2023 BMS Tax Prepartion Season Client Intake Form

2023 BMS Tax Preparation Client Intake Form

READ FIRST: Please complete this form in its ENTIRETY and click SUBMIT when finished. Upload all documents at the end of the form. Please wait until you have ALL of your documents before submitting this form. Note: If you are claiming any dependents, be sure to upload their SS CARDS, BIRTH CERTIFICATES, and all items that show their address is the same as yours. (e.g. school records, medical records, doctor bills, Medicaid Statement, Social Services Records, or anything that shows your child's name and current address).
Which tax years are you requesting filed? (The IRS has 10 years to collect or pay out on case files. The IRS will only pay out on the the most recent 3 years).
Did you Buy or Trade any Crypto Currency last tax year? ex.(Bitcoin)
Do you owe the IRS, Child Support or in default with student loans?
If you are filing multiple years you must complete a separate form for each year.
What type of return are you requesting prepared?

PersonalBusinessNon-Profit
Taxpayer's Passport/ ID/ Driver's License/State ID **

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Taxpayer's and Dependent(s) Social Security Card(s)

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w2/ 1099/ other Income form(s)

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IPPIN Identity Theft# (If Applicable)

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1099 Unemployment Taxpayer/Spouse form(s)

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Form 1098-T (School Credit)

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1098 Mortgage Interest Statement

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Upload Any Misc. Documents

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Upload a copy of your daycare form here.

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Dependent(s) Birth Certificate(s)

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Proof of Residency For Claiming Head of Household /(Lease/Utility Bill )

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PLEASE UPLOAD YOUR 1095A IF APPLICABLE (Proof of Insurance from the marketplace).

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File Upload of your last season's tax return (2022)(If you are a new client)

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Filing Status

SingleHead of HouseholdMarried Filing SeparateMarried Filing JointQualifying WidowerOther
Did you live in multiple states during the year?

Taxpayer Information
Name*

First NameLast Name
Age
Date of Birth*

MonthDayYear
Date
Phone Number*
Please enter a valid phone number.
Email*
example@example.com
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Occupation*
SSN*
Are you a full-time student?*

YesNo
Are you totally and permanently disabled?*

YesNo
Are you legally blind?*

YesNo
Is this taxpayer dependent may be claimed by another taxpayer?*

YesNo

Spouse Information
Name

First NameLast Name
Age
Date of Birth

MonthDayYear
Date
Phone Number
Please enter a valid phone number.
Email
example@example.com
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Occupation
Are you a full-time student?

YesNo
Are you totally and permanently disabled?

YesNo
Are you legally blind?

YesNo
Is this individual dependent of other?

YesNo

Dependents

Enter your dependents here

	Name	SSN	Date of Birth	Relationship
1
2
3
4
5
6

Do you, your spouse (if any), and your dependent(s) (if any) have health insurance within 12 months last year? If yes, who offered coverage for it?

	Yes/No	Employer	Spouse Ins	Exchange/ Marketplace	Direct with Insurer	Medicare	Medicaid
Taxpayer
Spouse
Dependent 1
Dependent 2
Dependent 3
Dependent 4
Dependent 5

Expenses
Please fill in your expense information below within the current year you are filing 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

Total Expenses
Are you a Zelle® income receiver? No reason to have fear. Read the article below: https://www.zellepay.com/faq/does-zelle-report-how-much-money-i-receive-irs
Additional comments
How did you hear about us?*
Who are you working with or referred you to us?*
Are you interested in Credit Repair?
Are you interested in business credit without personally guaranteeing any unsecured loan?
Do you need a real estate mortgage?
What type of mortgage do you believe you need?
If someone referred you, please type his or her name here.
If you have any questions or concerns, Comment below:
If you made it this far Great!!! As a Bonus choose a FREE GIFT CERTIFICATE from Aj!!!
*For my clients who refer 10 friens

Acknowledgment & Signature
I attest that all information I entered here is accurate and true to the best of my knowledge. I allow Aj Brown & Associates LLC and its subsidiaries to capture my sensitive data i.e. personal information, government id, social security number(s) (SSN), and other personal and financial information. I have read and agree to the terms and conditions and privacy policy of Aj Brown & Associates LLC. By signing below, you acknowledge that you have read and understood your responsibilities and our responsibilities in requesting your tax return to be processed for compliance. For any questions call corporate offices at (754) 253-0803.
Date Signed*

MonthDayYear
Date
Taxpayer Signature*

Clear
Date Signed

MonthDayYear
Date
Spouse Signature (If Applicable)

Clear
Please verify that you are human*
Should be Empty:

2023 BMS Tax Preparation Client Intake Form

If you are filing multiple years you must complete a separate form for each year.