A Tax Office Intake 2022

Please submit all documents at the same time as this portal will not let you go back and add information. 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 in natural light before proceeding. If you are not sure what you may need please refer to our what you need client check list here

How did you hear about us?

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

First NameLast Name

Are you a returning client*

YesNo

Who would you like to prepare your taxes?

Tax Payers Name*

First NameLast 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*

Upload Taxpayer's Identification*

Browse to add files or take picture and upload

Upload Taxpayer's SSN Card

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Spouse's Name

First NameLast 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

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

CityState / Province

Postal / Zip Code

What is Your Filing Status?

Are you self employed?*

YesNo

How many dependents are you claiming?*

Dependent #1

First NameLast 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 NameLast 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 NameLast 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.)?

Did you receive any Advance Child Tax Credits? If so Upload/ take a picture of your 6419.

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Are there any dependents in daycare?*

YesNo

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

CityState / 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?*

YesNo

Did you have insurance through the Market Place in 2021*

YesNo

If so, upload 1095-A

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Did you trade any Virtual Currency*

YesNo

Were you or any of your dependents in college in 2021?*

YesNo

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

YesNo

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

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Did you receive any letters from the IRS?*

YesNo

Do you owe the IRS?*

YesNo

Did you withdraw from your 401K?*

YesNo

If yes, upload your 1099-R form

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Did You Collect Unemployment?*

YesNo

If yes, upload your related unemployment documents

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Do you have W2's*

YesNo

If yes how many

Upload W2's here

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Do you have Social Security*

YesNo

If Yes, Upload 1099-SSA form

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Do you have rental property?*

YesNo

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 third stimulus?*

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

YesNo

Enter Number for Tax Payer

Enter Number for Tax Payer's Spouse

How would you like to receive your tax refund?

CheckDirect DepositE-1-Debit Card

Name of Bank (For Direct Deposit Only)

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

Checking AccountSavings 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 A Tax Office, 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 A TAX OFFICE, INC REQUIRES ALL FEES PAID AT THE TIME OF SERVICE.

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 A Tax Office INC. to prepare my or our tax return can be substantiated by receipts, canceled checks and other documentations. This information provided to A Tax Office Inc. 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 A Tax Office INC 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 A Tax Office Inc. 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 A Tax Office Inc. and my or we and that I must submit written authorization to A Tax Office Inc. 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 am giving A Tax Office 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 A Tax Office For You and/or associated affiliates hold no responsibility for any misrepresentation or false claims.

*

I Acknowledge

Primary Taxpayer's Signature*

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

Date

CLIENT INTAKE FORM