Tax Client Intake Form

Tax Client Intake Form

Tax Preparation Client Intake Form
Filing Status*

SingleHead of HouseholdMarried Filing SeparateMarried Filing JointQualifying Widower

Name*

First NameLast Name
Age*
Date of Birth*

MonthDayYear
Date
Social Security Number*
Phone Number*
Please enter a valid phone number.Format: (000) 000-0000.
Email*
example@example.com
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Occupation*
Are you a full-time student?*

YesNo
Are you totally and permanently disabled?*

YesNo
Are you legally blind?*

YesNo
Is this individual dependent of other?*

YesNo

Name

First NameLast Name
Age
Date of Birth

MonthDayYear
Date
Social Security Number
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Email
example@example.com
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Occupation
Are you a full-time student?

YesNo
Are you totally and permanently disabled?

YesNo
Are you legally blind?

YesNo
Is this individual dependent of other?

YesNo

Enter your dependents here

Rows	Name	Date of Birth	Relationship	How many months dependent lived with you	Totally and permanemtly disabled
1
2
3
4
5
6

Does you, your spouse, and your dependents have health insurance within 12 months last year? If yes, who covers for it?

Rows	Yes/No	Employer	Spouse Ins	Exchange/ Marketplace	Direct with Insurer	Medicare	Medicaid
Taxpayer
Spouse
Dependent 1
Dependent 2
Dependent 3
Dependent 4
Dependent 5

Please fill-up the information within the current year only.

General Expenses

Rows	Amount
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

Total Expenses
Additional comments

- I confirmed that all information I entered here is accurate and true.
- I allow All-In Bookkeeping (AIB) to capture my sensitive data like personal id, government id, social security number (SSN), and other information.
- By signing below, you acknowledge that you have read and understood your responsibilities and our responsibilities in doing this tax return.
- Thank you for taking the time to complete our intake package. For our new clients, this information is critical to ensure an accurate filing of your tax returns. For our existing clients, while we may have some of this information from past engagements, we kindly request you provide it again so we can make sure our records are 100% accurate and up to date.
IMPORTANT: UPON COMPLETION OF ALL APPLICABLE PARTS OF THIS FORM YOU MUST CLICK THE "SUBMIT" BUTTON AT THE BOTTOM OF THE FORM TO SEND THIS INFO TO OUR OFFICE. CLOSING YOUR BROWSER BEFORE CLICKING THE "SUBMIT" BUTTON WILL DELETE ALL INFO WITHOUT SENDING TO US. IT SHOULD BE NOTED THAT UPON CLICKING THE SUBMIT BUTTON YOU WILL GET A CONFIRMATION EMAIL THAT WE RECEIVED YOUR INFO.

Please also note that to comply with federal and state identity theft protection efforts our firm will ask for a valid state issued photo identification card during your engagement meeting.
Date Signed

MonthDayYear
Date
Taxpayer Signature
Date Signed

MonthDayYear
Date
Spouse Signature
Should be Empty: