5 Starr Tax Professionals

Thank you for allowing us to prepare your tax return. It is important you provide ALL Information requested in this form to help our qualified staff in completing your 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*

Tax Payer Information*

First NameLast Name

Date of Birth*

SSN/ITIN*

Occupation

Email*

US Citizen*

YesNo

Legally Blind*

YesNo

Permanently Disabled*

YesNo

Are you legally married?*

YesNo

Spouse Information*

First NameLast Name

Date of Birth*

SSN/ITIN*

Occupation

US Citizen*

YesNo

Legally Blind*

YesNo

Permanently Disabled*

YesNo

Address*

Street Address

#Apt

CityState

Zip Code

Home/Primary Phone*

By submitting this form, you agree to receive text messages from 5 Starr Tax Professionals

Email*

example@example.com

Do you receive government assistance?*

YesNo

List the type of assistance you receive *

FOOD STAMPS, SSI, SECTION 8 ETC

Do you have dependents?*

YesNo

How many dependents are you claiming?*

123+

Dependent 1 relationship*

Son, Daughter, Sister, etc.

Name and info of dependent 1*

First NameLast Name

Date of Birth*

Social Security #*

Months living with you?*

Dependent 2 relationship*

Son, Daughter, Sister, etc.

Name and info of dependent 2*

First NameLast Name

Date of Birth*

Social Security #*

Months living with you?*

Dependent 3 relationship*

Son, Daughter, Sister, etc.

Name and info of dependent 3*

First NameLast Name

Date of Birth*

Social Security #*

Months living with you?*

Please list additional dependents

Did you or anyone on this tax return attend college?*

YesNo

Please list who all attended college*

Does anyone attend daycare/aftercare?*

YesNo

Please list who all attended daycare*

	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 through 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?
Have you verified birthday information entered on the return?
Did you/spouse provide over 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 the taxpayer and lived in the home for a full year?
-Under 19 and younger than you or your spouse?
-Full-time student age 19-24?
-Disabled and can you provide proof?
*Are you claiming a brother, sister, niece, nephew, grandchild, or parent?
Did the parents of the dependent also live in the household?

Please respond according to the previous question.

	Type
-If no, what is the reason for the absence?
-If yes, did they 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

Do you confirm that all the answers provided above are accurate, correct, and complete to the best of your knowledge?*

YesNo

Are you self-employed?*

YesNo

Who owns/operates this business?*

Name of Business*

Business EIN #

Business Description*

Total Revenue*

(Before Expenses)

	AMOUNTS
Advertising
Bad Debts
Commissions Paid
Fees Paid
Depletion
Depreciation/Section 179
Insurance (other than health)
Mortgage
Other Interest
License
Professional Services
Payments Legal Services
Office Expenses
Phones
Business Line
Cellular
Pager
Rent
Vehicle
Machinery
Equipment
Other Business Rent
Supplies
Taxes
Real Estate
Personal Property
Employee
Other
Travel
Meals/Entertainment
(enter total, 50% deductable)
Wages
Pension and Profit Sharing

	AMOUNTS
Cost of Goods Sold
Beginning Inventory
Purchases
Personal Use Total
Ending Inventory
Equipment Purchased or Sold (List)
Car Expenses
Mileage
Commuting
Other
Actual Expenses
Costs of Gas
Oil
Tires
Repairs
Tolls/Parking

Upload Documents FLYERS, BANK STATEMENTS, LEDGERS, RECEIPTS, ETC

Do you confirm that the income and expenses listed were received within the current tax year?*

YesNo

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.

How would you like your IRS refund?*

CheckDirect DepositFast MoneyCard

Bank Name

9-Digit Routing Number

Bank Account Number

Account Type

CheckingSavings

Are you a new client?*

YesNo

How did you hear about us?*

Refered by Who?*

UPLOAD ALL W2'S, 1099'S, SOCIAL SECURITY CARDS, BIRTH CERTIFICATES, IDENTIFICATION, CHILDCARE FORMS, AND COLLEGE 1098-T ALONG WITH ANY SUPPORTING DOCUMENTS YOU MAY HAVE HERE

Signature*

Date*

Date

Spouse Signature*

Date*

Date

(optional)

CLIENT INTAKE FORM

Thank you for allowing us to prepare your tax return. It is important you provide ALL Information requested in this form to help our qualified staff in completing your return. If you have any questions, please ask, you will need your:

Filling status

Part 1: Your Personal Information

Part 2: Dependent Information

Part 3: EITC Questionnaire

Part 4: Self Employment

Part 5: Bank Information

Part 6: Additional Information

Part 7: Document Upload

TaxPayer Notes