DSK Tax & Bookkeeping Services Client Intake Form
3708 McHard Road Ste B Missouri City Texas 77489
*****Please Note*****
Remember to include a driver's license or ID for the taxpayer, along with two forms of ID for each dependent. Social Security cards are suitable forms of ID.
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Month
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Day
Year
Date
Full Name
First Name
Last Name
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Drivers License or State Issued ID Number
Drivers License or State Issued ID Exp. date
/
Month
/
Day
Year
Date
Email
example@example.com
Date of Birth
-
Month
-
Day
Year
Date
How did you hear about us? (Family, Friend, Social Media, Public Advertisement, etc)
Filing Status
Single
Head of Household
Married Filing Jointly
Married Filing Separately
Social Security Number
Contact Number
*
Check All that Applies
W-2
Schedule C/Business Income
Household Income
Education
Are you a recipient of Obama Care/Marketplace Insurance or did you purchase Medical Insurance from the federal marketplace? If so, please provide form 1095A in the upload section at the bottom of this application:
Yes
No
Number of dependents?
Dependent #1 Name
First Name
Last Name
Dependents relationship to you (daughter, son, sister, brother, mother, etc)
Dependent #1 Social Security Number
Sex of Dependent #1
Male
Female
1st Dependents Date of Birth:
-
Month
-
Day
Year
Date
Is Dependent #1 disabled?
Yes
No
Do you provide more than 50% of the support for this dependent?
Yes
No
Has this dependent lived with you at lease 50% of the year?
Yes
No
Dependent #2 Name
First Name
Last Name
#2 Dependents relationship to you (daughter, son, sister, brother, mother, etc)
Dependent #2 Social Security Number
Sex of Dependent #2
Male
Female
Dependent #2 Date of Birth
-
Month
-
Day
Year
Date
Is Dependent #2 disabled?
Yes
No
Do you provide more than 50% of the support for this dependent?
Yes
No
Has this dependent lived with you at lease half of the year?
Yes
No
Dependent #3 Name
First Name
Last Name
#3 Dependents relationship to you (daughter, son, sister, brother, mother, etc)
Dependent #3 Social Security Number
Sex of Dependent #3
Male
Female
Dependent #3 Date of Birth:
-
Month
-
Day
Year
Date
Is Dependent #3 disabled?
Yes
No
Do you provide more than 50% of the support for this dependent?
Yes
No
Has this dependent lived with you at lease half of the year?
Yes
No
Did you pay any child care expenses last year?
Yes
No
If yes, what was the cost of child care expenses paid last year?
Please provide the name, address, and social security number or EIN # of your Childcare provider
Your IRS Assigned Filing Pin # (if applicable)
Occupation/Title
Federal Income Tax withheld (Box 2 on W2)
Do you have business income or any other source of income? If yes, please indicate what type of business you have in the line below.
Gross Amount of Annual Business Income Collected in 2023 Tax Year
Please select documents you have provided for proof of loss/profit for business/self employment
Written Ledger
Receipts
Bank Statements
Invoices
Would you like to apply for a Cash Advance?
Yes
No
How would you like to collect your Refund?
Direct Deposit
Paper check
Cash Advance
Would you like your refund deposited into your checking or savings account?
Checking
Savings
Direct Deposit Routing #: (Required if Direct Deposit was selected, please double check information)
Direct Deposit Account# (Required if Direct Deposit was selected, please double check information)
Upload Copy of W2, Last Paycheck stub, Two forms of id's for dependents & DL for individual filing
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