Tax Preparation Client Intake Form

Tax Preparation Client Intake Form
Filing Status*

SingleHead of HouseholdMarried Filing SeparateMarried Filing JointQualifying Widower

Name*

First NameLast Name
Social Security Number *
Date of Birth*

MonthDayYear
Date
Phone Number*
Please enter a valid phone number.
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Email*
example@example.com
Do you have any other income than your W-2(s)?*

YESNO
Occupation*

First NameLast Name
Social Security Number
Date of Birth

MonthDayYear
Date
Phone Number
Please enter a valid phone number.
Email
example@example.com
PLEASE READ CAREFULLY

I understand that to claim a person as a dependent, they must meet IRS requirements for relationship, age, residency, and support.

By listing a dependent below, I confirm that:

This person meets the IRS definition of a qualifying child or qualifying relative

This person lived with me for more than half of the tax year (unless an exception applies)

I provided more than half of their financial support (if rerequired)

This dependent is not being claimed by another taxpayer unless permitted by IRS rules

I understand that providing false or inaccurate information may result in denial of credits, repayment of refunds, penalties, or audits.

First NameLast Name
Social Security Number
Date of Birth

MonthDayYear
Date
Relationship

First NameLast Name
Social Security Number
Date of Birth

MonthDayYear
Date
Relationship

First NameLast Name
Social Security Number
Date of Birth

MonthDayYear
Date
Relationship

First NameLast Name
Social Security Number
Date of Birth

MonthDayYear
Date
Relationship
IF YOU ARE CLAIMING A DEPENDENT: Please answer the questions below that apply to your relationship with the dependent. As required by the IRS, we must verify that no one else is eligible to claim your dependent other than you.
If you are claiming a niece, nephew, aunt, or uncle: What is your relationship to the dependent? Where are the parents of the dependent (or dependents)?
If you are claiming a son or daughter: Where is the other parent of the dependent (or dependents)?
If you are claiming a brother or sister: What is your relationship to the dependent? Why are the parents not claiming the dependent (or dependents)?
Did you pay someone to watch your child/children?

YesNo

CHILDCARE INFORMATION

	Provider/Daycare	EIN OR SSN IF PROVIDED	ADDRESS	TOTAL QUALIFIED EXPENSES PAID
CHILDCARE INFO

Are you married?*

YesNo
Have you been married before?*

YesNo
Can you provide separation/divorce paperwork?*

YesNo
Did you collect social security or retirement income?

YesNo
Did you purchase health insurance through healthcare.gov marketplace ( Obama Care)?*

YesNo
If yes, did you receive a 1095-A Form from the marketplace?

YesNo
Were you ever disallowed the E.I.T.C prior to this year?*

YesNo
Did you receive unemployment compensation (1099-G) regular or PUA last year?*

YesNo
If yes, did you receive regular unemployment or PUA?

RegularPUA
PLEASE READ CAREFULLY

I understand that the American Opportunity Tax Credit (AOTC) has specific IRS eligibility requirements.

By requesting the AOTS, I confirm that the student listed below:
- Was enrolled at least half-time in a degree or certificate program at an eligible
- Has not completed four years of post-secondary education before the tax year
- Did not claim the AOTC for more than four tax years
- Had qualified education expenses paid during the tax year
- Was not convicted of a federal or state felony drug offense by the end of the tax year
I understand that inaccurate or incomplete information may result in denial of the credit, repayment of refunds, penalties, or IRS examination.
Did you make college tuition payments and received a 1098-T Form last year?*

YESNO

	NAME OF COLLEGE/UNIVERSITY	WERE YOU PT or FT?	How many years have you claimed the AOTC	EIN
COLLEGE INFO

Do you have an IP Pin?*

YESNO
IP PIN
Child SupportAlimonyStudent LoansBack TaxesState TaxesNone of the above

Business Name
EIN
Business Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Business Email
example@example.com
Business Phone Number
Please enter a valid phone number.
What is your business entity?

Sole ProprietorLLCNonprofitCorporation
What type of products/services do you offer?
Aprox how many clients did you service in the tax year?
What type of expenses do you have?
How much did your business make for the tax year?
What type of payments do you take?
If requested could you submit all income and expense documents?
Total business income for the tax year:
Total expenses for 2025:

How would you like to receive your refund*

Refund Transfer Direct DepositRefund Transfer Debit CardRefund Transfer Paper Check

Bank Information*

	Name of Bank	Routing Number	Account Number
Enter Bank Data

Are you currently renting?*

YesNo
How much did you pay in rent for the tax year?
Type a question
How long have you been rented this property?
# of months
Are you currently own/buying your home?*

YesNo

General Expenses

	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

I hereby state that all informastin provided above is true and accurate to the best of my knowledge. I authorize Honest and Trust Tax to prepare my tax return(s) based on the information I have supplied. I understand that I am financially responsible for any balance due resulting from false or incomplete information provided by me.

If there is a balance due, the tax preparation fee must be paid upfront. In the event that my refund is intercepted or applied to an outstanding debt owed to any entity, I understand that I am still responsible for paying the full tax preparation fee for services rendered.

If an amandment must be filed for any reason not caused by an error of the tax preparer, an upfront fee of $150.00 will be required. Please review your tax return carefully- it will be emailed to you prior to submission. Any additional copy/email reuested after the initial one will incur a $10.00 reprint/email fee.

All bank and service fees are disclosed within your return and are non-refundable and non-negotiable. No exceptions.

To track your refund:

Visit www.irs.gov for federal refunds.

Visit your state Department of Revenue website for state refunds.

Please do not combine federal and state refund amounts when tracking. Allow up to 8 weeks from the submission date before contacting the IRS regarding refund status.

IRS contact: 1-800-829-1040

To check your federal refund swtatus online, you will need your filing status, Social Security number, and the total refund amount before fees.

https://sa.www4.irs.gov/irfof/lang/en/irfofgetstatus.jsp
Identification*

Cancelof
Taxpayer's Social Security Card*

Cancelof
Head of Household

Cancelof
Dependent Birth Certificate or Certificates

Cancelof
Dependent Social Security Card or Cards

Cancelof
W2 form(s)

Cancelof
Self Employment

Cancelof
College Forms

Cancelof
Healthcare Forms

Cancelof
IP Pin (paper from the IRS)

Cancelof
Direct Deposit

Cancelof
Misc. Forms

Cancelof
Previous Year Tax Return

Cancelof
Is this your First Year with H&T Tax Service ?*

YesNo
Were you Referred?*

YesNo
Name who Referred you

First NameLast Name
Additional comments

- I confirmed that all information I entered here is accurate and true.
- I allow Honest and Trust Tax Service 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.
Date Signed*

MonthDayYear
Date
Taxpayer Signature*

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Date Signed

MonthDayYear
Date
Spouse Signature

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Take Photo*
Do you want to apply for an advance loan?*

YesNo

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