REGULAR INTAKE FORM 2025
🚨MUST READ:
By beginning to complete or submitting this intake form, you consent to S.E.G Tax Services securely storing your information with Jotform. Please note that your intake forms are deleted after your appointment. This applies from the moment your intake form is submitted until it is deleted. Rest assured, your information will not be sold or shared with third parties or other companies, except as required by law or to prevent fraud. In certain situations, we may share client data if necessary, depending on the circumstances. The information you provide will be used solely for tax-related purposes unless you specify otherwise. If you do not agree to have your information stored, please notify us immediately, and we will provide an alternative method for proceeding with your tax filing.
Today's Date
*
-
Month
-
Day
Year
Date
Civil Status
*
Please Select
Single
Married
Divorce
Widow
Date of Marriage
-
Month
-
Day
Year
Date
Date of Divorce
-
Month
-
Day
Year
Date
Date of Death
-
Month
-
Day
Year
Date
Full Name
*
First Name
Last Name
Date of Birth
*
Format: 00- 00-0000.
Social Security Number or ITIN
*
Format: 000-00-0000.
Phone Number
*
Format: (000) 000-0000.
Would you authorize us to contact you by text message?
*
Yes
No
E-mail Address
example@gmail.com
*IMPORTANT
If you are married or married filing separate please fill out all of your spouse's information to avoid delays in processing your tax return.
Spouse's Full Name
*
First Name
Last Name
Date of Birth
*
.
Format: 00- 00-0000.
Social Security Number or ITIN
*
Format: 000-00-0000.
E-mail Address
example@gmail.com
Address
*
Physical Address
Mailing Address / PO BOX
City
State / Province
Postal / Zip Code
Who received income at household?
*
Taxpayer
Spouse
Dependent
Back
Next
How many dependents will you be claiming?
*
Please Select
0
1
2
3
4
5
Name of Dependent (1)
*
First Name
Last Name
Date of Birth (1)
*
-
Month
-
Day
Year
Date
Relationship to you (1)
*
Please Select
Child
Nephew/Niece
Step Child
Brother/Sister
Parent
Grandchild
Great-Grandchild
How many months did they live with you? (1)
*
Please Select
1
2
3
4
5
6
7
8
9
10
11
12
Is this dependent a full time college student (1)
*
Yes
No
Dependents income (if applicable) (1)
*
Name of Dependent (2)
*
First Name
Last Name
Date of Birth (2)
*
-
Month
-
Day
Year
Date
Relationship to you (2)
*
Please Select
Child
Nephew/Niece
Step Child
Brother/Sister
Parent
Grandchild
Great-Grandchild
How many months did they live with you? (2)
*
Please Select
1
2
3
4
5
6
7
8
9
10
11
12
Is this dependent a full time college student (2)
*
Yes
No
Dependents income (if applicable) (2)
*
Name of Dependent (3)
*
First Name
Last Name
Date of Birth (3)
*
-
Month
-
Day
Year
Date
Relationship to you (3)
*
Please Select
Child
Nephew/Niece
Step Child
Brother/Sister
Parent
Grandchild
Great-Grandchild
How many months did they live with you? (3)
*
Please Select
1
2
3
4
5
6
7
8
9
10
11
12
Is this dependent a full time college student (3)
*
Yes
No
Dependents income (if applicable) (3)
*
Name of Dependent (4)
*
First Name
Last Name
Date of Birth (4)
*
-
Month
-
Day
Year
Date
Relationship to you (4)
*
Please Select
Child
Nephew/Niece
Step Child
Brother/Sister
Parent
Grandchild
Great-Grandchild
Dependents income (if applicable) (4)
*
How many months did they live with you? (4)
*
Please Select
1
2
3
4
5
6
7
8
9
10
11
12
Is this dependent a full time college student (4)
*
Yes
No
Dependents income (if applicable) (4)
*
Name of Dependent (5)
*
First Name
Last Name
Date of Birth (5)
*
-
Month
-
Day
Year
Date
Relationship to you (5)
*
Please Select
Child
Nephew/Niece
Step Child
Brother/Sister
Parent
Grandchild
Great-Grandchild
How many months did they live with you? (5)
*
Please Select
1
2
3
4
5
6
7
8
9
10
11
12
Is this dependent a full time college student (5)
*
Yes
No
Dependents income (if applicable) (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 2025?
*
Yes
No
Did you have more than one job in 2025?
*
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 and/or State
No
Did you get rent or real estate income from any property?
*
Yes
No
How many properties do you have?
Did you receive interest from your savings account? (1099-INT or 1099-DIV)
*
Yes
No
Did you receive unemployment in 2025? (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?
*
Whose PIN is it?
*
Enter first and last name of who has the PIN
Back
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 any hobbies?
*
Yes
No
Did you sell, trade or receive stocks or crypto currencies?(Stocks, Bitcoin or Form 1099-B)
*
Yes
No
Do you have a foreign bank account or a company?
*
Yes
No
Did you pay any student loans in 2025? (Need form 1098-E)
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Yes
No
Did you or your children attend college in 2025? (Nee form 1098-T)
*
Yes
No
How long have you/they been in college?
College/University Expenses
Rows
Students Name
Type of Expenses (Example: books)
Total
1
2
Did you have health insurance in 2025?
*
Yes
No
Who is your insurance through?
*
Work
Medicaid
Medicare
Marketplace (form 1095-A is needed to file your tax return)
Will you be dropping off documents or coming in?
*
Drop off
In person appointment
Sending documents online
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: