Tax Preparation New Client Intake Form

Tax Preparation New Client Intake Form
Filing Status*

SingleHead of HouseholdMarried Filing SeparateMarried Filing JointQualifying Widow/Widower
Do you have any children or dependents you are claiming?*

YesNo

Name (Must match information on file with Social Security Administration)*

First NameMiddle NameLast Name
Date of Birth*

MonthDayYear
Date
SSN*
Phone Number*
Please enter a valid phone number.Format: (000) 000-0000.
Email*
example@example.com
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Employment Status*

EmployedUnemployedSelf-employed
Please describe your self-employment situation*
*Please specify if you have a Sole Proprietorship, LLC, S-Corp, or Partnership*
Occupational Title*
Example: Nurse, Office Administrator, Manager, Unemployed, etc.
Are you a full-time student?*

YesNo
Are you totally and permanently disabled or legally blind?*

YesNo
Are you or can you be claimed as a dependent of someone else?*

YesNo

Name (Must match information on file with Social Security Administration)*

First NameLast Name
Date of Birth*

MonthDayYear
Date
SSN*
Phone Number*
Please enter a valid phone number.Format: (000) 000-0000.
Email*
example@example.com
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Employment Status*

EmployedUnemployedSelf-employed
Please describe your self-employment situation*
*Please specify if you have a Sole Proprietorship, LLC, S-Corp, or Partnership*
Occupational Title*
Example: Nurse, Office Administrator, Manager, Unemployed, etc.
Are you a full-time student?*

YesNo
Are you totally and permanently disabled or legally blind?*

YesNo
Are you or can you be claimed as a dependent of someone else?*

YesNo

Enter your dependents here (Name, SSN, and DOB must match information on file with Social Security Administration). *FOR UNUSED ROWS PLEASE PUT N/A IN THE RELATIONSHIP COLUMN**

Rows	Full Name	SSN	Date of Birth (MM/DD/YYYY)	Relationship
1
2
3
4
5
6

Did you, your spouse, and/or your dependents have health insurance at any point during the tax period your return is being prepared for?*

YesNo
Did any dependent have any form of income?*

YesNo
Please describe type/source of income*

Please only include amounts paid in the tax period your return is being prepared for.

Note: If the total amount of expenses is less than $12,950 ($24,900 for married) then you can skip this section.

General Expenses

Rows	Amount
Medical Expenses
Dental Expenses
Health Insurance Premiums paid
Long Term Care Premiums
Prescription Drugs and Medications
Charitable Cash Contributions
Home Mortgage Interest from 1098
Property Taxes Paid
Any Major Sales Tax Amounts Paid(Boats, Autos, etc.)

Total Expenses
Additional comments or other items you may feel are relevant

By clicking submit, I agree to the terms listed below:
- I confirm that all information I have entered here is accurate and true and understand that incorrect information can result in the tax return e-file submission to be rejected by the irs, additional preparation fees, and intentional fraud can result in penalties, fines, and criminal charges.
- I authorize Spence Accounting Services, LLC to collect my sensitive data such as personal information, government issued id, social security number (SSN), and any other relevant information including but not limited to financial information that is necessary to prepare my tax return.
- I have read the terms and conditions and privacy policy of Spence Accounting Services, LLC.
Please verify that you are human*
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