Tax Preparation Client Intake Form

Tax Preparation Client Intake Form
Filing Status*

SingleHead of HouseholdMarried Filing SeparateMarried Filing JointQualifying Widower

Enter your dependents here*

Does you, your spouse, and your dependents have health insurance within 12 months last year? If yes, who covers for it?*

Expenses
Please fill-up the information within the current year only.

This is use for itemized tax returns only.

General Expenses

	Amount
Medical Expenses
Dental Expenses
Insurance Premiums paid
Long Term Care Premiums
Prescription Drugs and Medications
Home Mortgage
Investment Interest
Cash Contributions
Non-Cash Contributions
Unreimbursed Business Expenses
Union Dues
Tax Preparation Fees
Investment Expenses
Gifts to Charity
Uniform
Cell Phone
Tools
Gambling Loses

Acknowledgment & Signature
I confirmed that all information I entered here is accurate and true. I allow The Consultants Center, LLC to capture my sensitive data like personal id, government id, social security number (SSN), and other information. I have read the terms and conditions and privacy policy of the Consultants Center, LLC. By signing below, you acknowledge that you have read and understood your responsibilities and our responsibilities in doing this tax return.
Date Signed*

MonthDayYear
Date
Taxpayer Signature*

Clear
Date Signed

MonthDayYear
Date
Spouse Signature

Clear

My Products

DEPOSITTHIS DEPOSIT GO TOWARDS YOUR FINAL PAYMENT | ESTE DEPOSITO CONTARA PARA SU PAGO FINAL

$25.00

Total

$0.00

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