Tax Preparation Client Intake Form
Taxpayer Information
Name
*
First Name
Last Name
SSN Last 4
This is a secure form
Date of Birth
*
-
Month
-
Day
Year
Date
Filing Status
Single
Head of Household
Married Filing Separate
Married Filing Joint
Qualifying Widow(er)
Not sure
Did we prepare your taxes last year?
Yes
Did you receive a federal tax refund last year?
Yes
No
Are you a victim of identity theft?
Yes
No
If yes, approximately what amount did you receive
Enter your Identity Theft PIN Number issued by IRS.
Email
*
example@example.com
Phone Number
*
-
Area Code
Phone Number
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Upload Your Documents Here
Upload your tax documents (ex. 1099, 1098, 1095). Be sure to scan a copy of your 2021 tax form if we did not prepare your taxes in 2021.
Browse Files
You can upload multiple files. You can also scan multiple files on the same document if you wish.
Cancel
of
Occupation
Are you a full-time student?
Yes
No
Are you totally and permanently disabled?
Yes
No
Are you legally blind?
Yes
No
Can you be claimed on another individual's tax return?
*
Yes
No
Spouse Information
My spouse is filing separate
I do not have a spouse (Skip this section)
Spouse's Name
Spouse's Date of Birth
-
Month
-
Day
Year
Date
SSN Last 4
This is a secure form.
Name
First Name
Last Name
Phone Number
-
Area Code
Phone Number
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Email
example@example.com
Occupation
Dependents
Can YOU be claimed on someone else's taxes?
Yes
No
Are there changes to your dependents from last year
I do not have any dependents. (Skip Section)
No Changes (Skip Section)
Add new dependent(s)
Remove dependent(s)
Other
Enter any NEW dependents here (only list those not filed last year)
Name
SSN
Date of Birth
Relationship
1
2
3
4
5
6
Do you have any expenses for child care?
Yes
No
Do you, your spouse, and your dependents have health insurance within 12 months last year? If yes, who covers for it?
Yes/No
Employer
Spouse Ins
Exchange/ Marketplace
Direct with Insurer
Medicare
Medicaid
Taxpayer
Yes
No
Spouse
Yes
No
Dependent 1
Yes
No
Dependent 2
Yes
No
Dependent 3
Yes
No
Dependent 4
Yes
No
Dependent 5
Yes
No
Tax Specific Questions
Employment Status
Employed
Unemployed
Self-employed
Are you contributing to 401k or other pre-tax account?
Yes
No
Do your dependents have tuition expenses and a 1098T from their school?? Be sure to upload this form.
Yes
No
If so, how much did you pay in childcare expenses? Be sure to upload documentation
Do you have energy star rated improvements to your home?
Windows
Doors
Solar
Other
Do you own rental property that you are currently renting to a tenant?
Yes
No
What is the monthly rental amount?
How long did you rent this property to a tenant in 2023?
# of months
Do you own your home?
Yes
No
Do you have documents that shows you paid for property taxes?
Yes
No
Have you sold any stock?
Yes
No
Did you withdraw money from your 401?
Yes
No
Did you pay for vehicle tax?
Yes
No
Do you have mortgage interest? Be sure to upload the 1098.
Yes
No
Do you have real estate tax? Be sure to upload the 1098.
Yes
No
Expenses
Please enter the information for expenses from 2023 only.
General Expenses
Amount
Medical Expenses
Dental Expenses
Home Insurance Premiums paid
Long Term Care Premiums
Prescription Drugs and Medications
Home Mortgage
Investment Interest
Cash Contributions
Non-Cash Contributions
Unreimbursed Business Expenses
Union Dues
Tax Preparation Fees
Investment Expenses
Other
Do you have any self-employment income to report?
Yes (If yes, the Business Expenses section is REQUIRED
No (If no, skip the Business Expenses section)
Business Expenses
Amount
Advertising Expenses
Car/Truck
Office Expenses
Equipment Lease
Repairs/Maintenance
Business Supplies
Taxes and Licenses
Travel (Hotel, Flight)
Business Meals
Wages (to others)
Cellular Service
Internet
Subscriptions
Uniforms (Cleaning, purchase)
IT Equipment (Computer, printer, scanner)
Other
Enter the amount of income you received from your business
Approximately how many business miles did you drive last year?
Approximately how many personal miles did you drive last year?
Refund/Payment Information
Do you typically receive a refund each year?
Yes
No
Enter the approximate refund you received last year
How do you prefer to receive your refund this year?
*
Paper Check (3-4 weeks)
Direct Deposit (8-14 days)
If you owe a balance, how do you prefer to make your payment
*
I will send Paper Check
I will make an online payment to IRS.GOV
I will pay via direct debit from my account (must provide bank information)
I request a payment plan (extra fees, interest, and penalties may apply)
Enter your Bank Routing Number
*
9 digit number
Enter your Account Number
*
Re-Enter your Account Number
*
Type of account
*
Savings
Checking
Acknowledgment & Signature
Additional comments
0/9
I confirmed that all information I entered here is accurate and true.
I give OMG Tax Company permission to prepaare my taxes and agree to hold OMG Tax Company harmless in the event an audit is requested by IRS.
I agree to allow OMG Tax Company to capture my sensitive data like personal id, government id, social security number (SSN), and other information.
I understand that I am responsible for information presented to OMG Tax Company for the preparation of my taxes. I understand further that it is my responsibility to verify the accuracy of the infromation contained in my tax filing to IRS.
I understand that I am responsible for payment for tax preparation services regardles of the refund or tax owed amount. If I choose not to have my taxes filed, I am still responsible for paying at least 75% of the preparation fee.
By signing below, I acknowledge that I have read and understood my responsibilities and the responsibilities of OMG Tax Company in preparing and filing this tax return.
Taxpayer Signature
*
Date Signed
*
-
Month
-
Day
Year
Date
Spouse Signature
Date Signed
-
Month
-
Day
Year
Date
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