Tax Genius Tax Intake

THE TAX GENIUS
To make this a smooth process for you in completing our secure client intake form scan or take clear pictures of all of your documents before proceeding.

How did you hear about us?

Social Media Referral Google Walk By Mailer

If someone referred you, please type in his or her name

First Name Last Name

Are you a returning client *

Yes No

Who would you like to prepare your taxes?

Tax Payers Name *

First Name Last Name

Taxpayer's Phone Number *

Example: xxx-xxx-xxxx

Taxpayer's Job Title

Taxpayer's Date of Birth *

Example: 01/01/2001

Taxpayer's SSN *

Example: xxx-xx-xxxx

Taxpayer's Email Address *

example@example.com

Upload Taxpayer's Identification *

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Upload Taxpayer's SSN Card

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Spouse's Name

First Name Last Name

Spouse's SSN

Example: xxx-xx-xxxx

Spouse's Phone Number

Example: xxx-xxx-xxxx

Spouse's Date of Birth

Example: 01/01/2001

Spouse's Email Address

Example: example@example.com

Spouse's Job Title

example@example.com

Upload Spouse's Identification

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Upload Spouse's SSN Card

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Home Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code

What is Your Filing Status?

Are you self employed? *

Yes No

How many dependents are you claiming? *

Dependent #1

First Name Last Name

Dependent #1 Date of Birth

01/01/2001

Dependent #1 SSN

What is Dependent #1's Relationship to you (son, daughter, etc.)?

Dependent #2

First Name Last Name

Dependent #2 Date of Birth

Example: 01/01/2001

Dependent #2 SSN

What is Dependent #2's Relationship to you (son, daughter, etc.)?

Dependent #3

First Name Last Name

Dependent #3's Date of Birth

01/01/2001

Dependent #3s SSN

Example: xxx-xx-xxxx

Dependent's #3 SSN

What is Dependent #3's Relationship to you (son, daughter, etc.)?

Dependent #4's First Name

First Name

Dependent #4's Last Name

Last Name

Dependent #4's Date of Birth

01/01/2001

Dependent #4's SSN

Example: xxx-xx-xxxx

What is Dependent #4's Relationship to you (son, daughter, etc.)?

Are there any dependents in daycare? *

Yes No

If yes, please upload the form you received from your daycare provider or fill in the information below.

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Name of Care Giver

Care Giver Tax ID#

Care Giver

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code

Amount Paid

Upload a copy of your daycare form here.

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Can someone else claim you as a dependent? *

Yes No

Did you have insurance through the Market Place in 2020 *

Yes No

If so, upload 1095-A

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Did you trade any Virtual Currency *

Yes No

Were you or any of your dependents in college in 2020? *

Yes No

Do you have a 1098-T Form for either you or your dependents from the college or institution for either you or your dependents? *

Yes No

If you have a 1098-T form, upload it here.

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Did you receive any letters from the IRS? *

Yes No

Do you owe the IRS? *

Yes No

Did you withdraw from your 401K? *

Yes No

If yes, upload your 1099-R form

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Did You Collect Unemployment? *

Yes No

If yes, upload your related unemployment documents

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Do you have W2's *

Yes No

If yes how many

Upload W2's here

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Do you have Social Security *

Yes No

If Yes, Upload 1099-SSA form

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Do you have rental property? *

Yes No

Upload all other documents that you may have such as, but not to to stocks, business income, rental property information,IRA, HSA, mortgage interest etc.....

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How much money did you receive for the first stimulus? *

How much did you receive for the second stimulus? *

Did you receive a 1044 letter? *

Yes No

Do you have a Personal Protection Pin from the IRS. *

Yes No

How would you like to receive your tax refund?

Check Direct Deposit E-1-Debit Card

Name of Bank (For Direct Deposit Only)

Which type of account would you like your refund deposited into?

Checking Account Savings Account

Routing Number

Bank Account Number

How would you like to pay for our services?

If you would like your fees deducted from your refund. By doing this, you are allowing The Tax Genius, Inc to check the Financial Management System (FMS) on your behalf for any outstanding debt that may be deducted from the refund due to you. If your refund is offset by the IRS, student loans, child support or your check is mailed, you are still obligated to pay our company the fees associated with filing your tax return. I choose not to have my fees deducted from my return. I choose to pay my fees at the time of service, for completion of my tax return. I understand that THE TAX GENIUS REQUIRES ALL FEES PAID AT THE TIME OF SERVICE.

I am giving The Tax Genius For You permission to prepare all forms related to my tax return; to apply for and secure RAC's and RAL's on my behalf; and sign all necessary forms and file my taxes electronically. I take full responsibility for the accuracy of this form and understand that The Tax Genius For You and/or associated affiliates hold no responsibility for any misrepresentation or false claims.

Acknowledgement

Please read the following statements and sign below. " I acknowledge that by typing or writing my name on this and the following documents, I am agreeing that all information is correct, truthful and legally binding. I or we acknowledge that the information submitted to The Tax Genius. to prepare my or our tax return can be substantiated by receipts, canceled checks and other documentations. This information provided to The Tax Genius is true, accurate and complete to the best of my or our knowledge. I or we also, understand that in the event of an audit, that I or we are responsible for gathering all necessary information for the audit. I or we also, understand that I or we may request the assistance of The Tax Genius in helping to put such information together for the IRS or NC Department of Revenue. I or we also, understand, that as a taxpayer, I or we are responsible for my or our own tax return and that I or we can’t hold The Tax Genius harmless for any misrepresentation of information. I or we may have provided to the preparer. I/we have received and read this statement of the company’s private policy and understand that I/we tax return information is kept confidential between The Tax Genius and my or we and that I must submit written authorization to The Tax Genius before any copy or fax of my return(s) information will be released to any outside party. (Example: mortgage company, financial institutions, educational institutions, etc.) *PRIVACY ACT: We reserve the right to use your contact information to email, text, call or mail you with advertisement or promotional materials.

*

I Acknowledge

Primary Taxpayer's Signature *

Clear

Spouse's Signature (If not applicable type or sign N/A) *

Clear

Date