CLIENT INTAKE

TAX PREPARATION INTAKE FORM
Name

First NameLast Name
Current Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
DATE OF BIRTH

MonthDayYear
Date
Social Security Number
YEAR OF TAX PREP
NEW OR RETURNING CLIENT
FILING STATUS
Select Filing Status
FILING STATUS WILL BE ULTIMATELY DETERMINED BY INFORMATION GIVEN AND TAX PREPARERS DISCRETION
Number of Dependents
TAXPAYER

ENTER IN YOUR INFORMATION
Occupation
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Email
example@example.com
Upload Driver's License or State Id

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TAXPAYER IP PIN (issued from IRS yearly)
SPOUSE

YOUR SPOUSES INFORMATION, IF LEGALLY MARRIED OR PRESUMED MARRIED BY COMMON LAW STATUTE IN THE STATE YOU RESIDE IN
Name

First NameLast Name
Date Of Birth

MonthDayYear
Date
Social Security Number
Occupation
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Email
example@example.com
Spouse's Driver's License or State Id

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SPOUSE IP PIN (issued from IRS yearly)

CHILDCARE INFORMATION
CHILDCARE PROVIDER 1 NAME
CHILDCARE PROVIDER 1 SSN OR EIN
AMOUNT PAID FOR CHILDCARE
WHICH CHILD(REN) RECIEVED CHILDCARE?
CHILDCARE PROVIDER ADDRESS

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
HIGHER EDUCATION

COLLEGE AND TUITION INFORMATION
UPLOAD SCHOOL TAX FORM(S) (1098-T)

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HAVE YOU CLAIMED THE AMERICAN OPPORTUNITY EDUCATION CREDIT IN THE PAST?
UPLOAD STUDENT LOAN INTEREST FORM (1098-E)

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ITEMIZED DEDUCTIONS
MEDICAL
OUT OF POCKET MEDICAL EXPENSES
TAXES PAID BY YOU
STATE AND LOCAL TAXES OR GENERAL SALES TAX PAID
STATE AND LOCAL REAL ESTATE TAX
STATE AND LOCAL PERSONAL PROPERTY TAXES
ANY OTHER STATE AND LOCAL TAXES PAID
INTEREST YOU PAID
HOME MORTGAGE INTEREST YOU PAID
UPLOAD YOU 1098-MORTGAGE STATEMENT

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GIFTS TO CHARITY
CHARITY 1 NAME AND AMOUNT DONATED
CHARITY 2 NAME AND AMOUNT DONATED
CHARITABLE CONTRIBUTION DOCUMENTS

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SOLAR POWER EXPENSES
ENERGY/ SOLAR POWER COST
UPLOAD PROOF/ DOCUMENTS FOR ENERGY/ SOLAR POWER COST

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UNEMPLOYMENT
DID YOU RECIEVE ANY UNEMPLOYMENT OR PAY ANY UNEMPLOYMENT OVERPAYMENTS BACK?
UPLOAD ANY UNEMPLOYMENT DOCUMENTS RECIEVED

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MISC.
US Vacation Destination
Who Referred you? (Get $25 off Prep Fee)
REFUND DISBURSEMENT
How would you like to receive your refund?
BANK NAME
ROUTING NUMBER
ACCOUNT NUMBER
Would you like to apply for the REFUND Advance? (January 2-March 15, 2023)
I HAVE BEEN ADVISED THAT ONLY ONE PERSON PER ADDRESS CAN CLAIM THE HEAD OF HOUSEHOLD STATUS.
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I UNDERSTAND THAT HEAD OF HOUSEHOLD STATUS MEANS THAT 1.) you are unmarried or considered on the last day of the year. 2.) You paid more than half the cost of keeping up a home for the year. 3.) A qualifying person lived with you in the home for more than half the year (except for tempory absenses such as school).

Howeever, if the qualifying person is your depedent parent, he or she doesn't have to live with you. (See Special rule for parent, later, under Qualifying person). --IRS PUBLICATION 501
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HAVE BEEN ADVISED that the Special rule for parents and the HEAD OF HOUSEHOLD STAUS

are as follows:

If your qualifying person is your father or mother, you may be elgible to file as head of house hold even if your father or mother doesn't live with you. However, you must be able to claim an exemption for your father or mother. ALSO, you must pay more than half the cost of keeping up a home that was the main home for the entire year for your father or mother. If you pay more than half the cost of keeping your parent ina rest home or home for the elderly, that counts as paying more than half the cost of keeping up your parent's main home. --IRS PUBLICATION 501
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I UNDERSTAND THAT IF I AM AUDITED & MY HEAD OF HOUSEHOLD STATUS IS CHALLENGED, I WILL NEED TO PROVIDE THE FOLLOWING ITEMS: rent receipts, utility bills, grocery receipts, upkeep and repair bills, property insurance statement, and other household bills, -IRS FORMS 886-H-HOH.
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By completing this intake form you agree that:

The information provided is true and accurate to your knowledge.

I understand that IF I AM DUE A REFUND AND MY REFUND IS INTERCEPTED IN ANYWAY I STILL OWE OSE TAX, OSE TAX & ACCOUNTING PROFESSIONALS, LLC AND/OR OSE TAX FINANCIAL SERVICES, LLC FOR THEIR PREPARATION FEES. The taking or reduction of my tax refund from any government body DOES NOT EXEMPT ME FROM PAYING THE FULL AMOUNT OF THE TAX PREPARATION SERVICES THAT I HAVE RECEIVED.

I understand that if after 30 days my refund has not been released from the IRS, OSE Tax, OSE Tax & Accounting Professionals, LLC & OSE Tax & Financial Services will begin collection activities on my account. After 30 days, payment is considered past due, and will be subject to a $50.00 late fee. The entire balance includes all related late & collection fees as well as any other fees incurred. OSE Tax, OSE Tax & Accounting Professionals, LLC & OSE Tax & Financial Services charges a 10% interest rate on past invoices compounded monthly. Checks returned for nonsufficient funds are subject to a $50.00 fee. If court action is required, court fees, attorney fees, and a $105.00 collection fee will be added to the total amount owed to OSE TAX, OSE Tax & Accounting Professionals, LLC. & OSE Tax & Financial Services, LLC.
Signature
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