2021 Tax Year- Client Intake Form

Thank you for considering PTS this tax season! To ensure we have all information needed to best serve you, please take a moment to fill out the form below. Should you have any questions/concerns, please feel free to contact us.
2021 Tax Year- Client Intake Form
How did you hear about us?*

ReferralInstagramFacebookExisting ClientOther
Name of person who referred you (if applicable)

First NameLast Name
New Clients Only: Did you file a tax return last year? If so, please upload a copy of your 2020 tax return at the end of this form if available.

YesNo
Filing Status as of December 2021?

Single (Not Married)Head of HouseholdMarried Filing Separate (not living with spouse)Married Filing JointQualifying WidowerUnsure

Name

First NameLast Name
Age
Date of Birth

MonthDayYear
Date
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Email
example@example.com
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Occupation
SSN
Is spouse a full-time student?

YesNo
Is spouse totally and permanently disabled?

YesNo
Is spouse legally blind?

YesNo

Did you pay more than half the expenses to maintain your residence in 2021?*

YesNo
Did you provide support for a child and or family member for more than 6 months in 2021?*

YesNoN/A
Did you live with the child and or family member for more than 6 months in 2021?*

YesNoN/A
If the dependent/qualifying child is a relative, did the custodial parent release their right to claim the dependent/qualifying child?*

YesNoN/A
Have you been unallowed EIC (Earned Income Credits) in a previous year or had the credits reduced?*

YesNoN/A
Can your dependent be claimed on another taxpayer's return?*

YesNoN/A
Did your dependent(s) earn more than $4300 in income in 2021?*

YesNoN/A

Enter your dependents here

Rows	Name	SSN	Date of Birth	Relationship	Number of months lived with you?
1
2
3
4
5
6

Advance Child Tax Credit Amount (If not received, enter 0. If received, refer to form 6419 mailed to you by the IRS).*
Did you incur expenses for your dependent(s)/qualifying child(ren)to attend daycare or receive childcare from an individual? (if so, please upload the form received from daycare)*

YesNoN/A
If you paid child care expenses to an individual, please provide the information below

Did you, your spouse, and your dependents have health insurance within 12 months last year? (Insurance obtained through the Marketplace requires filing of form 1095A or return can be delayed)*

Rows	Yes/No	Employer	Spouse Ins	Exchange/ Marketplace	Direct with Insurer	Medicare	Medicaid
Taxpayer
Spouse
Dependent 1
Dependent 2
Dependent 3
Dependent 4
Dependent 5

Please read & click below to upload ALL required documents/forms requested from or related to information you provided above

Requested Documents (Identification and Income Required on ALL returns, other documents are needed if applicable to Taxpayer/Return)
- Driver's License or other photo-government issued identification
- Social Security Cards (taxpayer, spouse, all dependents)
- Income (W2, 1099, Self-Employment income/expense logs or summary, receipts, bank statements (for business income), etc. )
- Proof of Residence (Lease agreement, utility bill, recent mail w/ current address)
- Proof of Dependent (Birth certificates, shot record)
- Healthcare (1095A if applicable, Form 1095C, or 1095B,Health Insurance Card, etc)
- Prior Year Tax Return (If new client)
- 1098-T Form-School Tuition Statement (if applicable to taxpayer or dependents)
ALL signature forms will be required prior to e-filing return and will be discussed/provided to taxpayer by preparer
Photo/Government ID*

Cancelof
Social Security Cards*

Cancelof
Income Documents (W2, 1099, Business Income/Expenses)*

Cancelof
Proof of Residence for Head of Household (see list of accepted documents above)*

Cancelof
1098-T (Tuition Statement Form) or Childcare/Daycare Form*

Cancelof
Other Forms/Documentation*

Cancelof
Additional comments

We do our very best to assist each client , provide the best service and meet each client's tax needs. It is understood that your refund could be offset by the IRS for various reasons such as child support obligations, student loans, outstanding federal or state tax fees/penalties, etcetera. However, our company's fees are based upon the service(s) provided to you in preparing your tax return and you are still obligated to pay those fees.

By signing this form, you acknowledge and understand that if full payment for services are not received within 45 days, Preferable Tax Services, LLC may take legal actions to resolve this matter.

I authorize Preferable Tax Services, LLC to capture my sensitive data such as personal identification, government identification, social security number (SSN), etc.

I authorize Preferable Tax Services, LLC and its associated affiliates to prepare all tax-related forms needed to file my return. I attest and confirm that all information was willingly provided and I take full responsibility for the accuracy of the information entered/uploaded in this form, not holding Preferable Tax Services, LLC and its affiliates responsible for any misrepresentation, false claims, or inaccurate information.

By signing below, I acknowledge that I have read and understood my responsibilities and Preferable Tax Services LLC's and its affiliates' responsibilities in preparing my tax return. I understand that my return will NOT be filed until all forms, fees and documents are reviewed, understood, agreed upon and signed.
Date Signed*

MonthDayYear
Date
Taxpayer Signature*
Date Signed

MonthDayYear
Date
Spouse Signature
Should be Empty: