent 2) *

First Name Middle Name Last Name Suffix
Male or Female *

Female Male
Relationship *
Date of Birth *

Month Day Year
Date
Social Security Number (last 4 digits only) *
Name (Dependent 3) *

First Name Middle Name Last Name Suffix
Male or Female *

Female Male
Relationship *
Date of Birth *

Month Day Year
Date
Social Security Number (last 4 digits only) *
Name (Dependent 4) *

First Name Middle Name Last Name Suffix
Male or Female *

Female Male
Relationship *
Date of Birth *

Month Day Year
Date
Social Security Number (last 4 digits only) *
Tax Payer Income and Expense

For 2018, the standard deduction amount has been increased for all filers. For 2018, you can't claim a personal exemption deduction for yourself, your spouse, or your dependents. The deduction of miscellaneous itemized deductions is suspended for tax years 2018 through 2025 by the Tax Cuts and Jobs Act. Social security number (SSN) required for child tax credit.
Standard deduction amounts increased.

For 2018, the standard deduction amount has been increased for all filers. The amounts are:
Did your household receive Federal stimulus check (Direct Economic Income Payments in 2020? If so, please provide total amounts received for each distribution. Payments were issued to American households twice. *
What's your income? Please check all that apply. Please provide a brief explanation below to assist tax preparer. *
What's your spouses income? (if applicable) Please provide a brief explanation below to assist tax preparer.
Did your marital status change from the prior year? Please check all that apply. If checked, please provide a brief explanation below to assist tax preparer. *
Did you change your address from last year? If yes, please provide a brief explanation below to assist tax preparer. (Note: Please check for you AND your spouse) *
Any change in your dependents from last year? If yes, please provide a brief explanation below to assist tax preparer. (Note: Please check for you AND your spouse) *
Did you have children under 19 (or 24 if a full time student) who had more than $12,000 earned income, $1,050 in unearned income or $12,000 of combined earned and unearned income? If yes, please provide a brief explanation below to assist tax preparer. (Note: Please check for you AND your spouse) *
Are all your dependents either US Residents or Citizens? If yes, please yes or no, provide a brief explanation below to assist tax preparer. (Note: Please check for you AND your spouse) *
Is anyone living in your household disabled? If yes, provide a brief explanation below to assist tax preparer. (Note: Please check for you AND your spouse) *
Did you pay any adoption expenses? If yes, please provide a brief explanation below to assist tax preparer. (Note: Please check for you AND your spouse) *
Did you provide over half the support for someone you aren't claiming as a dependent? If yes, please provide a brief explanation below to assist tax preparer. (Note: Please check for you AND your spouse) *
Are you being claimed or eligible to be claimed as a dependent of someone else's return. If yes, please provide a brief explanation below to assist tax preparer. (Note: Please check for you AND your spouse) *
Were either you or your spouse in the military or National Guard? If yes, please provide a brief explanation below to assist tax preparer. (Note: Please check for you AND your spouse) *
Did you purchase or sell your primary residence? Or did you refinance your primary residence? If yes, please provide a brief explanation below to assist tax preparer. *
Have you been notified by the IRS of changes to a previously submitted tax return? If yes, please provide a brief explanation below to assist tax preparer. (Note: Please check for you AND your spouse) *
Have you received any other IRS or State Audit or Assessment Notices? If yes, please provide a brief explanation below to assist tax preparer. (Note: Please check for you AND your spouse) *
Did you make any gifts over $15,000 to any individuals. If yes, please provide a brief explanation below to assist tax preparer. (Note: Please check for you AND your spouse) *
Are you unemployed or your spouse unemployed If yes, please provide a brief explanation below to assist tax preparer. (Note: Please check for you AND your spouse) *
Do you haveTax Exempt Interest and/or Dividends? If yes, please provide a brief explanation below to assist tax preparer. (Note: Please check for you AND your spouse) *
Do you have any taxable refunds, credits or offsets? Example, monies owed that might result in the IRS or State withholding of any refunds due. Can include: past due child support, over payments, student loan defaults, etc. If yes, please provide a brief explanation below to assist tax preparer. (Note: Please check for you AND your spouse) *
Do you or your spouse have Business Income (independent contractor, Self Employment Income, 1099) If yes, please provide a brief explanation below to assist tax preparer. (Note: Please check for you AND your spouse) *
Did you have any Stock Sales (Capital Gains) (MAKE SURE ALL BASIS INFO IS PROVIDED) If yes, please provide a brief explanation below to assist tax preparer. (Note: Please check for you AND your spouse) *
Did you receive any Rental Real Estate Income? Please check any of the following that you and/or your spouse received last year.no) If yes, please provide a brief explanation below to assist tax preparer. (Note: Please check for you AND your spouse) *
Did you or your spouse receive any other type of income?Example, alimony, social security, inheritance, lottery, etc. If yes, please provide a brief explanation below to assist tax preparer. (Note: Please check for you AND your spouse) *
Are you contributing to a 401k, 403b or other pre-tax account? If yes, please provide a brief explanation below to assist tax preparer. (Note: Please check for you AND your spouse) *
Are you requesting state return(s)? Which State? *
Did everyone on this tax return (living in household) have health insurance coverage all 12 months last year? Y / N. If no, please provide brief explanation. *
Do you have Educator Expenses (Teaching Expenses) Please check any of the following that apply to you and/or your spouse. If yes, please provide a brief explanation below to assist tax preparer. (Note: Please check for you AND your spouse) *
Do you have a Health Savings Account Deductions Please check any of the following that apply to you and/or your spouse. If yes, please provide a brief explanation below to assist tax preparer. (Note: Please check for you AND your spouse) *
Did you pay for Student Loan Information (could take several weeks) If yes, please provide a brief explanation below to assist tax preparer. (Note: Please check for you AND your spouse) *
Did you pay Tuition and Fees for post secondary education (you, spouse or your dependents) If yes, please provide a brief explanation. *
Did you pay for qualifying Childcare Expenses? If yes, please provide details including Provider Name, Provider Address and Provider EIN number. *
Business Income

You are considered to have a business if your work/earnings are as independent contractor, self-employed, 1099 worker, etc.
Do you have business income? How much did you earn? Annual Business Earning/Revenue/Sales Amount *
Business Description and NAICS Code (if not sure, put I don't know.) *
Business Name *
EIN (If applicable) If you don't have a Business Tax ID, mark n/a. *
Business Start Date Please state month and year. *
Business Address *
Do you have a dedicated space in your home used specifically for your business? If Home business, what is the date home first used for business? *
What is the square footage of home area used for business? *
What is the total square footage of the home? *
Vehicle Information used for business (Year/Make/Model) *
Date Placed in Service *
Total Miles Driven in tax year *
Business Miles driven in tax year *
Do you have depreciation assets? Y/N *
Please list business expenses. We'll need a ledger of each expense with amount paid in the tax year *
E-FILE / FILING INFO - REFUND / PMT INFO

Tax preparation and filing fees must be paid in advance of the start of services.
How do you want any refund sent to you? *

Direct Deposit
What type of bank account do you want funds deposited? *

Checking Savings
Please enter Banking institution name. *
Provide Banking Routing # *
Provide Banking Account # *
Electronic signature

Clear
Please verify that you are human *
Should be Empty:

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Tax Client Intake Form

Tax Payer Information

Dependents Information

Tax Payer Income and Expense

Standard deduction amounts increased.

Business Income

E-FILE / FILING INFO - REFUND / PMT INFO