Tax Intake Form

Tax Payers Name

First NameLast Name

Email

example@example.com

Taxpayer's Phone Number*

Example: xxx-xxx-xxxx

Taxpayer's Job Title

Taxpayer's Date of Birth*

Example: 01/01/2001

Taxpayer's SSN

Example: xxx-xx-xxxx

Home Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Spouse name

First NameLast Name

Spouse's SSN

Example: xxx-xx-xxxx

Spouse's Date of Birth

Example: 01/01/2001

Spouse's Phone Number

Example: xxx-xxx-xxxx

Spouse's Email Address

Example: example@example.com

Are you self employed?*

YesNo

If someone referred you, please type his or her name here.

What is your marital status as of December*

Single (Not Married)Married living with SpouseMarried not living with spouse

Did you pay over half the expenses of maintaining your residence for the entire year?*

YesNo

Did you support a child or family member for more than 6 months out of the year?*

YesNo

Dependent #1

First NameLast Name

Dependent #1 Date of Birth

01/01/2001

Dependent #1 SSN

What is Dependent #1's Relationship to you (son, daughter, etc.)?

Dependent #2

First NameLast Name

Dependent #2 Date of Birth

Example: 01/01/2001

Dependent #2 SSN

How many months did Dependent #2 live with you in 2024? (If all year, enter 12)

What is Dependent #2's Relationship to you (son, daughter, etc.)?

Dependent #3's Date of Birth

01/01/2001

Dependant #3

First NameLast Name

How many months did Dependent #3 live with you in 2024? (If all year, enter 12)

Dependent #3s SSN

Example: xxx-xx-xxxx

What is Dependent #3's Relationship to you (son, daughter, etc.)?

Dependent #4's First Name

First Name

Last Name

Dependent #4's Date of Birth

01/01/2001

Dependent #4's SSN

Example: xxx-xx-xxxx

What is Dependent #4's Relationship to you (son, daughter, etc.)?

Are there any dependents in daycare?

YesNo

How would you like to receive your tax refund?

Check (Only available for in office visits)Direct Deposit

Name of Bank

Which type of account would you like your refund deposited into?

Checking AccountSavings AccountOther

Routing Number

Bank Account Number

Can someone else claim you as a dependent?

YesNo

Did you have health insurance for the entire year?

YesNo

Was your insurance through your employer?

YesNo

Was your insurance through the Affordable Care Act (The Marketplace)?

YesNo

Did your dependents have health insurance for the entire year?

YesNoNot Appliable

Was YOUR DEPENDENTS' insurance through Medicaid?

YesNoNot Applicable

Was YOUR DEPENDENTS' insurance through the Affordable Care Act (The Marketplace)?

YesNoNot Applicable

Have you ever been denied the Earned Tax Credit (EITC)?

YesNo

Did you trade any Virtual Currency

YesNo

Do you have a 1098-T Form for either you or your dependents?

YesNo

If you have a 1098-T form, upload it here.

Are you interested in AUDIT PROTECTION?

YesNo

CLIENT NON PAYMENT/OFFSET CLAUSE

At Tax Angels LLC, 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 with in 30 days legal actions will be sought to resolve payment.

Primary Taxpayer's Signature

Spouse's Signature (If no spouse, leave blank)

CLIENT FORM