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 Name
Middle Name
Last Name
Suffix
Phone Number
*
Please enter a valid phone number.
Did your phone number change from LAST year?
*
YES
NO
Email
*
example@example.com
Date of birth
*
-
Month
-
Day
Year
Date
Social Security Number
*
Please upload copy
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Did you stay at this address LAST year?
*
YES
NO
Are you a U.S. Citizen?
*
Please Select
Yes
No
Do you have an Identity Protection Pin?
*
If so please provide above
Can anyone claim you?
*
Please Select
Yes
No
Last year were you?
Where you Totally and Permanently disabled?
*
Yes
No
Where you a Full-time student?
*
Yes
No
Where you Legally blind?
*
Yes
No
Spouse's Full Name
First Name
Middle Name
Last Name
Spouse's Social Security Number
Please upload a copy
Date of birth
-
Month
-
Day
Year
Date
Spouse's Email
example@example.com
Is your Spouse a U.S. citizen?
Please Select
Yes
No
Do you have an Identity Protection Pin?
If so please provide above
Can anyone claim you or your Spouse?
Please Select
Yes
No
Last year was your Spouse?
Was your Spouse Totally and Permanently disabled?
Yes
No
Was your Spouse a Full-time student?
Yes
No
Was your Spouse Legally blind?
Yes
No
Signature
Household Questions
List dependents or anyone who you supported last year(Must provide proof medical or school docs)
Dependent #1
First Name
Middle Name
Last Name
Suffix
Date of birth
-
Month
-
Day
Year
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?
Please Select
Yes
No
Unsure
Full-time student?
Please Select
Yes
No
Unsure
Disabled?
Please Select
Yes
No
Unsure
Dependent #2
First Name
Middle Name
Last Name
Suffix
Date of birth
-
Month
-
Day
Year
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?
Please Select
Yes
No
Unsure
Full-time student?
Please Select
Yes
No
Unsure
Disabled?
Please Select
Yes
No
Unsure
Dependent #3
First Name
Middle Name
Last Name
Suffix
Date of birth
-
Month
-
Day
Year
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?
Please Select
Yes
No
Unsure
Full-time student?
Please Select
Yes
No
Unsure
Disabled?
Please Select
Yes
No
Unsure
Dependent #4
First Name
Middle Name
Last Name
Suffix
Date of birth
-
Month
-
Day
Year
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?
Please Select
Yes
No
Unsure
Full-time student?
Please Select
Yes
No
Unsure
Disabled?
Please Select
Yes
No
Unsure
If you have additional dependent list name, DOB, SSN and relationship to you
Signature
*
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Save
Income/Expenses
Last year (Please upload all supporting documents in portal)
Income
W2 or salary
Self-employment or 1099-MISC
Disability (1099-R, W2)
Unemployment (Form 1099G)
Retirement income (1099-R)
Social Security or Railroad Retirement (SSA-1099, RRB-1099)
Income (or loss) from Rental property
Tip Income
Interest/Dividends (1099-INT, 1099-DIV)
Other
If Self-employed, what is type of business is it
If you received a W2 or 1099 Can I verify your employment?
*
Yes
No
No W2 or 1099
Employer's Phone Number
Supervisors Name
Expenses
Alimony or separation payments? If yes, do you have the recipient’s SSN?
Contributions to a retirement account? IRA (A) 401K (B) Roth IRA (B) Other
College expenses for yourself, spouse or dependents? (Form 1098-T)
For supplies used as an eligible educator such as a teacher, teacher’s aide, counselor, etc.?
Expenses related to self-employment income or any other income you received?
Student loan interest? (Form 1098-E)
Child or dependent care expenses such as daycare? (List Provider's info below)
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
City
State / Province
Postal / Zip Code
Amount paid to Provider
If applicable
Any additional information
Signature
*
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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.
Have a Health Savings Account? (5498-SA, 1099-SA, W-2 with code W in box 12)
Have credit card or mortgage debt cancelled/forgiven by a lender or have a home foreclosure? (Forms 1099-C, 1099-A)
Adopt a child?
Have Earned Income Credit, Child Tax Credit or American Opportunity Credit disallowed in a prior year?
Purchase and install energy-efficient home items? (such as windows, furnace, insulation, etc.)
Receive the First Time Homebuyers Credit in 2008?
Make estimated tax payments or apply last year’s refund to this year’s tax? If so how much?
File a federal return last year containing a “capital loss carryover” on Form 1040 Schedule D?
Have health coverage through the Marketplace (Exchange)? [Provide Form 1095-A]
Presidential Election Campaign Fund $3 for Taxpayer
Presidential Election Campaign Fund $3 for Spouse
Other
Did you receive Advance Child Tax Credit? If so please upload Proof of Amount below
Yes (upload Letter 6419 from IRS)
No
Unknown
Receive an Economic Impact Payment (stimulus) if so How much?
If you received all payments type "Received All"
If you are due a refund, would you like:
*
Direct deposit (Provide deposit slip, if applicable)
Prepaid Debit card
Check
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?
Yes
No
Provide a credit or debit card
Other
Would you like a Cash Advance up to $7000?:
*
Up to $1000 interest free
More than $1000 with interest determined by bank
None
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