Tax Preparation Client Intake Form

Tax Preparation Client Intake Form

This form assists us in gathering your tax information. You will be asked to provide all tax forms necessary to complete an accurate income tax return.
Filing Status*

SingleHead of HouseholdMarried Filing SeparateMarried Filing JointQualifying Widower

Enter your dependents here

If your child did not live with you but you are claiming them as your dependent, check here:

Custodial parent must sign form 8332

Does you, your spouse, and your dependents have health insurance within 12 months last year? If yes, who covers for it?

Tax Related Questions
Employment Status*

EmployedUnemployedSelf-employedOther
Occupation
CHECK ALL THAT APPLY

Wage statement W-2InterestDividendsCommission - 1099UnempolymentPensions, Retirement IncomePartnership/ S Corporation (k-1)Estate/TrustsLottery or Gambling Winnings1099-S, 1099-A, 1099-CSSI/Railroad retirement/ IRAsMunicipal Bonds/Sell StocksTips/Other IncomeAlimonyStock SalesOwn Rental Property
Are you contributing to 401k or other pre-tax account?

YesNo
Is this your first time opening a pre-tax account?

YesNo
Does you/or dependents have tuition expenses?

YesNo
Do you have energy star rated improvements to your home?

WindowsDoorsFurnaceOther
Do you rent or own your home?

RentOwn
What is the monthly rental amount?
How long have you lived at the property?
# of months
Do you have documents that shows you paid for property taxes?

YesNo
Did you take money from your 401?

YesNo
Did you pay your vehicle tax?

YesNo
Do you have mortgage interest?

YesNo
Do you have real estate tax?

YesNo
Did you receive a federal tax last year?

YesNo
Are you a victim of identity theft?*

YesNo
Please fill-up the information within the current year only. ONLY IF APPLY TO YOU.

General 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
Educator expense
Alimony Paid
Ira Contributions
Gambling Losses
Moving Expense
Miles, Fuel, Travel & Lodging, Moving cost
Student loan interest paid

Child Care Provider's Information
Name

First NameLast Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Provider's SSN/EIN
Provider's Phone #
If more than one child, please indicate year-round cost for each child separately:
1st Child
2nd Child
3rd Child
4th Child

Taxpayer Incentives
To thank you for doing business with us which incentive would you prefer?

3 nights / 2day vacation$25

Acknowledgment & Signature
- I confirmed that all information I entered here is accurate and true.
- I allow Capitol Tax service 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 Capitol Tax service.
- By signing below, you acknowledge that you have read and understood your responsibilities and our responsibilities in doing this tax return.
Date Signed*

MonthDayYear
Date
Taxpayer Signature*

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Date Signed

MonthDayYear
Date
Spouse Signature

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