Tax Client Intake Form

Driver's License #*
State Driver's License Was Issued*
Date Driver's License Was Issued *
MM/DD/YYYY
Driver's License Expiration Date*
MM/DD/YYYY
Photo of Social Sec. Card & Driver's License *

Identification
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Do you have an Identity Protection Pin issued by the IRS?*

YesNo
If yes, please upload your IP Pin from the IRS here.

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What is your filing status?*
Can someone else claim you as a dependent?*

YesNo
Are you filing an eligible spouse on your tax return?*

YesNo

Spouse Name*

First NameMiddle NameLast NameSuffix
Social Security Number*
Occupation*
Date of Birth*

MonthDayYear
Date
Phone Number*
Email*
example@example.com
Address*

Street Address

Street Address Line 2

CityState

Zip Code
Driver's License #*
State Driver's License Was Issued*
Date Driver's License Was Issued *
MM/DD/YYYY
Driver's License Expiration Date*
MM/DD/YYYY
Photo of Driver's License and Social Security Card *

Identification
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Child and Dependent Daycare Expenses

If the provider is a person, enter the care provider's SSN
Child Name Amount Paid*

First NameAmount Paid
Provider Phone Number*
Provider*

NameTax ID #/ SSN
Provider Address*

Street Address

Street Address Line 2

CityState

Zip Code
Do you want to enter another child care provider?*

YesNo
Child Name Amount Paid*

First NameAmount Paid
Provider*

NameTax ID #/ SSN
Provider Phone Number*
Provider Address*

Street Address

Street Address Line 2

CityState

Zip Code

Business Owners Data Sheet

Schedule C
Let's maximize your refund with benefits of being a business owner! Please answer the following:
Name of Business (Enter your name if no legal business name)*
Employer ID Number (Leave blank if using your ssn)
EIN
Business Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
What is the legal structure of your business?*
What is your NAICS code or business industry code? If you do not know, please tell us what type of business this is.*
Amount of business taxes paid throughout the year?
$
What is the make and model of your vehicle used for business purposes?
What month, day, and year did you start using this vehicle for business use?
Business Income

All business income received during the fiscal year
Total Business Income
$
Business Expenses

Complete to the best of your ability. In each field enter the approximate amount you spent in each category.
Advertising
Social media, Flyers, Business Cards, etc
Contract Labor
An person or company paid to assist you
Insurance
(Other than health)
Interest
Mortgage, Loans, Credit Cards, etc.
Legal & Professional Services
Training, Conferences, Mentors, Lawyers, etc
Office Expenses
Software, postage, email, internet, and any operating expenses
Did you pay any commercial rent? If so, how much for the year?*
Rent and Lease
Vehicles, Machinery, Equipment, Electronics, Accessories, etc.
Repairs and Maintenance
Supplies
Objects used to operate your business
Taxes and Licenses
Travel, Meals, and Entertainment
Airfare, Uber, Taxi, Lyft, Business Dining, Business Entertainment, and etc.
Utilities
Did you work from home? If so, what is the square footage of your home?*
Other Expenses
Is there any other information, questions, or concerns that you want to include to your tax preparer pertaining to your business?
Attach any photos or documents that you want us to have on file.

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Additional Questions
Do you pay tithes to your church or make monetary donations to charity or non profit?*

YesNo
If so, how much for the year?
Do you pay for your parents living expenses including rent, mortgage, utilities, or medical bills?*

YesNo
If so, how much for the year?
Have you ever been disallowed certain credits or had them reduced in previous years such as EIC or education credits?*

YesNo
In the event you are locked out of your account, what is your mother's maiden name?*
Please Note: Upon completion and submission of this intake form, you are acknowledging your intent to file your taxes with Mastermind Tax and Financial Services with the knowledge that you are responsible for paying the preparation fees either upfront or via your refund and in the event that your refund is taken by the IRS for taxes owed or any other obligation, you are still responsible for paying the preparation fees. If you decide to go somewhere else or decide not to file, you are still responsible for paying the preparation fees for the work we have done in preparing your tax return. In this case, you are giving permission for Mastermind Tax and Financial Services to debit your preparation fees from your bank account on file.

Upon signature and submission of this form, you acknowledge that you have read, understand, and agree to these terms.
E- Signature Below*

Clear
By filling out this form, you are giving us permission to prepare your tax return and you are confirming that ALL information entered is accurate. If you have any questions do not hesitate to call our office at (866) 481-3466 or email Info@mastermindtaxfs.com
Should be Empty:

Client Tax Data Sheet

Payment/Refund

Dependents

Child and Dependent Daycare Expenses

Income

Upload photos of your W-2,1099, and ALL Income documents

Business Owners Data Sheet

Business Income

Business Expenses

Multi-Member LLC and Partnership Tax Returns

Future Plans

Corporate Tax Returns

Future Plans

Personal Expenses

Health Insurance

Additional Questions