REGULAR INTAKE FORM 2024
Date
*
-
Month
-
Day
Year
Date
Civil Status
*
Please Select
Single
Married
Divorce
Widow
Date of Marriage / Divorced or Deceased
Full Name
*
First Name
Last Name
Date of Birth
*
Phone Number
*
Would you authorize us to contact you by text message?
*
Yes
No
E-mail Address
example@gmail.com
Spouse's Full Name
First Name
Last Name
Date of Birth
.
E-mail Address
example@gmail.com
Address
*
Physical Address
Mailing Address / PO BOX
City
State / Province
Postal / Zip Code
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Dependents
Fist Name & Last Name
Date of Birth
Relationship to you
How many months living with you in the US?
Full time college Student?
Yes or No
Dependents income
(if applicable)
1
2
3
4
5
Did you pay daycare expenses?
*
Yes
No
Daycare Provider info
Providers Name
Adress
SSN
Employer Identification Number
Total amount paid for daycare
Were there any deaths of a spouse or dependent in 2023?
*
Yes
No
Did you have more than one job in 2023?
*
Yes
No
Have you received a letter from the IRS or state revenue department within the past year?
*
Yes, please bring any letter received from the IRS
No
Did you get rent or real state income from any property?
*
Yes
No
Did you pay real estate property state taxes?
*
Yes
I do not pay real estate property state taxes
How many properties do you have?
*
Did you bring your property tax statement?
*
Yes
No
Did you receive interest from your savings account? (1099-INT or 1099-DIV)
*
Yes
No
Did you receive unemployment in 2023? (1099-G)
*
Yes
No
Have you received any other income through the follow: (Select all that apply)
Social Security Benefits (SSA-1099)
Gambling (W-2G)
Lottery
Roth IRA or Traditional IRA (Form 5498)
Retirement Plan Distribution (1099-R)
None
Have you, your spouse or a dependent been a victim of identity theft? Did the IRS give you an Identity Theft Protection Pin
*
Yes
No
If yes, what is the six-digit Identity Protection Pin?
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Next
Did you have some debt that was canceled or forgiven? (example: Credit card(s), Bankruptcy 1099-C)
*
Yes
No
Are you self-employed?
*
Yes
No
Did you receive income from hobbies?
*
Yes
No
Have you sell, trade or receive stocks or crypto currencies?(Stocks, Bitcoin or Form 1099-B)
*
Yes
No
Did you have a foreign bank account or a company?
*
Yes
No
Did you or your children attend college in 2023? (Need form 1098-T)
*
Yes
No
How long have you been in college?
College/University Expenses
Students Name
Type of Expenses (Example: books)
Total
1
2
Did you receive the First time home buyers credit in 2008?
*
Yes
No
Did you receive Form 1095-A, health insurance Marketplace Statement?
*
Yes
No
Will you be dropping off documents or coming in?
*
Drop off / Dejar documentos
In person appointment / Cita en persona
Sending documents online/ Mandar documentos en linea
If coming in what date is your appointment?
appointment date
How would you like to receive your tax refund?
*
Please Select
Direct Deposit
Check Mailed
Type of Account
Please Select
Checking
Savings
Account Information
Routing Number
Account Number
Signature
*
Please verify that you are human
*
Print Form
Submit
Should be Empty: