D5 Tax Client Intake Form

Filing Status*

Name*

First NameLast Name

Preferred Name*

First NameLast Name

Pronoun*

He/SheShe/HerThey/Them

Age*

Date of Birth*

Date

Phone Number*

Please enter a valid phone number.

Cell Phone Provider*

Email*

example@example.com

Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Occupation*

SSN*

Are you a full-time student?*

YesNo

Are you totally and permanently disabled?

YesNo

Are you legally blind?

YesNo

Is this individual dependent of other?*

YesNo

Spouse Name

First NameLast Name

Spouse Age

Spouse Date of Birth

Date

Spouse Phone Number

Please enter a valid phone number.

Spouse SSN

Spouse Cell Phone Provider

Spouse Email

example@example.com

Spouse Occupation

Are you a full-time student?*

YesNo

Are you totally and permanently disabled?

YesNo

Are you legally blind?

YesNo

Is this individual dependent of other?

YesNo

Enter your dependents here

	Name	SSN	Date of Birth	Relationship
1
2
3
4
5
6

Employment Status*

EmployedUnemployedSelf-employed

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

YesNo

Does your dependents have tuition expenses?*

YesNo

Do you have any expenses for child care?*

YesNo

Are you currently renting?

YesNo

Do you have your own home?

YesNo

Do you have documents that shows you paid for property taxes?

YesNo

Did you sell any stock?

YesNo

Did you take money from your 401?

YesNo

Did you pay for vehicle tax?

YesNo

Do you have mortgage interest?

YesNo

Do you have real estate tax?

YesNo

Did you receive a federal tax last year?*

YesNo

Are you a victim of identity theft?*

YesNo

Are you currently selling or considering selling your home in the future?*

YesNo

Are you purchasing a home this year?*

YesNo

Are you or a loved currently in need of any of the following?*

Are you currently receiving both Medicaid and Medicare(red, white,&blue card)?*

yesno

Please fill-up the information within the current year only.

General Expenses

	Amount
Medical Expenses
Dental Expenses
Insurance Premiums paid
Long Term Care Premiums
Prescription Drugs and Medications
Home Mortgage
Investment Interest
Cash Contributions
Non-Cash Contributions
Unreimbursed Business Expenses
Union Dues
Tax Preparation Fees
Investment Expenses

Total Expenses

Would you like to apply for the advance?*

YesNOI would like more information

How would you like to receive your refund? ( if applicable)*

Financial Institution *

Routing Number *

Account Number*

Tax Professional you are requesting*

CaTonya ScottLaTanya HallZoe PeopleLicet Green

How did you hear about us?*

If referred by someone, please list their name here so we can thank them

Additional comments

I, hereby, state that all the information above is true to the best of my knowledge and that I am allowing D5 Tax Services, LLC to prepare my taxes based on that fact. I understand that I am financially responsible for any outstanding balance due to any false information given. If there is a balance due, you must pay the tax preparation fee upfront. If for any reason you owe an entity and they take the entire refund, you are STILL responsible to pay the tax preparation fee for services rendered. *For any reason an amendment has to be filed with no fault of the tax preparer, an upfront fee of $150.00 is required! Please view your tax return, which is emailed to you (it is sent prior to submission). Any copy after the first copy is a fee of $25.00. ALL FEES (bank and service fees) are found in the return and are non-refundable nor negotiable! NO EXCEPTIONS TO THIS!! Please utilize www.irs.gov for all federal refund tracking. Please utilze your state Department of Revenue site for any State Refund tracking. Do NOT add the amounts together. Federal taxes are federal, and state taxes are state when tracking your status. Please allow 8 weeks to surpass from the date of submission before calling the IRS, if you have any tracking questions. For any direct assistance please email d5taxservicesllc@yahoo.com or IRS 1-800-829-1040 to check your federal refund status. You will need your filing status, social security number, and the total amount of the refund before fees https://sa.www4.irs.gov/irfof/lang/en/irfofgetstatus.jsp

Client Intake covers years 2018,2019,2020,2021,2022,2023,2024,2025

Date Signed*

Date

Taxpayer Signature*

Date Signed

Date

Spouse Signature

LETTER OF ENGAGEMENT TO PREPARE TAX RETURN The undersigned person(s) has authorized D5 Tax Services, LLC or any authorized representative of D5 Tax Services to prepare their federal and/or state tax return(s) D5 Tax Services, LLC claims no responsibility for the tax return(s) other than preparing the said return(s) The accuracy of the return(s) will be directly related to the information that you, the taxpayer(s), provide D5 or any authorized representative of D5 Tax Services, LLC. The information received by D5 Tax Services, LLC will be used in compliance with the rules and regulations of the Internal Revenue Service. Two forms of identification such as a social security card or a form with picture identification should be presented to the preparer during services. We will gladly key your check-stub information for estimates ONLY. You must provide our office with the appropriate documents such as a W-2, 1099, 1098, childcare information, college student, mortgage information, etc., for your tax return to be properly e-filed to the IRS. We will supply you with a copy of your tax return and advise you to keep it in a safe and secure place in case it is needed. There will be a $25 fee for any additional copies of your tax return. In the event of an electronic filed tax return refund, anticipated loan, etc., D5 Tax Services, LLC makes no claim or guarantees regarding the time for expected delivery. All dates and/or responsibility LETTER OF ENGAGEMENT TO PREPARE TAX RETURN is limited to the preparation of the return for electronic transmission. After electronic transmission, any delays caused by the IRS, Bank(s) and/or any other government agency involved are not the responsibility of D5. By signing this Letter of Engagement, to prepare your Tax Return(s), you have agreed to fully compensate and authorize D5 Tax services,LLC to prepare your tax return(s For payment of services rendered, it is to be electronically deducted from your refund. The taxpayer(s) is/are fully responsible for any unpaid balance. Any outstanding balance must be paid in full during the time of services rendered. The taxpayer(s) will be responsible for any and all fees and expenses, including collection, attorney fees, damages, court cost and interest that may incur in D5 Tax Services, LLC collecting the unpaid debt.If using refund transfer option to pay fees due and payable to D5 Tax Services, LLC, in the event that fees are unpaid due to other debt requirements or any other unforeseeable situations, you authorize D5 Tax Services, LLC to collect funds due and payable via ACH debit from account on file until funds are recouped. D5 Tax Services, LLC will have the right to report to any Credit Reporting Agency using any information provided.

Disclaimer: D5 Tax Services Quote Policy

At D5 Tax Services,LLC, we prioritize efficiency and accuracy in providing our services. We do not offer tax quotes as the time required to generate a quote is equivalent to the time needed for the preparation of a comprehensive tax return. Our commitment is to deliver precise and thorough tax solutions, and we believe that dedicating our resources directly to the preparation process ensures the highest quality of service for our clients.

If you are in the process of shopping around for quotes, please note that our focus is on delivering comprehensive and accurate tax solutions rather than providing standalone quotes. We encourage you to consider the value of our commitment to thorough tax preparation, ensuring that your financial needs are met with precision and expertise.

Additionally, please be aware that if you submit the intake form and later decide not to file, there will be a $125 fee associated with us preparing your return, and this fee is due upon completion of your quote or can/will automatically be debited from your account. We appreciate your understanding and look forward to assisting you with your tax requirements. Thank you for considering D5 Tax Services, LLC.

Tax Payer Name*

First NameLast Name

Tax Payer Signature*

Spouse Name

First NameLast Name

Spouse Signature

Federal law requires this consent form be provided to you. Unless authorized by law, we cannot use, without your consent, your tax information for purposes other than the preparation and filing of your tax return. In addition to tax preparation services, (D5 Tax Services, LLC) is in the business of providing year round financial consultation and tax planning services. These services cannot be provided without your consent.

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.

Duration of Consent: 3 years

Consent to Use

I consent to the use of my tax information for purposes other than preparing my tax return. I consent for you to communicate with me via newsletter, e-mail, website, phone, or other means with information and recommendation that may be of use to me, including but not limited to:

1. Tax Advice: Advisory services relating to events in my life that have tax consequences such as college, investment transaction, marriage, divorce, healthcare saving plans, and retirement.

2. Budgeting: Services related to planning and forecasting finances.

3. Coaching: Services relating to life and business coaching, in which your financial information could be reviewed to offer service.

4. Retirement Tax Planning: Services related to retirement planning, social security planning, minimum required distribution from retirement accounts and other planning services.

5. Investment and Asset Advice: Services related to the tax consideration of buying, selling, and exchanging property including stocks, bonds, and real estate.

6. Other Tax and Financial Advice: Services related to responding to your tax questions.

7. Marketing: Consist of e-mail, text, direct mail and phone calls.

8. Contact FMS: IRS service that notify the taxpayer if he/she has a Federal or State tax offset.

Text Messages: By checking this box and submitting this form, you give us consent to use automated technology to call and text you at the phone numbers(s) above, including your wireless number if provided. Please note that you are not required to provide this consent to make a purchase from us.

By signing this form, I/We, expressly consent to the use of my (2024) tax information for the purpose of providing these auxiliary tax and financial services. I understand that (D5 Tax Services, LLC) is using tax information furnished by me to provide me with the services listed above.

By checking this box you agree to receive recurring messages from D5 Tax Services, Reply STOP to Opt out. Reply HELP for help. Message frequency varies. Message and data rates may apply. Carriers are not liable for delayed or undelivered messages. No mobile information will be shared with third parties/affiliates for marketing/promotional purposes. All OPT-IN requests include text messaging originator opt-in data and consent; this information will not be shared with third parties.

Name*

First NameLast Name

Taxpayer Signature*

Spouse Name

First NameLast Name

Spouse Signature

Upload W2(s) and/or 1099(s)

Upload ID, Social security cards for self and dependents

Upload All Other Additional Tax Documents

Tax Preparation Client Intake Form

LETTER OF ENGAGEMENT

CONSENT TO USE