Client Intake Form 2021
  • CLIENT INTAKE FORM

    PLEASE FILL OUT ALL INFORMATION APPLICABLE
  • Date of Birth*
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  • Format: (000) 000-0000.
  • Date of Birth
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  • Format: (000) 000-0000.
  • Filing Status:*
  • HEAD OF HOUSEHOLD FILERS MUST PRESENT ONE OF THE FOLLOWING TO FILE THIS STATUS. PICK ONE OF THE 3 OPTIONS THAT YOU WILL SUBMIT TO BE APPROVED TO FILE HEAD OF HOUSEHOLD.
  • Date of Birth
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  • Date of Birth
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  • Date of Birth
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  • IF YOU ARE CLAIMING A DEPENDENT, PLEASE ANSWER THE QUESTIONS BELOW THAT PERTAINS TO YOUR DEPENDENT RELATIONSHIP. PER THE IRS REQUEST, WE MUST PROVE THAT NOBODY ELSE IS ELIGIBLE TO CLAIM YOUR DEPENDENT BUT YOURSELF.

  • Did you pay someone to watch your child/children?
  • Did you collect social security or retirement income?
  • Did you purchase health insurance through healthcare.gov marketplace (Obama Care)?*
  • If yes, did you receive a 1095-A Form from the marketplace?
  • Were you ever disallowed the E.I.T.C prior to this year?*
  • Did you receive unemployment compensation (1099-G) regular or PUA last year?*
  • If yes, did you receive regular unemployment or PUA?
  • Did you make college tuition payments and received a 1098-T Form last year?*
  • Do you have any other income than your w-2(s)?*
  • Do you owe any delinquent:*
  • How would you like to receive your refund?*
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  • I, hereby, state that all the information above is true to the best of my knowledge and that I am allowing Money Tree Tax to prepare my taxes based on that fact. I understand that I am financially responsible for any outstanding balance due to any false information given.

    If there is a balance due, you must pay the tax preparation fee upfront. If for any reason you owe an entity and they take the entire refund, you are STILL responsible to pay the tax preparation fee for services rendered. 

    *For any reason an amendment has to be filed with no fault of the tax preparer, an upfront fee of $200.00 is required! Please view your tax return, which is emailed to you (it is sent prior to submission). Any copy after the first copy is a fee of $15.00.

     ALL FEES (bank and service fees) are found in the return and are non-refundable nor negotiable! NO EXCEPTIONS TO THIS!!

    Please utilize www.irs.gov for all federal refund tracking. Please utilze your state Department of Revenue site for any State Refund tracking. Do NOT add the amounts together. Federal taxes are federal,  and state taxes are state when tracking your status. Please allow 8 weeks to surpass from the date of submission before calling the IRS, if you have any tracking questions. 

    For any direct assistance please email moneytreetaxbr@gmail.com

    IRS Contact 800-829-1040

     

    Please click this link to check your federal refund status. You will need your filing status, social security number, and the total amount of the refund before fees

    https://sa.www4.irs.gov/irfof/lang/en/irfofgetstatus.jsp 

    •                  CONSENT TO USE OF TAX RETURN INFORMATION
                                                 Consent
      Federal law requires this consent form be provided to you. Unless authorized by law, we cannot
      use your tax return information for purposes other than the preparation and filing of your tax
      return without your consent.
      You are not required to complete this form. If we obtain your signature on this form by
      conditioning our tax return preparation services on your consent, your consent will not be valid.
      Your consent is valid for the amount of time that you specify. If you do not specify the duration
      of your consent, your consent is valid for one year.
      Taxpayer hereby consents to the use by (name of accounting firm/preparer) of any and all tax
      return information contained in the taxpayer’s federal income tax returns (Forms 1040, 1040NR,
      1040A, 1040EZ, etc. and supporting schedules) for the purpose of mailing, including electronic
      transmission, to the taxpayer information pertaining to:
    • Newsletters of accounting firm/preparer
    • Newsletters of affiliated financial planning firm to the accounting firm/preparer
    • Press releases and published articles of accounting firm/preparer
    • Upcoming seminars, webinars, and webcasts
    • Accounting firm/preparer promotion or hire announcements                                                                                                                                               The tax information may not be disclosed or used by (name of accounting firm/preparer) for any
      purpose other than that permitted by this consent document.
      This consent will be valid for a period of three years beginning on date this consent is signed by tax payer.

      If you believe your tax return information has been disclosed or used improperly in a mannerunauthorized by law or without your permission, you may contact the Treasury InspectorGeneral for Tax Administration (TIGTA) by telephone at 1-800-366-4484 by email at
      complaints@tigta.treas.gov.
  • Date
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  • Date
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  • Federal law requires this consent form be provided to you. Unless authorized by law, we cannot disclose your tax return information to third parties for purposes other than those related to the preparation and filing of your tax return without your consent. If you consent to the disclosure of
    your tax return information, Federal law may not protect your tax return information from further use or distribution.
    You are not required to complete this form. Because our ability to disclose your tax return information to another tax return preparer affects the tax return preparation service(s) that we provide to you and its (their) cost, we may decline to provide you with tax preparation services or change the terms (including the cost) of the tax preparation services that we provide to you if
    you do not sign this form. If you agree to the disclosure of your tax return information, your consent is valid for the amount of time that you specify. If you do not specify the duration of your consent, your consent is valid for one year from the date of signature. This consent to disclose may result in your tax return information being disclosed to a tax return preparer located outside the United States, including your personally identifiable information such as your Social Security Number (“SSN”). Both the tax return preparer in the United States that will disclose your SSN and the tax return preparer located outside the United States that will receive your SSN maintain an adequate data protection safeguard (as required by the
    regulations under 26 U.S.C. Section 7216) to protect privacy and prevent unauthorized access of tax return information. If you consent to the disclosure of your tax return information, Federal agencies may not be able to enforce U.S. laws that protect the privacy of your tax return information against a tax return preparer located outside of the U.S. to which the information is disclosed.
    If you (and your spouse) agree to allow Money Tree Tax Bookkeeping and Financial Service (U.S. based firm) to disclose your tax return
    information, including your SSN, to the foreign entity or entities listed below for purposes of providing assistance in the preparation of your individual tax return, please check the box below, provide the information requested, sign and date your consent to the disclosure of your tax return information.


    I (We) authorize Money Tree Tax Bookkeeping and Financial Service to disclose my (our) tax return information including my (our) SSN(s) to allow Money Tree Tax Bookkeeping and Financial Service to in providing me (us) with tax return
    preparation services.

    If you believe your tax return information has been disclosed or used improperly in a manner unauthorized by law or without your permission, you may contact the Treasury Inspector General for Tax Administration (TIGTA) by telephone at 1-800-366-4484, or by e-mail at
    complaints@tigta.treas.gov.

  • Date
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  • Refund Offset Consent

    The Treasury Offset Program (TOP) collects past-due (delinquent) debts (for example, child support payments) that people owe to state and federal agencies. TOP matches people and businesses who owe delinquent debts with money that federal agencies are paying (for example, a tax refund). Calling this number without your consent is illegal. By signing below you are giving any staff at Money Tree Tax the consent to call the TOP number to verify any debt (if any) using your personal information.

  • Child/ Dependent Care (Form 2441)

    This form is for children under the age of 13 years old that was cared for by a person or a facility. Also for a person who is permanently disabled that received care from and individual or facility
  • Date
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  • Child/ Dependent Care (Form 2441)

    This form is for children under the age of 13 years old that was cared for by a person or a facility. Also for a person who is permanently disabled that received care from and individual or facility
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