Common Cents Tax Solutions Client Intake Form

Thank You for taking the time to complete your Client Intake Form. This information is critical to ensure your tax return is filed accurately. Please take your time and review all information before you submit. Please note that if documents are missing or information is incorrect this will result in a delay in processing your return.

This intake form will take 20- 30 minutes to complete.

Please complete this form in its ENTIRETY and click SUBMIT when finished. Upload all documents at the end of the form.

Please wait until you have ALL of your documents before submitting this form.

Note: If you are claiming any dependents, be sure to upload their SS CARDS, BIRTH CERTIFICATES, and all items that show their address is the same as yours. (e.g. school records, medical records, doctor bills, Medicaid Statement, Social Services Records, or anything that shows your child's name and current address).
Client Intake Form
CLIENT INTAKE FORM
How Did You Hear About Us?*
Tax Professional *
If someone referred you, please type their name here.
If you are filing multiple years you must complete a separate form for each year.
Which Tax Year Are You Filing*
GENERAL INFORMATION
Do you owe the IRS, Child Support or in default with student loans?*
Can someone else claim you as a dependent?*
Taxpayer's Name*

First NameLast Name
Taxpayer's Social Security Number*
Example: xxx-xx-xxxx
Taxpayer's Date of Birth*
Ex: 01/02/1979
Taxpayer's Job Title*
Taxpayer's Phone Number*
Please enter a valid phone number.
Home Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Taxpayer's Email Address*
example@example.com
Were you previously issued an Identity Protection Pin (IP PIN) by the IRS?
IP PIN IDENTITY THEFT (IF APPLICABLE) (Stand directly over the item on a flat surface and zoom in for a clear shot.)

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What is your martial status as of December 31, 2023?*

Single, Never MarriedMarriedQualifying Surviving Spouse
Taxpayer's Driver's License/State ID (Stand directly over the item on a flat surface and zoom in for a clear shot)

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Taxpayers SS Card (Stand directly over the item on a flat surface and zoom in for a clear shot)

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Spouse's Full Name

First NameLast Name
Spouse's Social Security
Example: xxx-xx-xxxx
Spouse's Date of Birth
Example: 01/02/1979
Spouse's Phone Number
Please enter a valid phone number.
Spouse's Email Address
example@example.com
Spouse's Driver's License/State ID (Stand directly over the item on a flat surface and zoom in for a clear shot)

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Spouses SS Card (Stand directly over the item on a flat surface and zoom in for a clear shot)

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Did you and your spouse live apart for more than 6 months in 2023?
What months?
Did you buy,sell trade or accept payment for services in Crypto Currency? (Bitcoin)
Do you have gambling winnings for 2023?*
Upload W2-G Section

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Did you make any charitable contributions?
Did you withdraw from your 401K in 2023?
Have you ever been disallowed for EITC/AOTC/CTC/ACTC?*
Do you receive any Government Assistance Programs such as Food stamps, TANF, Medicaid, or Medicare?
Please list programs.
Please list the programs along with the supporting documents. (Stand directly over the item on a flat surface and zoom in for a clear shot.)

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Do you have a 1098 Mortgage Interest Statement?
Upload your 1098 Mortgage Interest Statement Here. (Stand directly over the item on a flat surface and zoom in for a clear shot.)

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Was your insurance through the Affordable Care Act (The Marketplace)
PLEASE UPLOAD YOUR 1095A IF APPLICABLE (Stand directly over the item on a flat surface and zoom in for a clear shot.)

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Did anyone in your household attend college?
Form 1098-T (School Credit) *Stand directly over the item on a flat surface and zoom in for a clear shot.

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INCOME
Upload W2 statements (Stand directly over the item on a flat surface and zoom in for a clear shot.)

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1099 NEC (Stand directly over the item on a flat surface and zoom in for a clear shot.)

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Did you receive unemployment in 2023
1099 Unemployment Taxpayer/Spouse (Stand directly over the item on a flat surface and zoom in for a clear shot.)

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Upload other Misc. Income Documents such as 1099 INT, 1099 DIV, 1099 NEC. (Stand directly over the item on a flat surface and zoom in for a clear shot.)

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LIVING SITUATION
Which best describes your current living situation?

Single parent with dependent(s)Legal guardianship of dependent(s)/Foster ParentSingle Parent/Guardian living with other financial providers
Did you provide more than half of the financial support to maintain your household for you and your dependent(s) for more than 6 months?

YESNO
Did anyone else provide care and support for the dependent(s) besides you for more than 6 months?

YESNO
Proof of Residency For Claiming HOH
Provide the following documents; Lease, Utility bill, Letter from Clergy, Rental Receipts, Housing Assistance document. (Stand directly over the item on a flat surface and zoom in for a clear shot.)

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SELF EMPLOYED (Complete only if you have your OWN business ,or in a partnership, or Contractor)
Are you self-employed?
What is the name of your business?
Enter EIN- Employer Identification Number
Legal Address of Business

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
What is your business email address?
example@example.com
What is your business phone number?
Please enter a valid phone number.
What is your business entity?

Sole ProprietorLLC-Single MemberLLC-Multi-MemberC-CorpS-CorpNonprofit
What Was Your Gross Income For 2023?
Did you recieve or apply for the ERC (Employee Retention Credit)?
Detailed Summary of Expenses (Stand directly over the item on a flat surface and zoom in for a clear shot.)

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How long have you owned your business?
What services do you perform?
How many clients do you have?
What types of items do you need to operate?
Do you travel for business?
How do you track of mileage?
When and where do you have to travel for business?
Please provide documentation of Business License and Registration

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Who maintains the business records?
Do you maintain separate banking accounts for personal and business transactions?
How do you differentiate between personal and business transactions and monetary assets?
What form of records were provided?
Please upload supporting business documents. (ex P&L, 1099 NEC, Summary of Income, Spread sheet with expenses). (Stand directly over item on a flat surface and zoom in for a clear shot.)

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DEPENDENT INFORMATION
Do you have dependents to claim on your 2023 tax return?*
How many dependents are you claiming?
Dependent #1 Name

First NameLast Name
Dependent #1 Date of Birth
01/02/2015
Dependent #1 Social Security Number
What is Dependent #1's Relationship to you (son, daughter, etc.)?
How many months did dependent #1 live with you?
Dependent #2 Name

First NameLast Name
Dependent #2 Date of Birth
01/02/2015
Dependent #2 Social Security Number
What is Dependent #2's Relationship to you (son, daughter, etc.)?
How many months did dependent #2 live with you?
Dependent #3 Name

First NameLast Name
Dependent #3 Date of Birth
01/02/2015
Dependent #3 Social Security Number
What is Dependent #3's Relationship to you (son, daughter, etc.)?
How many months did dependent #3 live with you?
Dependent #4 Name

First NameLast Name
Dependent #4 Date of Birth
01/02/2015
Dependent #4 Social Security Number
What is Dependent #4's Relationship to you (son, daughter, etc.)?
How many months did dependent #4 live with you?
Dependent #5 Name

First NameLast Name
Dependent #5 Date of Birth
01/02/2015
Dependent #5 Social Security Number
What is Dependent #5's Relationship to you (son, daughter, etc.)?
How many months did dependent #5 live with you?
Dependent 1 Social Security Card (Stand directly over the item on a flat surface and zoom in for a clear shot)

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Dependent 2 Social Security Card (Stand directly over the item on a flat surface and zoom in for a clear shot)

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Dependent 3 Social Security Card (Stand directly over the item on a flat surface and zoom in for a clear shot)

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Dependent 4 Social Security Card (Stand directly over the item on a flat surface and zoom in for a clear shot)

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Dependent 5 Social Security Card (Stand directly over the item on a flat surface and zoom in for a clear shot)

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Dependent 1 Birth Certificate (Stand directly over the item on a flat surface and zoom in for a clear shot)

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Dependent 2 Birth Certificate (Stand directly over the item on a flat surface and zoom in for a clear shot)

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Dependent 3 Birth Certificate (Stand directly over the item on a flat surface and zoom in for a clear shot)

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Dependent 4 Birth Certificate (Stand directly over the item on a flat surface and zoom in for a clear shot)

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Dependent 5 Birth Certificate (Stand directly over the item on a flat surface and zoom in for a clear shot)

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Did any one else provide support for your dependents?*
ParentRelativeGovernment AgencyOther
If you chose "other" please type other information here
ACKNOWLEDGEMENT AND SIGNATURE
Are you interested in Audit Protection? (Mandatory For ALL Schedule C'S)
Are you interested in a Mortgage Loan?
Are you interested in Credit Repair?
Are you interested in Business Loans?
Are you interested in Personal Loans?
As our thanks for you filing you taxes with us,please choose one from your vacation option below. (*Please note: you have 1 month to accept, 18 months to book, you are responsible for taxes and fees, all details will be sent to you).

7 Night Luxury Resort Giveaway for 2 Adults & 2 KidsWeekend Getaway Airfare Plus 2 Nights Hotel for 25 Day/4 Night Cruise 2 Adults
STOP!

Did you finish uploading your documents?

IF YOU DID NOT UPLOAD ALL NECESSARY DOCUMENTS YOUR INTAKE FORM WILL BE VOIDED.

CLIENT NON-PAYMENT/OFFSET CLAUSE

At Common Cents Tax Solutions, we strive to assist all of our clients in their tax needs, however, we understand that situations arise. If your refund is offset by the IRS, student loans, child support or your check is mailed, you are still obligated to pay our company the fees associated with filing your tax return.

By signing this agreement you acknowledge that if payment is not made in full within 30 days legal actions will be sought to resolve payment.
How would you like your refund disbursed?
Direct Deposit Information
Name of Bank
Routing Number
Account Number
Type of Account
Primary Taxpayer Signature*

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Primary Taxpayer Spouse Signature (If no spouse, leave blank)

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I am giving Common Cents Tax Solutions permission to prepare all forms related to my tax return. To apply for and secure RAC's and RAL's on my behalf, sign all necessary forms and file my taxes electronically. I take full responsibility for the accuracy of this form and understand that Common Cents Tax Solutions and/or associated affiliates hold no responsibility for any misrepresentation or false claims.
Primary Taxpayer Signature*

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Date*

MonthDayYear
Date
Primary Taxpayer Spouse Signature (If no Spouse, leave blank)

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Date

MonthDayYear
Date
Should be Empty:

Client Intake Form

CLIENT INTAKE FORM

GENERAL INFORMATION

INCOME

LIVING SITUATION

SELF EMPLOYED (Complete only if you have your OWN business ,or in a partnership, or Contractor)

DEPENDENT INFORMATION

ACKNOWLEDGEMENT AND SIGNATURE

STOP!