Tax Preparation Client Intake Form
2025 Tax year
Filing Status
Single
Head of Household
Married Filing Separate
Married Filing Joint
Qualifying Widower
Taxpayer Name
First Name
Last Name
Date of Birth
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
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
City
State / Province
Postal / Zip Code
Occupation
Spouse Name
First Name
Last Name
Date of Birth
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
SSN
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Email
example@example.com
Occupation
Do you, your spouse or dependents receive IP Pin from IRS?
If you answered yes, please upload the letter with your pin number(s)
Enter your dependents here
Rows
Name
Date of Birth
Social Security
Relationship
1
2
3
4
5
6
Do you pay for Child care?
If you answered yes, what is the child care provider name and address
How much do you pay weekly for childcare?
Are you or your dependent(s) attending college or trade school?
If you answered yes, has the school provided you with a 1098-T.? Please upload the 1098-T below
Check all that applies
Rows
Check
This person was over the age 18 and full-time student at an eligible educational institution.
Check if this person was disabled.
Check if this qualifying child Is Not Your Dependent
Check if you wish to Not claim this dependent for Earned Income Credit Purposes
Check if this dependent is married
This individual made over , $4,700 of income
This dependent qualifies or multiple Support Declaration
Are you a full time student?
Does you, your spouse, and your dependents have health insurance within 12 months last year? If yes, who covers for it?
Rows
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
If you had Market Place Health Insurance, did you receive 1095A form?
Yes
No
If you answered yes, please upload the document below.
Employment Status
Employed
Unemployed
Self-employed
If you are self-employed- How do you determine your income?
Do you have any expenses?
Yes
No
Are you contributing to 401k or other pre-tax account?
Yes
No
Do you own a home?
Yes
No
Did you receive a 1098- mortgage statement?
Yes
No
Do you have energy star rated improvements to your home?
Windows
Doors
Furnace
Other
Do you have mortgage interest?
Yes
No
Are you currently renting?
Yes
No
Did you sell any stock?
Yes
No
Did you purchase a new vehicle?
Yes
No
Are you a victim of identity theft?
Yes
No
Do you have a balance with IRS?
Yes
No
Did you withdraw from 401K?
Yes
No
Did you receive a federal tax last year?
Yes
No
General Expenses
Rows
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
Total Expenses
Additional comments
I confirmed that all information I entered here is accurate and true.
I allow M & K Xclusive Multi Services 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 M & K Xclusive Multi Services.
By signing below, you acknowledge that you have read and understood your responsibilities and our responsibilities in doing this tax return.
Upload your Photo ID, W2, 1099 and other supporting documents.
Browse Files
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Date Signed
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Taxpayer Signature
Date Signed
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Spouse Signature
Submit
Submit
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