TAX FLO Client Intake Form

TAX FLO Client Intake Form

All Information Concerning Client is Secure & Confidential.
TAX FLO Tax Professionals

www.igotflo.com
It is very important you provide ALL the information requested in this form to help in completing you return. IF YOU HAVE ANY QUESTIONS, Please ask. You will need your:
- Tax Information such as Forms W-2, 1099, 1098
- Social Security cards or ITIN letters for you and all persons on your tax return.
- Proof of identity (government-issued photo ID such as driver's license, state ID, or other photo ID)
Please Select Preparer of your choice:*
How did you hear about us?

FacebookInstagramReferralReturning Client
If someone referred you, please list the name.
Filing Status

SingleHead of HouseholdQualifying Widower
Married

Married filling jointlyMarried filing separately

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?

Rows	Yes/No	Employer	Spouse Ins	Affordable Care Act (Marketplace)	Direct with Insurer	Medicare	Medicaid
Taxpayer
Spouse
Dependent 1
Dependent 2
Dependent 3
Dependent 4
Dependent 5

If you or your dependent received health insurance through the Affordable Care Act (Marketplace) Please upload your marketplace insurance 1095-A form

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Please answer accordingly.*

Rows	YES	NO
Has correct identification been provided?
Do all names on return match SS cards provided?
By your state's definition, are you LEGALLY married?
If yes, did your spouse live in your home though July or until December?
Did you/spouse receive military pay?
Can anyone claim you/spouse as a dependent?
Did you/spouse live with someone with a higher adjusted gross income?
Are you renting a room and can provide a rental agreement?
Do you have a Dependent/Qualifying child(ren)?
Have you verified birthday information entered on the return ?
Did you/spouse provide 50% of total support per ea. dependent?
Does your dependent have a valid. SS#?
- Under 19 and lived in the taxpayer's home more than one half of the year
- Under 19 and foster child of taxpayer and lived in home for full year
- Under 19 and younger than you or your spouse
- Full time student age 19- 24
- Totally disable and can provide proof
* Are you claiming a brother, sister, niece, nephew, grandchild, or parent?
Did the parents of the dependent also live in the household?

Rows	Type
- If no, what is the reason for absence?
- If yes, did the financially contribute to the household?
- If yes, is your adjusted gross income higher than that of. the parents?
How many months have the dependent lived in your household?
Can anyone else claim this dependent? Y/N

Any Notes:
(optional)
*

I understand the above questions and have answered them to the best of my abilities.

Taxpayers's Driver License/ID *

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Taxpayer and dependent(s) Social Security card(s)

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Taxpayer's W-2/1099's

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Dependent(s) Birth Certificate

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Proof of Residency / Along w/ any supporting documents you have

Lease/Rental agreement, childcare forms, Mortgage interest form 1098, Light bill
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I confirmed that all information I entered here is accurate and true and can be supported by necessary documents. I allow TAX FLO 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 TAX FLO. By signing below, you acknowledge that you have read and understood your responsibilities and our responsibilities in doing this tax return.
Were you issued an Identity Pin from the IRS?

YesNo
If so, please list your pin here.
Date Signed*

MonthDayYear
Date
Taxpayer Signature*
Date Signed

MonthDayYear
Date
Spouse Signature
Taxpayer Notes
List any additional information you think the your preparer may need
Are you self-employed? If so continue, if not upload all supporting documents and hit submit.

YesNo
TAX FLO

Sole Proprietor Information Sheet
Name

First NameLast Name
I certify that I incurred the following expenses and received the revenue for tax year
Total Revenue

Upload Documents

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Signature*
Print Name:*
EIN:
SSN if Sole Proprietor
Date*

MonthDayYear
Date
Tax Preparer Notes
Tax preparers are not allowed to give you any totals for your expenses toward your business. By signing this form, you agree that the information that has been provided by you, is true.

Information to obtain to support your expenses. Ex; receipts, bank statements, etc.
Should be Empty:

TAX FLO