• Tax Preparation Client Intake Form

  • Filing Status
    • Taxpayer Information 
    • Date of Birth
       - -
      2 digit month, 2 digit day, 4 digit year
    • Format: (000) 000-0000.
    • Are you a full-time student?
    • Are you totally and permanently disabled?
    • Are you legally blind?
    • Is this individual dependent of other?
    • Spouse Information 
    • Date of Birth
       - -
      2 digit month, 2 digit day, 4 digit year
    • Format: (000) 000-0000.
    • Are you a full-time student?
    • Are you totally and permanently disabled?
    • Are you legally blind?
    • Is this individual dependent of other?
    • Dependents 
    • Enter your dependents here
      Rows
    • Does you, your spouse, and your dependents have health insurance within 12 months last year? If yes, who covers for it?
      Rows
    • Tax Related Questions 
    • Employment Status
    • Are you contributing to 401k or other pre-tax account?
    • Is this your first time opening a pre-tax account?
    • Please select what state return are you requesting?
    • Does your dependents have tuition expenses?
    • Do you have any expenses for child care?
    • Do you have energy star rated improvements to your home?
    • Are you currently renting?
    • What is the monthly rental amount?
    • Do you have your own home?
    • Do you have documents that shows you paid for property taxes?
    • Did you sold any stock?
    • Did you take money from your 401?
    • Did you pay for vehicle tax?
    • Do you have mortgage interest?
    • Do you have real estate tax?
    • Did you receive a federal tax last year?
    • Are you a victim of identity theft?
    • Expenses 

    • Please fill-up the information within the current year only.

    • General Expenses
      Rows
    • Appointment to go over changes and to make sure I have everything! Quick 15-30 min call.
    • Acknowledgment & Signature 
      • I confirmed that all information I entered here is accurate and true.

      • I allow D&J DreamTeam LLC to capture my sensitive data like personal Id, government Id, social security number (SSN), and other information.

      • I have read the terms and conditions and privacy policy of D&J DreamTeam LLC
      • By signing below, you acknowledge that you have read and understood your responsibilities and our responsibilities in doing this tax return.
    • Date Signed
       - -
      2 digit month, 2 digit day, 4 digit year
    • Date Signed
       - -
      2 digit month, 2 digit day, 4 digit year

  • Consent to Disclosure of Tax Return Information

    Jamika Brooks Name of Tax preparer (“we”, “us” and “our”)

    Federal law requires this consent form be provided to you (“you” refers to each taxpayer, if more than one). Unless authorized by law, we cannot disclose your tax return information to third parties for purposes other than the preparation and filing of your tax return without your consent. If you consent to the disclosure of your tax return information, Federal law may not protect your tax return information from further use or distribution.

    You are not required to complete this form to engage our tax return preparation services. If we obtain your signature on this form by conditioning our tax return preparation services on your consent, your consent will not be valid. If you agree to the disclosure of your tax return information, your consent is valid for the amount of time that you specify. If you do not specify the duration of your consent, your consent is valid for one year from the date of signature.

    You have indicated that you are interested in applying for a Refund Transfer (“RT”) product from Santa Barbara Tax Products Group, LLC, a division of Green Dot Corporation, a Delaware corporation (“Processor”) using banking services of Civista Bank (“Bank”). In order to have your refund processed by and through Processor, we must disclose all of your 2022 tax return information to Processor and Bank.

    If you would like us to disclose your 2022 tax return information to Processor and Bank for this purpose, please sign and date your consent to the disclosure of your tax return information.

    By signing below, you (including each of you if there is more than one taxpayer) authorize us to disclose to Processor and Bank all of your 2022 tax return information so that Processor can evaluate and process your application and Bank can provide banking services for the RT product. You understand that if you are not willing to authorize us to share your tax information with Processor and Bank, you will not be able to obtain an RT product from Processor, but you can still choose to pay us directly to have your tax return prepared and filed.

  • Consent to Use of Tax Return Information

    Jamika Brooks Printed name of tax preparer (“we”, “us” and “our”)

    Federal law requires this consent form be provided to you (“you” refers to each taxpayer, if more than one). Unless authorized by law, we cannot use your tax return information for purposes other than the preparation and filing of your tax return without your consent.

    You are not required to complete this form to engage our tax return preparation services. If we obtain your signature on this form by conditioning our tax return preparation services on your consent, your consent will not be valid. Your consent is valid for the amount of time that you specify. If you do not specify the duration of your consent, your consent is valid for one year from the date of signature.

    For your convenience, we have entered into an arrangement with Santa Barbara Tax Products Group, LLC, a division of Green Dot Corporation, a Delaware corporation (“Processor”), using banking services of Civista Bank, to provide qualifying taxpayers with the opportunity to apply for refund processing services offered by and through Processor. To determine whether these services may be available to you, we will need to use your tax return information by analyzing it and calculating the amount of your anticipated refund.

    If you would like us to use your tax return information to determine whether these services may be available to you while we are preparing your return, please sign and date this consent to the use of your tax return information.

    By signing below, you (including each of you if there is more than one taxpayer) authorize us to use the information you provide to us during the preparation of your 2022 tax return to determine whether to present you with the opportunity to apply for refund processing services through Processor.

  •  
  • Should be Empty: