Client Intake Form

Date

Filing Status (HOH, Single, Married Filing Joint, Married Filing Seperate)

Primary Full Name

Primary Social Security Number

Primary's DOB

Date

Primary's Email Address

Primary Occupation:

Primary License Number

Primary License Issue Date

Primary License Expiration Date

State of Issuance

Spouse's Full Name

Put N/A if you are not married. Required if married.

Spouse's Social Security Number

Put N/A if not applicable. Required if married.

Spouse's Date of Birth

Date. Required if married.

Spouse's Email address

Spouse Occupation

Required if married.

Spouse License Number

Required if Married Filing Joint or Married Filing Separately

Spouse License Issue Date

Required if Married Filing Joint or Married Filing Separately

Spouse License Expiration Date

Required if Married Filing Joint or Married Filing Separately

Spouse License State of Issuance

Required if Married Filing Joint or Married Filing Separately

Home Phone

Format: (000) 000-0000.

Primary Cell Phone

Format: (000) 000-0000.

Spouse's Cell Phone

Address

City

State.

ZIP Code

Dependent's Name(s), Relationship, Gender, and Social Security Number.

How many months did dependent love with you for the year?

Were any credits disallowed in the previous year?

Do you have a copy of prior years' AGI or Tax Documents?

Do you own a business?

If yes, what type of business (Sole Proprietorship, Single MemberLLC, Multi-Member LLC, S-Corp, C-Corp or Partnership)?

Put N/A if you do not have a business.

What's the name of the business and give a brief description of what you do?

Put N/A if this does not apply.

Do you own rental property?

Do you have investments?

Do you own Crypto Currency?

Are you in a qualifying educational institution or have a dependent in a qualifying educational institution?

If so, did you receive a form 1098T for your institution?

Is anyone listed on the return considered disabled by law?

If your previous answer was yes, who is it?

Can you provide SSA form or award letter?

Any dependent or childcare expenses?

Where did you pay your childcare expenses? (Please provide the name, EIN, and amount paid.

Put N/A if this does not apply.

Is there anyone listed on the return that is NOT a U.S. resident?

Did you receive any unemployment during the tax year?

What was the total amount of unemployment received? (if applicable)

Put N/A if this does not apply.

Did you or anyone in your household receive insurance through the marketplace?

Do you have employer paid health insurance

Do you have proof of employer insurance?

Did you pay any medical expense, copays, hospital bills, pharmacy, and/or physician's expense?

If so, can you provide proof

Put N/A if this does not apply.

Did you make any estimated payments or carryover payments for the tax year?

Are you an educator and have any applicable educators' expense up to amount set by federal guidelines?

Do you have any cancellation of debt? List amount. (1099-C will need to be provided)

List Name of Debtor and Amount Forgiven

Did you have any gambling winnings?

Can you provide the w2-G form for your winnings?

Did you purchase a home in 2008 and still qualify for First Time Homebuyer Credit?

Have you received any rental payments for any rental properties?

Do you have proof of expenses? (Credit card/Bank statements, repair bills, payment receipts)?

Are you claiming injured spouse of filing taxes for deceased?

Other

If you answered yes to the question above, for whom are you filing?

Put N/A if it does not apply.

Bank Name

Checking or Savings?

Account Number

Routing Number