D & S Financial Services LLC"Powered By Unlimited Taxes & More Inc.

D & S Financial Services LLC"Powered By Unlimited Taxes & More Inc.

D & S Financial Services LLC"Powered By Unlimited Taxes & More Inc.
Date

MonthDayYear
Date
Appointment

Tax Preparation Client Intake Form
Did you File a Tax Return last year?
Have you Filed with us before?
Direct DepositPaper CheckPrepaid Card
SingleHead of HouseholdMarried filing separatelyMarried filing jointlyQualifying Widow(er)

Name

First NameLast Name
Age
Date of Birth

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

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Occupation
SSN
YesNo
YesNo
YesNo
YesNo
Have you ever been Audited?
Have any credits ever been disallowed?

Name

First NameLast Name
Age
Date of Birth

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

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Occupation
SSN
YesNo
YesNo
YesNo
Have any credits ever been disallowed?
Have you ever been Audited?
YesNo

Please Enter your dependent information here

Rows	Name	SSN	DOB	Relationship
Dependent 1
Dependent 2
Dependent 3
Dependent 4
Dependent 5
Dependent 6

Did 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
Dependent 6

Please input all relevant information within the current year only

Rows	Amount
Medical Expenses
Dental Expenses
Insurance Premium Paid
Long Term Care Premiums
Prescription Drugs/Medication
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 "D&S Financial Services LLC" to capture my sensitive data like personal ID, government ID, social security number (SSN), and other information.

• I have read the terms and conditions and privacy policy of "D&S Financial Services LLC".

• I consent D&S Financial Services LLC to use my entire 2022 tax return and information collected during the preparation of my taxes to ensure that any refund settlement products and related banking services that I obtain or apply for can be issued, processed, underwritten, and serviced. The foregoing activities and related services may be performed by one of the following companies and/or their affiliates: Refundo INC.

• 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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