Time 4 Moore 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?

General Expenses - *this section is for personal expenses only, do not include business expenses in this section if applicable

	Primary Taxpayer	Spouse
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

REFUND OPTIONS
How do you want to receive your federal refund?

Direct DepositPaper check
Bank Name
Routing number
Account number
How do you want to receive your state refund (if applicable)?

Direct DepositPaper check
Bank Name
Routing number
Account number

Acknowledgment & Signature
- I confirmed that all information I entered here is accurate and true.
- I allow Time 4 Moore 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 Time 4 Moore LLC.
- I certify that I'm entitled to a tax refund and if for any reason my tax refund is denied or offset, I agree to pay Time 4 Moore LLC for my tax preparation and electronic submission to the IRS within 30 days.
- By signing below, you acknowledge that you have read and understood your responsibilities and our responsibilities in doing this tax return.
File Upload - Feel free to upload all of your documents here.

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Date Signed

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Taxpayer Signature

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Date Signed

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Date
Spouse Signature

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