Client Intake 2024

Client Intake
Please Select Your Filing Status*

SingleHead of HouseholdMarried Filing JointlyMarried Filing SeperatelyQualifying Widow/er
Taxpayer Legal Name*
Date of Birth*

MonthDayYear
Date
Drivers license *

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Social Security Number*
Social Security Card

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Mailing address*
Occupation*
Phone Number*
Email Address*
example@example.com
Spouse Name
Date of Birth

MonthDayYear
Date
Spouse Drivers License

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Social Security Number
Spouse Social Security Card

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Mail address
Occupation
Spouse Phone Number
Email Address
example@example.com
How did you hear about us?*
Loyalty Taxes
Dependents
First Dependents Legal Name
Dependent Birthday
Dependent Social Security
How many months did this person live in your home?
What is the relationship of this person to you?
Second Dependents Name
Second Dependents Birthday
Second Dependents Social Security
How many months did this person live in the home?
What is this persons relationship to you?
Third Dependents Name
Third Dependents Birthday
Third Dependents Social Security
How many months did this child live in the home?
What is your relationship
Fourth Dependents Name
Fourth Dependents Birthday
Fourth Dependents Social Security
How many months did this person live in the home?
What is this persons relationship to you?
Fifth Dependents Name
Fifth Dependents Birthday
Fifth Dependents Social Security
How many months did this person live in the home?
What is this persons relationship to you?
Dependent Social Security Card

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Information
If you are not the child's biological parent, why are you claiming the child?*
Do you have custodial rights to the child?*
Can you provide documentation to prove that you paid over 50% of the expenses for the home?*
Can you provide documentation proving this child lived with you over half the year if audited by the IRS?*
Have any credits been disallowed from the IRS?*
Child and Dependent Daycare Expense
Name of childcare provider_
How much did you pay?
Daycare EIN or identifying number_
Childcare Document

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Attach all documents that can be used to assist your tax preparer with the preparation of your tax return
Wages and salaries (Attach W2's)

Interest Income (Attach 1099)

List and Identify as Non-Taxable Interest received from "Seller Financed" Mortgage Dividend Income (Attach 1099)

Capital Gains & Loss Other Gains and Losses (Business Rental, Farm Assets)

Pensions, IRA distributions, annuities, and rollovers Rent, Royalties, Partnerships, S Corporations, Estates & Trusts

Social Security Benefits Received (Attach annual statement) Unemployment Compensation

State & local Refunds Other income

Self-Employment

Household Employee
Income Documents*

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Loyalty Taxes
Taxpayers State Driver's License was Issued*
Taxpayers Date Driver's License was issued*

MonthDayYear
Date
Taxpayers License Expiration Date*

MonthDayYear
Date
Spouses State Driver's License was Issued
Spouses Date Driver's License was issued

MonthDayYear
Date
Spouses License Expiration Date

MonthDayYear
Date
Check method that you prefer your return (Checks can be picked up at office or sent via mail) Direct Deposit

Direct Deposit info (Attach voided check)
Banking Institution*
Account Type*
Account Number*
Routing Number_*
Cancelled Check for Direct Deposit

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Questions to help us assist you better
Is this your first year filing your taxes with Loyalty Taxes & Financial Services?*

YesNo
2) Did your marital status change during the year?*
3) Did you have Marketplace Health Insurance (Obamacare ACA) this year? (Should have form 1095 A)*
4) Did you attend College or university last year? (Form 1098 T)*
6) Do you owe from previous years? If so, which years?*
7) Do you have a self employment business that should be included on your return?*
8) Did you adopt a child?*
10) Have you purchased energy efficient items for your home?*
If so, what?
11) Have you won money gambling?*
12) Do you have a Health Savings Account?*
13) Do you pay interest on student loans?*
14) Have you received another estimate?*
15) Did you file TurboTax last year?*
Who did you use?*
16) Do you use a specific Tax Preparer here at Loyalty?*
17) At anytime did you: (a) receive (as a reward, award or compensation); or (b) sell, exchange, gift, or otherwise dispose of a digital asset (or a financial interest in a digital asset)?*
Did you own or control a foreign bank account, trust or financial asset in 2023?*

YesNo
1. Health Insurance Yearly.
2. Copays/ Deductibles/ Doctor Bills
3. Prescriptions
4. Glasses/Contacts,
5. X Rays/Lab work/etc,
6. Nursing Help
7. Hospital Care (Including meals and lodging)
8. Medical Aids (hearing aids, crutches, wheelchairs, etc.)
9. Medical miles driven before 6/ 30
11. Other medical expenses
Medical Bills

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1. Mortgage interest Please included 1098 form
2. Taxes you have paid in the year filing.
Form 1098

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CHARITY
Who did you give it to?
Reasonable value of property on the day you donated it.
2. Non cash gifts to charity: Description of donated items. Cost or other basis of property. Reasonable value of property on the day you donated it.
Please provide receipt of donation.
Donation Receipts

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Casualty/Theft Description
Complete to the best of your ability

Attach Schedule C form and other support documents

Social media, flyers, business cards, etc.

A person or company paid to assist you Mortgage, Loans, credit cards, etc. Training, conference, mentors, lawyers, etc.

Software, postage, email, internet, and any operating expenses

Vehicles, machinery, equipment, electronics, accessories, etc. Objects used to operate your business

We will supply a document for you to input your profit loss information into for us to input into the software easier if you do not have a formatted profit/loss document. 1. Can you provide bank statements if asked by the IRS to substantiate business expenses?
1. Can you provide bank statements if asked by the IRS to substantiate business expenses?
2. Do you keep business and personal expenses separated?
3. Do you keep a mileage log?
4. Do you keep copies of receipts and invoices?
5. How long have you owned your business?
Should be Empty:

Client Intake

Loyalty Taxes

Dependents

Information

Loyalty Taxes

Questions to help us assist you better