Tax Preparation Client Intake Form

Name

First NameLast Name
Date of Birth

MonthDayYear
Date
Upload Attachments Here (birth certificate)

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Phone Number
Please enter a valid phone number.
SSN
Upload Attachments Here (social security card)

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PIN # (fill out only if provided by IRS)
Driver license number Issue Date Exp Date
Upload Attachments Here

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Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Email
example@example.com
Filing Status

SingleHead of HouseholdMarried Filing SeparateMarried Filing JointQualifying Widower
Employment Status

EmployedUnemployedSelf-employed
Income (check all that apply)

W2Self Emoloyed1099Head of Household Income
Upload Attachments Here (proof of income)

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Self Employed ( if you check self employed, please answer the following)
Job Description
Months On Job
Income Made On Job
Loss (please attach description sheet)

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EIN #
Check If You DO NOT have EIN #
DBA
Check if you DO NOT have DBA
Self Employed ( if you check self employed, please answer the following)
Job Description
Months On Job
Income Made On Job
Loss (please attach description sheet)

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EIN #
Check If You DO NOT have EIN #
DBA
Check if you DO NOT have DBA
Education
College Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Amount spent on supplies
Did you attend college more than half of the year in 2023?

YesNo
Do you have a 1098T form? If no please explain why :

YesNo
Explain :
Dependents

Enter your dependents here

	Name	SSN	Date of Birth	Relationship	Disable Y or N	Provide more than 50% support Y or N	Is anyone else claiming the child or allowed to claim child? Y or N	If yes, explain:
1
2
3
4
5
6
7
8

ANY AND ALL INFORMATION HAS BEEN FILLED OUT BY ME AND TO THE BEST OF MY KNOWLEDGE. THE DATA FILLED OUT BY ME, (TAXPAYER) IS ACCURATE AND TRUTHFUL. I give GOLDEN TIER TAXES authority to use the information provided by myself, the taxpayer, for filing purposes. I did not receive any help filling this form out. If any information is incorrect or inaccurate, I take FULL RESPONSIBILITY FOR IT. I UNDERSTAND this form holds up in a court of law and can be used against me if needed.
Taxpayer Signature

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Date Signed

MonthDayYear
Date
Should be Empty:

Education