Client Intake Form

Client Intake Form

Client Intake Form

Please fill out to the best of your abilities
Prosperity Tax Pros by Lisa Marie, and its tax preparers main objective is to help clients file their taxes and ensure the accuracy of various tax forms. Prepare and assist with tax return for clients to be able to pay any needed fees and review financial records. Also calculate tax returns using protected software. Prosperity Tax Pros by Lisa Marie does not control or work for IRS and is not responsible for any stipulations set forth by IRS. We only prepare your tax return for distribution of return or to stay in compliance with IRS. All information provided MUST be good faith and given to best of your knowledge and is accurate and said to be true. Prosperity Tax Pros by Lisa Marie is not held liable or accountable for any inaccuracies provided by client(s) also referred as "Taxpayer" that may result in being garnish or audited by IRS. By signing below you agree to said terms.

Lisa Marie Moore, Owner/Senior Tax Preparer, Prosperity Tax Pros by Lisa Marie
Taxpayer's Name

First NameMiddle NameLast NameSuffix
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Did your phone number change from LAST year?
Email
example@example.com
Date of birth

MonthDayYear
Date
Social Security Number
Please upload copy
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Did you stay at this address LAST year?
Are you a U.S. Citizen?
Do you have an Identity Protection Pin?
If so please provide above
Can anyone claim you?
Last year were you?
Where you Totally and Permanently disabled?
Where you a Full-time student?
Where you Legally blind?
Spouse's Full Name

First NameMiddle NameLast Name
Spouse's Social Security Number
Please upload a copy
Date of birth

MonthDayYear
Date
Does your Spouse have an Identity Protection Pin?
If so please provide above
Spouse's Email
example@example.com
Is your Spouse a U.S. citizen?
Can anyone claim you or your Spouse?
Last year was your Spouse?
Was your Spouse Totally and Permanently disabled?
Was your Spouse a Full-time student?
Was your Spouse Legally blind?
Signature
Household Questions

List dependents or anyone who you supported last year(Must provide proof medical or school docs)
Dependent #1

First NameMiddle NameLast NameSuffix
Date of birth

MonthDayYear
Date
Social Security Number
Relationship to you
Daughter, Son, Stepson, Stepdaughter etc...
Did they stay with you the whole year?
If not how many months did they stay with you?
U.S. Citizen?
Full-time student?
Disabled?
Dependent #2

First NameMiddle NameLast NameSuffix
Date of birth

MonthDayYear
Date
Social Security Number
Relationship to you
Daughter, Son, Stepson, Stepdaughter etc
Did they stay with you the whole year?
If not how many months did they stay with you?
U.S. Citizen?
Full-time student?
Disabled?
Dependent #3

First NameMiddle NameLast NameSuffix
Date of birth

MonthDayYear
Date
Social Security Number
Relationship to you
Daughter, Son, Stepson, Stepdaughter etc
Did they stay with you the whole year?
If not how many months did they stay with you?
U.S. Citizen?
Full-time student?
Disabled?
Dependent #4

First NameMiddle NameLast NameSuffix
Date of birth

MonthDayYear
Date
Social Security Number
Relationship to you
Daughter, Son, Stepson, Stepdaughter etc
Did they stay with you the whole year?
If not how many months did they stay with you?
U.S. Citizen?
Full-time student?
Disabled?
If you have additional dependent list name, DOB, SSN and relationship to you
Signature

Income/Expenses

Last year (Please upload all supporting documents in portal)
Income

Other
If Self-employed, what is type of business is it
If you received a W2 or 1099 Can I verify your employment?

No W2 or 1099
Employer's Phone Number
Supervisors Name
Expenses

Other
Child or dependent care Provider's Name
If applicable
Child or dependent care Provider's EIN or SSN
If applicable
Provider's Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Amount paid to Provider
If applicable
Any additional information
Signature

Life Events

(Please upload or provided all supporting documents into portal or email)
Last year did any of the below apply. Please mark which do.

Other
If you are due a refund, would you like:
Bank's Name
Please ensure that it is correct. I will not be responsible for incorrect information.
Routing Number:
Please ensure that it is correct. I will not be responsible for incorrect information.
Account Number:
Please ensure that it is correct. I will not be responsible for incorrect information.
If you have a balance due, would you like to make a payment directly from your bank account?
If so, do you want to use account listed above?

Other
Would you like a Cash Advance up to $7000?:
W2 Upload

Cancelof
Identification and Social Security Upload

Cancelof
Signature
Today's Date

MonthDayYear
Date
Should be Empty: