2023 Tax Client Intake Form

Tax Payer Name*

First NameLast Name

Spouse Name*

First NameLast Name

Tax Payer SSN

Spouse SSN

Tax Payer Occupation

Spouse Occupation

E-MAIL

Tax Payer Phone Number

Area CodePhone Number

Spouse Phone Number

Area CodePhone Number

Tax Payer Date of Birth

Date

Spouse Date of Birth

Date

Are you new to our firm?

YesNo

Tax Payer Address

Street Address

County

CityState / Province

Postal / Zip Code

Spouse Address (Enter "SAME" if same as Tax Payer Address)

Street Address

County

CityState / Province

Postal / Zip Code

Was this your address all of 2023? If no, please enter previous address

Tax Payer Phone Number

Area CodePhone Number

Spouse Phone Number

Area CodePhone Number

Tax Payer Driver's License Information

Spouse Driver's License Information

Marital Status at 12/31/2023

Were you divorced or separated during the year?

YesNo

Have you received any notices from the IRS or state revenue department within the past year?

YesNo

Do you owe student loans that are in default status?

YesNoUnknownOther

Dependent 1

Dependent 2

Dependent 3

Dependent 4

Did any of the children have income above $1,050 for the 2023 tax year?

YesNo

Do any of the children have a disability

YesNo

Is it anticipated that a different taxpayer will seek to claim a child listed above as their dependent for tax year 2023?

YesNo

Other Dependent or person who lived with you

If you are due a refund, would you like it directly deposited into your bank?

Lifestyle and Taxes- Select all that apply

Children and Education- Select all that apply

Investments- Select all that apply

Deductions- Select all that apply

Business- Select all that apply

State of residence during 2023 and dates

School District

Do you rent or own your home

RentOwn

Self-Employed Income

Method used for calculating self-employed income

List Self-Employed expenses with amounts for 2022- If business is home based, please include amount of rent and utilities. If vehicle used for business purposes, please include amount of car note, insurance, maintenance and any repairs.

If you need to itemize deductions, please provide amounts and/or receipts to your Tax Specialist. These amounts can include, but are not limited to, Medical Expenses, Taxes Paid, Interest Paid, Charitable Contributions, Casualty and Theft Losses and other Miscellaneous Itemized Deductions.

Please provide to your Tax Specialist all forms W2, 1099-INT, 1099-DIV, 1099-R, 1099-MISC, and other income reporting statements.

PRIVACY POLICY

The nature of our work requires us to collect certain nonpublic information. We collect financial and persoanl information from applications, worksheets, reporting statements, and other forms, as well as interviews and conversations with our clients and affiliates. We mat also review banking and credit card information about our clients int he performance of receipt of payment. Under our policy, all information we obtain about you will be provided by you or obtained with your permission.

Our firm has procedures and policies in pklace to protect your confidential information. We restrict access to your confidential information to those within our firm who need to know in order to provide you with services. We will not disclose your personal information to a third party without your permission, except where required by law. We maintain physical, electronic, and procedural safeguards in compliance with federal regulations that protect your personal infromation from unauthorized access

Please upload documents below:

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I agree that all information provided is true and factual. I understand that falsifying information is against the law. I agree that upon completion of my tax return, if my return is intercepted and not paid, I am responsible for all preparation fees to be paid to my Tax Specialist*

I AgreeI Disagree

HAVE YOU UPLOADED ALL DOCUMENTS NEEDED TO FILE YOUR RETURN

Date

Signature