Client Intake Form 2022

1
Required Documents Please upload (Instructions Below)
W-2’s and 1099’s
Driver License, ID, or Passport
Social Security Cards
Copy of last year’s federal and state tax returns
Missing some required documents
Have all required documents
2
Taxpayer Name* This field is required.
First Name
Last Name
Suffix
3
Social Security Number* This field is required.
4
Date of Birth* This field is required.
Date
Month
Day
Year
5
Occupation* This field is required.
6
Email* This field is required.
example@example.com
7
Phone Number* This field is required.
Please enter a valid phone number.
8
Spouse Information
First Name
Last Name
Suffix
9
Social Security Number
10
Date of Birth
date
Month
Day
Year
11
Occupation
12
Email
example@example.com
13
Phone Number
Please enter a valid phone number.
14
Address* This field is required.
NO P O BOX/ PHYSICAL ADDRESS ONLY
Street Address Line 2
City
State / Province
Postal / Zip Code
Please Select
Please Select
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
The Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
Brazil
Brunei
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos (Keeling) Islands
Colombia
Comoros
Congo
Cook Islands
Costa Rica
Cote d'Ivoire
Croatia
Cuba
Curaçao
Cyprus
Czech Republic
Democratic Republic of the Congo
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Polynesia
Gabon
The Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
North Korea
South Korea
Kosovo
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macau
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Nagorno-Karabakh
Namibia
Nauru
Nepal
Netherlands
Netherlands Antilles
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
Turkish Republic of Northern Cyprus
Northern Mariana
Norway
Oman
Pakistan
Palau
Palestine
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn Islands
Poland
Portugal
Puerto Rico
Qatar
Republic of the Congo
Romania
Russia
Rwanda
Saint Barthelemy
Saint Helena
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
Somaliland
South Africa
South Ossetia
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard
eSwatini
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Transnistria Pridnestrovie
Trinidad and Tobago
Tristan da Cunha
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
Uruguay
Uzbekistan
Vanuatu
Vatican City
Venezuela
Vietnam
British Virgin Islands
Isle of Man
US Virgin Islands
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Other
Country
15
Filing Status
Single
Married Filing Jointly
Married Filing Separately
Head of Household
Qualifying Widow
16
HEAD OF HOUSEHOLD FILERS MUST PRESENT ONE OF THE FOLLOWING TO FILE THIS STATUS. PICK ONE OF THE 3 OPTIONS THAT YOU WILL SUBMIT TO BE APPROVED TO FILE HEAD OF HOUSEHOLD.
Lease
Utility Bill
Mortgage Statement
17
Dependent 1
First Name
Last Name
Suffix
18
Social Security Number
19
Date of Birth
Date
Month
Day
Year
20
Relationship
Choose One
Choose One
Son
Daughter
Parent
Aunt
Uncle
Niece
Nephew
Stepchild
Brother
Sister
Stepbrother
Stepsister
Half Brother
Half Sister
Adopted Child
Grandchild
21
Dependent 2
First Name
Last Name
Suffix
22
Social Security Number
23
Date of Birth
Date
Month
Day
Year
24
Relationship
Choose One
Choose One
Son
Daughter
Parent
Aunt
Uncle
Niece
Nephew
Stepchild
Brother
Sister
Stepbrother
Stepsister
Half Brother
Half Sister
Adopted Child
Grandchild
25
Dependent 3
First Name
Last Name
Suffix
26
Date of Birth
Date
Month
Day
Year
27
Social Security Number
28
Relationship
Choose One
Choose One
Son
Daughter
Parent
Aunt
Uncle
Niece
Nephew
Stepchild
Brother
Sister
Stepbrother
Stepsister
Half Brother
Half Sister
Adopted Child
Grandchild
29
IF YOU ARE CLAIMING A DEPENDENT, PLEASE ANSWER THE QUESTIONS BELOW THAT PERTAINS TO YOUR DEPENDENT RELATIONSHIP. PER THE IRS REQUEST, WE MUST PROVE THAT NOBODY ELSE IS ELIGIBLE TO CLAIM YOUR DEPENDENT BUT YOURSELF.
30
If claiming son/daughter, where is the other parent of the dependent/dependents? Is the other parent providing any financial support?
31
If claiming niece, nephew, aunt, or uncle, how are you related to the dependent? Where are the parents to the dependent/dependents?
32
If claiming brother or sister, how are you related to the dependent? Why are the parents not claiming the dependent/dependents?
33
Did you pay someone to watch your child/children?
YES
NO
34
Did you collect social security or retirement income?
YES
NO
35
Did you purchase health insurance through healthcare.gov marketplace (Obama Care)?* This field is required.
Yes
No
36
If yes, did you receive a 1095-A Form from the marketplace?
Yes
No
37
Were you ever disallowed the Earned Income Tax Credit prior to this year?* This field is required.Taxpayer
Yes
No
38
Did you receive unemployment compensation (1099-G) regular or PUA last year?* This field is required.
YES
NO
39
If yes, did you receive regular unemployment or PUA?
Regular
PUA
40
Did you make college tuition payments and received a 1098-T Form last year?* This field is required.
YES
NO
41
Do you have any other income than your w-2(s)?* This field is required.
YES
NO
42
Do you owe any delinquent:* This field is required.
Child Support
Alimony
Student Loans
Back Taxes
State Taxes
None of the above
43
Did you receive the third Economic Impact Payment (Stimulus Payment) in 2021?* This field is required.
Yes
No
44
Enter the Amount of your Stimulus Payment Below* This field is required.
2021 Stimulus Total
Amount Received
Row 0, Column 0
Amount Received
2021 Stimulus Total
Row 0, Column 0
45
How would you like to receive your refund?* This field is required.
Refund Transfer Direct Deposit
Refund Transfer Debit Card
Refund Transfer Paper Check
46
Bank Information
Name of Bank
Routing Number
Account Number
ENTER BANK DATA
Row 0, Column 0
Row 0, Column 1
Row 0, Column 2
ENTER BANK DATA
Name of Bank
Row 0, Column 0
Routing Number
Row 0, Column 1
Account Number
Row 0, Column 2
47
I, hereby, state that all the information above is true to the best of my knowledge and that I am allowing On Time Taxes to prepare my taxes based on that fact. I understand that I am financially responsible for any outstanding balance due to any false information given.

If there is a balance due, you must pay the tax preparation fee upfront. If for any reason you owe an entity and they take the entire refund, you are STILL responsible to pay the tax preparation fee for services rendered.

*For any reason an amendment has to be filed with no fault of the tax preparer, an upfront fee of $150.00 is required! Please view your tax return, which is emailed to you (it is sent prior to submission). Any copy after the first copy is a fee of $10.00.

ALL FEES (bank and service fees) are found in the return and are non-refundable nor negotiable! NO EXCEPTIONS TO THIS!!

Please utilize www.irs.gov for all federal refund tracking. Please utilze your state Department of Revenue site for any State Refund tracking. Do NOT add the amounts together. Federal taxes are federal, and state taxes are state when tracking your status. Please allow 8 weeks to surpass from the date of submission before calling the IRS, if you have any tracking questions.

Please UPLOAD all required documents to Contact@honesttaxreturnservice.com

IRS Contact 800-829-1040

Please click this link to check your federal refund status. You will need your filing status, social security number, and the total amount of the refund before fees

https://sa.www4.irs.gov/irfof/lang/en/irfofgetstatus.jsp
48
Signature* This field is required.Taxpayer
49
Signature* This field is required.Spouse
50
Date
Date
Month
Day
Year
Should be Empty: