2023 Safeguard Tax Pro Client Packet

Safeguard Tax Professionals Client Information Sheet
Please Select Your Tax Preparer
Date*

MonthDayYear
Date
Filing Status*

MarriedHead of HouseholdSingleMarried Filing Sep.
Affordable Care Act (Obamacare)*

YESNO
SS#*
***-**-****
Taxpayer Name*
Taxpayer Date of Birth *

MonthDayYear
Date
Identity Pin #
Cell Phone
Please enter a valid phone number.
Home Phone
Please enter a valid phone number.
Spouse Name
Spouse Date of Birth

MonthDayYear
Date
SS#
Identity Pin #
Address*

Street Address

Apt#

CityState / Province

Postal / Zip Code
Occupation*
Email*
example@example.com
Dependent #1

First NameLast Name
Dependent #1 Date of Birth

MonthDayYear
Date
Dependent #1 Relationship
SafeGuard Tax Professionals will prepare your 2022 individual tax return based on the information you have provided. We will not audit or verify the information you furnished to us. You, the taxpayer(s), are ultimately responsible for the preparation and filing of your return. the taxpayer(s) named above, have provided to SafeGuard Tax Professionals the tax information and to the best of my knowledge this information is true.
Dependent #1 SS#
Dependent #2 Name

First NameLast Name
Dependent #2 Date of Birth

MonthDayYear
Date
Dependent #2 Relationship
Dependent #2 SS#
Dependent #3 Name

First NameLast Name
Dependent #3 Date of Birth

MonthDayYear
Date
Dependent #3 Relationship
Dependent #3 SS#
Dependent #4 Name

First NameLast Name
Dependent #4 Date of Birth

MonthDayYear
Date
Dependent #4 Relationship
Dependent #4 SS#
SafeGuard Financial will prepare your 2022 individual tax return based on the information you have provided. We will not audit or verify the information you furnished to us. You, the taxpayer(s), are ultimately responsible for the preparation and filing of your return.

I, the taxpayer(s) named above, have provided to SafeGuard Financial the tax information and to the best of my knowledge this information is true.
Taxpayers Signature*

Clear
Date*

MonthDayYear
Date
Spouse's Signature

Clear
Date

MonthDayYear
Date
EITC ELIGIBILITY INTERVIEW QUESTIONAIRE

Covers the Age, Relationship and Residency Test (Preparer place notes on all Questions)
Have you Provided correct Identification Numbers*

YesNo
Do the names on the return match your social security records, children included?*

YesNo
Are you legally married based on your state's legal definition of marriage?*

YesNo
if yes, did your spouse live in your home at any time during July thru December?

YesNo
Can someone else claim you/spouse as a dependent?*

YesNo
Did you/spouse receive any kind of military pay earnings?*

YesNo
Did you/spouse receive any kind of housing allowances or government assistance?*

YesNo
Did you/spouse live with anyone with a higher adjusted gross income?*

YesNo
If yes, but renting a room, do you have a rental agreement?

YesNo
DEPENDENTS AND/OR QUALIFYING CHILDREN
Do you have dependents and or qualifying children?*

YesNo
Have you verified your dependent's birthday information as entered in the return?*

YesNoType option 3
Did you/spouse provide over 50% of total support for each dependent?*

YesNo
Do your EIC qualifying children meet any one of these requirements: Have a valid social security number?*
Did your EiC qualifying children live with you in the same main home in the US?*

YesNo
Are you claiming a niece, nephew, grandchild, brother, sister or parent on your tax return?*

YesNo
Did the parents of the dependents also live in your household?

YesNo
If Not, why did the kids not live with the parents?
If the parents lived in your home, did they financially contribute to your household?

YesNo
How many months have the dependent lived in your household?
If lived with you, Is your Adjusted Gross Income higher than the parents of the dependents?

YesNo
Can anyone else claim this dependent?*

YesNo
Tax Payer Signature*

Clear
Date*

MonthDayYear
Date
Client Questionnaire
1. Did you/spouse have health insurance during the tax year? If so, was it through the marketplace?*
2. Did you/spouse receive unemployment during the tax year?*
3. Did you/spouse/dependents attend college during the tax year and receive a 1098T?*
4. Did you pay a mortgage during the tax year and receive a 1098?*
5. Did you/spouse pay any student loans during the tax year?*
6. Did you pay for childcare anytime during the tax year?*
7. Did you/spouse receive any 1099 forms? (Ex: 1099 Mis, 1099 NEC, 1099-G, & 1099-K)*
8. Do you currently have life insurance? If not, are you interested in a quote?*
9. Do you need any home coverages? (Ex. Texas Windstorm, Flood)*
10. Have you or a household member lost health coverage within the last 30 days?*
11. Are you interested in an Auto quote?*
12. Are you interested in Credit Repair?*
Taxpayer Sign*

Clear
Date

MonthDayYear
Date
Tax Refund Disbursement

How would you like your tax refund to be disbursed?
Check Pick up

YesNo
Direct Deposit:

YesNo
Bank Name
Accountholder Name
Routing Number
(nine digits)
Account Number
Account Type
Security Question*
Answer*
Do you want to Apply for a Refund Advance?*
Signature

Clear
Date

MonthDayYear
Date
Please Upload your Tax Documents
Taxpayer Income Documents

Cancelof
Taxpayer Identification

Cancelof
Social Security Cards for Taxpayer, Spouse & Dependents

Cancelof

Safeguard Tax Professionals Client Information Sheet

EITC ELIGIBILITY INTERVIEW QUESTIONAIRE

DEPENDENTS AND/OR QUALIFYING CHILDREN

Client Questionnaire

Tax Refund Disbursement

Please Upload your Tax Documents