Clear Strategy Tax Intake Form

Today's Date

Date

Tax Payer (T) Name

(T) DOB

(T) Last 4 SSN ONLY

(T) Phone

(T) E-mail

example@example.com

(T) Occupation

(T) IRS Pin

Spouse (S) Name

(S) DOB

(S) Last 4 SSN ONLY

(S) Phone

(S) E-mail

example@example.com

(S) Occupation

(S) IRS Pin

Address

City

State

ZIP

Please provide a copy of your Driver's License or State ID: (If MFJ, need BOTH ID's) or fill in the following information:

(T) Driver's License Number

(T) Issue Date

(T) Expiration Date

(S) Driver's License Number

Type a question

(S) Issue Date

(S) Expiration Date

Upload a copy of your driver's license:

Filing Status

*MFS - Spouse Name:

*MFS - Last 4 SSN Only:

Does Spouse itemize on separate return?

yesno

(T) US Citizen?

yesno

(S) US Citizen?

yesno

(T) Can you be claimed as a dependent?

yesno

(S) Can you be claimed as a dependent?

yesno

(T) Blind?

yesno

(S) Blind?

yesno

(T) Disabled?

yesno

(S) Disabled?

yesno

At any time during 2023, did you (a) receive (as a reward, award or payment for property or services) or (b) sell, exchange, gift or otherwise dispose of a digital asset (or a financial interest in a digital asset)?

yesno

(1) Name

(1) DOB

(1) Last 4 SSN ONLY

(1) Relationship

Type a question

(1) Months as Dependent

(2) Name

(2) DOB

(2) Last 4 SSN ONLY

(2) Relationship

(2) Months as Dependent

(3) Name

(3) DOB

(3) Last 4 SSN ONLY

(3) Relationship

(3) Months as Dependent

(4) Name

(4) DOB

(4) Last 4 SSN ONLY

(4) Relationship

(4) Months as Dependent

More than 4 dependents? List them below:

W-2's

yesno

#

Interest, 1099-INT

yesno

#

Dividends, 1099-DIV

yesno

#

Pensions, IRA, 1099-R

yesno

#

Social Security, SSA-1099

yesno

#

Unemployment, 1099-G

yesno

#

State or Local Refund

yesno

Alimony

yesno

Date of Divorce

Date

Misc: Jury Duty, etc.

yesno

A - Itemized Deductions: Medical Expenses, Mortgage Statements - 1098; Property Taxes - Summer and Winter Statemensts; PPT - auto license fee; Charitable Contributions - Cash and Non-cash

C - Business Income; Income and Expense statements

D - Capital Gains, 1099-B

E - Rental, Royalty, Partnership, S-Corp, income, 1099-Misc.

F - Farm income, 1099-PATR

Copy of previous year's Tax Returns (must have for accuracy)
Lump Sum Distribution
Sale of Home, need closing statement and basis of home sold
IRA/Retirement Contributions
Studen Loan Interest, 1099-E
Estimated Tax payments, need $ amount and date's paid
Carryover Amounts: Capital losses and Passive activities
Education Expenses, 1098-T
Adoption Expenses
Child Care Expenses; Provider name, address, EIN, $ amount paid
HSA Contributions (not through employer)
First-time homebuyer Credit repayment (2023 is final year)
Debt Forgiveness/Foreclosure, 1099-A, 1099-C
Marketplace Insurance, 1095-A
Teacher Expenses
Home Energy Improvements

Alimony Paid ($)

Divorce Date

Date

Upload applicable files here:

Any additional information you would like to include:

Clear Strategy Tax Intake Form

Dependents

Income

Schedules and Miscellaneous Information