Personal Information
Please complete the intake form to the best of your ability. If a question or section doesn't apply to you, kindly skip that section. Completion of this form is REQUIRED to ensure you are filing your personal and/or business income & expenses correctly. This form is also required to help make sure you are in full compliance with the IRS. Please call (682) 386 -1325 if you need assistance with completing the form.
How did you hear about Crystal Clear Tax Genie?
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Are you a new or returning tax client?
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Are you interested in a Refund Advance of up to $1,000? ( This comes with no interest and a $50 processing fee by the bank)
Please Select
yes
no
Are you submitting documents for your 2024 tax return?
Please Select
yes
no
What is the name of your preferred Tax Preparer?
Please Select
Desiree
Destiny
ANY AVAILABLE PREPARER
Filing Status
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Single
Head of Household
Married Filing Separate
Married Filing Joint
Qualifying Widower
Primary Taxpayers Name
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First Name
Last Name
Primary Taxpayers Date of Birth
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Month
-
Day
Year
Date
Primary Taxpayers Social (ssn)
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Please upload ID or Passport
*
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Please upload your ss card
*
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Address
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Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Was your main home in the U.S. for more than 6 months?
Please Select
yes
no
Best Phone Number
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-
Area Code
Phone Number
Primary Taxpayer Email
*
example@example.com
Taxpayers Occupation
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Where you, your spouse or dependent issued an IP PIN by the IRS?
Please Select
yes
no
If Yes Enter The IP PIN
Where you married as of December 31st for the year you are filing?
Please Select
yes
no
Spouses Name (if not applicable, skip)
First Name
Last Name
Spouses Date of Birth
-
Year
-
Month
Day
Date
Spouses Phone Number
Please enter a valid phone number.
Spouses Email
example@example.com
Can anyone claim you or your spouse as a dependent?
Please Select
yes
no
Are you claiming any dependent(s) this year?
Please Select
yes
no
Did you provide more than 50% care for this dependent?
Please Select
yes
no
If any dependent is disabled please enter the disabled dependents name
Do you owe any back child support?
Please Select
yes
No
If you owe child support, are you making payments?
Did any dependent(s) receive medicaid in the filing year?
Please Select
yes
No
Did the dependent receive food stamps or WIC?
Please Select
Yes
No
Enter your dependents here
Dependent Full Name
Social Security Number
Date of Birth
Relationship to you
1
2
3
4
5
6
Upload all Dependent(s) Social Security Cards
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Upload birth certificates for dependents
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Income & Deductions
This is part 2 of your client intake process. This information will help us to know what tax breaks and deductions you qualify for. Poceed to answer and upload all necessary documents that apply to you.
Did you receive a w2, 1099 MISC, 1099 INT, 1099 DIV, 1099 B, 1099 G OR 1099 S?
Please Select
W2
1099 MISC
1099 INT
1099 DIV
1099 B
1099 G
1099 S
Upload Corresponding documents
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Did you receive unemployment compensation this year?
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Yes
No
If so please upload form 1099- G
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Are you retired? Did you receive any retirement income?
Please Select
Yes im retired and received retirement income
No im not retired
If so please upload corresponding documents.
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Did you make an early withdrawal from your 401k/IRA?
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Yes
No
If so please upload corresponding documents.
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Did you receive any gambling winnings, lottery winnings, prizes or other awards?
Please Select
Yes
No
If so please upload corresponding documents.
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Did you have a home foreclosure, credit card or other debt forgiven/ cancelled?
Please Select
Yes
No
upload forgiven/cancelled debt forms.
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Did you receive healthcare from healthcare.gov or Obamacare.gov?
Please Select
Yes
No
If so you must report form 1095- A for the IRS to accept your return
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Are you self Employed?
Please Select
Yes
No
What kind of business did you own?
Business Name/ DBA
Do you have an EIN? If using an SSN the answer should be NO.
Please Select
Yes
No
Business EIN Number do not add the dash
Federal Tax classification
Sole Proprietorship
LLC
Partnership
S- Corporation
C- Corporation
Non- Profit Organization
Business Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Business Expense Organizer
Telephone/ cellular expense
Advertising
Contract Labor
Repairs & Maintenance
Utilities
Supplies
Supplies
Meals
Travel, Health Insurance
Insurance other than health
Depletion
Mortgage Interest
Other Interest
Rent or Lease of equipment
Rent or lease of property
Taxes and Licenses
Seminars & Training
Legal & Professional Services
Office Expenses
All other expenses
Friendliness
Did you use or purchase a vehicle for business use?
Please Select
Yes
No
Give make and model of vehicle
Give TOTAL Business miles driven this tax year
Give TOTAL miles driven this tax year
How much Did you pay to insure this vehicle for this year?
How much Did you pay for maintenance, repairs, car washes etc, for this year?
Business Use of Home/ Apartment
You may be able to deduct certain expenses for the part of your home that you use for business. In order to deduct these expenses, you must use an area of your home exclusively and regularly for business. If you regularly use an area of your home exclusively as an office, for inventory storage or to meet clients/ customers, you can deduct a portion of your real estate taxes, mortgage interest, rent, casualty losses, utilities, insurance, depreciation, maintenance, and repairs. You can deduct 100%vof the expenses that are related specifically to your home office, for example: painting, cleaning, or repairing your home office.
Did you use an area of your home exclusively and regularly for business?
Please Select
Yes
No
Home office Organizer
Square footage of entire home
Square footage of home office
mortgage interest
Real Estate Taxes
Rent/ Mortgage Expenses
Homeowners Insurance
Business Repairs and Maintenance
Home Office Furniture Expenses
Total amount paid for electricity this year
Total Paid For Water Bill This Year
Total Paid For Gas Bill This Year
Total paid for security this year
Total paid for internet this year
Total pain for HOA bill this year
Friendliness
Credits
Have you had Earned income credit, Child tax credit or American opportunity tax credit disallowed in a prior year?
Please Select
Yes
No
If so in what year?
Did you make any childcare or summer camp payments for dependents under 13?
Please Select
Yes
No
Daycare/ Aftercare Provider Information
Daycare/ Aftercare Provider's Name
Childcare provider's Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Childcare Provider Phone Number
Please enter a valid phone number.
Did you or anyone in your household attend a college or university this year?
Please Select
Yes
No
Upload Form 1098- T ( Tuition Statement)
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Adjustments To Income
Did you make any IRA contributions, withdrawals or rollovers?
Please Select
Yes
No
If so upload IRA contribution, withdrawal or rollover tax forms
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Did you contribute to a Health Savings Account this year?
Please Select
Yes
No
If so upload corresponding form 1099- SA from you HSA servicer
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Did you make any student loan payments?
Please Select
Yes
No
If so upload student loan interest statement form 1098- E
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Did you receive a first time home buyers credit in 2008?
Itemized Deductions
Did you pay any medical expenses?
Please Select
Yes
No
Upload corresponding documents
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Did you buy a car for personal use this year?
Did you buy or sell a home this year?
Please Select
Yes
No
If so upload closing disclosure/ HUD Statement
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Did you make any mortgage payments this year?
Please Select
Yes
No
If so upload mortgage interest statement (Form 1098)
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Did you make any charitable contributions?
Please Select
Yes
No
If so upload proof of charitable contributions
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Did you pay tithe and offering?
Please Select
Yes
No
If so upload proof of payment
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Refund and Payments
Would you like to pay your tax preparation fees upfront or out of your tax refund ( if applies)?
Upfront
Out of tax refund
If due a refund would you prefer direct deposit?
Please Select
Yes
No
Is the bank account in your name ( if not the refund will reject)
Please Select
Yes
No, Opt me for a check
Name of Bank
Routing
Accounting
Type of account your Refund will be going to
Checkings
Savings
I confirm and agree I double checked all information for any errors
Please Select
Yes, I Agree
No, I don't agree
If you have any questions that were not addressed via this questionnaire, please list them here.
To your knowledge do you owe the IRS?
No, I don't owe the IRS
Im not sure if I owe the IRS
Yes, I currently owe the IRS
Please upload any additional documents you received that questionnaire did not request
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Would you like to apply for refund advance up to $7,000 36% APR?
Please Select
Yes
No
Certification of Info Provided
*
Taxpayer Signature
*
Date Signed
*
-
Month
-
Day
Year
Date
Spouse Signature
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Submit
Should be Empty: