Tax Preparation Client Intake Form
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How did you hear about GoPro Tax?
Tazra
McKenzie
Other
Who Referred You?
Filing Status
Single
Head of Household
Married Filing Separate
Married Filing Joint
Qualifying Widower
Taxpayer Information
Name
First Name
Last Name
Age
Date of Birth
-
Month
-
Day
Year
Date
Phone Number
Please enter a valid phone number.
Email
example@example.com
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Occupation
Are you a full-time student?
Yes
No
Are you totally and permanently disabled?
Yes
No
Is this individual dependent of another taxpayer?
Yes
No
Spouse Information
Name
First Name
Last Name
Age
Date of Birth
-
Month
-
Day
Year
Date
Phone Number
Please enter a valid phone number.
Email
example@example.com
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Occupation
Are you a full-time student?
Yes
No
Are you totally and permanently disabled?
Yes
No
Is this individual dependent of another taxpayer?
Yes
No
Dependents
Enter your dependents here
Name
SSN
Date of Birth
Relationship
1
2
3
4
5
6
Does 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 Related Questions & Document Upload
Employment Status
Employed
Unemployed
Self-employed
Does your dependents have tuition expenses?
Yes
No
Do you have any expenses for child care?
Yes
No
Do you have energy star rated improvements to your home?
Windows
Doors
Furnace
Other
Do you have your own home?
Yes
No
Do you have documents that shows you paid for property taxes?
Yes
No
Did you take money from your 401K?
Yes
No
Do you have mortgage interest?
Yes
No
Do you have real estate tax?
Yes
No
Did you receive a federal tax last year?
Yes
No
Are you a victim of identity theft?
Yes
No
Please Upload Copy of Social Security Card
Browse Files
Drag and drop files here
Choose a file
Include social security cards for all individuals present on the tax form.
Cancel
of
Please Upload Copies of Income Documents
Browse Files
Drag and drop files here
Choose a file
Ex: W2, 1099, Unemployment, Business Income (if available)
Cancel
of
Please Upload Any Additional Miscellaneous IRS Forms
Browse Files
Drag and drop files here
Choose a file
Ex: Marketplace Insurance, 401K Distribution, Interest, etc.
Cancel
of
Please upload a copy of your ID
Browse Files
Drag and drop files here
Choose a file
Ex: State ID, Drivers License
Cancel
of
Please Upload a Copy Proof of Address
Browse Files
Drag and drop files here
Choose a file
Ex: Utility Bill, Mortgage Bill, Lease
Cancel
of
Expenses
Please fill-up the information within the current year only.
General Personal Expenses
Amount
Medical Expenses
Dental Expenses
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
Additional comments
Business
Total Business Income
Total Expenses
General Business Expenses (Skip section if you are not filing a business).
Amount
Advertising Expenses
Rent Expenses
Lease Expenses
Insurance Payments
Transportation Expenses
Vehicle Repairs
Payroll Expenses
Utilities
Food Expenses
Miscellaneous Expenses
Acknowledgment & Signature
I confirmed that all information I entered here is accurate and true.
I allow GoPro Tax 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 GoPro Tax.
By signing below, you acknowledge that you have read and understood your responsibilities and our responsibilities in doing this tax return.
Taxpayer Signature
Spouse Signature
Date Signed
-
Month
-
Day
Year
Date
Date Signed
-
Month
-
Day
Year
Date
Do you have life insurance?
Yes
No
Would you be interested in receiving information on final expense options, and family protection?
Yes
No
May we call/text you with updates on products/services? Terms and Privacy Policy can be found on our website at (www.goprotaxservice.com). Txt and data rates may apply. Reply STOP to end.
Yes
No
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