2023 Tax Year A Superior Tax Service Client Intake Form

2023 Tax Year A Superior Tax Service Client Intake Form
ATTENTION, PLEASE UPLOAD ALL DOCUMENTS HERE!!! Driver's License, SS Card for you and your dependents, Birth Certificates for dependents and if filing a relative Birth Certificates for you and that persons parent which links you as a relative, Shot Records or School Record, Light Bill or Rent Statement. Income: All income documents and tax deduction forms W-2, 1099, 1098-T / School Documents, Childcare Statements, If you had Insurance through the Healthcare Market we will need your 1095A form you can call 1-800-318-2596. Please gather all your documents before filing this form out.

Tax related documents include: W-2, 1099, 1098-T, 1095A and etc.
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Would you like to apply for the Cash Advance up to $7,000.00?
Filing Status
Did you receive an Identity Protection Pin Number?
“Your Name” Primary Taxpayer

First NameLast Name
Birth Date

MonthDayYear
Date
Primary Taxpayer Social Security Number
Format 123-45-6789
Cell Phone
Format: (000) 000-0000.
Home Phone
Format: (000) 000-0000.
Work Phone
Format: (000) 000-0000.
Occupation
Job Title
Email Address
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Did you live at this address 6 months or more? Yes or No
Spouse Information

If you do not have a spouse please continue to the next page.
Spouse Name

First NameLast Name
Birthdate

MonthDayYear
Date
Social Security Number
Format 123-45-6789
Phone Number
Format: (000) 000-0000.
Email Address

Dependents

Child Care Provider

Select Yes or No

Rows	Yes/No
The Taxpayer's Son, Daughter, or adopted child, or A child of the Taxpayer's son, daughter or adopted child, or The Taxpayer's stepchild, or The Taxpayer's Brother, Sister, Stepbrother, Stepsister, Half brother, or Half sister or The Taxpayer's eligible foster child?
If the child is married, are you claiming this child as a dependent? (If child is not married, then simply mark yes)
Did the child live with you in the United States for over half of the year, or The full year if the child is an eligible foster child?
Was the child, at the end of the year: Under age 19 OR Under age 24 and a full-time student OR Any age and permanently and totally disabled?
Could any other person check "Yes" on questions 1 through 4 for the child?
Was your main home, and your spouse if filing jointly, in the United States for more than half the year?

Select Yes or No

Rows	Yes/No
You were NOT married on or before December 31, 2023?
Your dependents lived with you less than 6 months during the year,
You were NOT married as of December 31, 2023.Your child, foster child, grandchild, niece or nephew, or sister or brother lived with you more than 6 months.
You were married as of December 31, 2023 or your spouse died during 2023.
You were married on or before December 31, 2023 and your spouse is filing a tax return using MFS.
If MFS, did you live together at ANY time during the tax year?If yes, did you live together during the final 6 months?
If MFS, did your spouse itemize his/her deductions?
Your spouse died during either 2022 or 2023, and Your child, stepchild or foster child lived with you for 12 months in 2023.

Rows	Yes	No
Can you or your spouse be filed on another tax return?
Have you or your spouse been a victim of Identity Theft? If so include Pin.
Have you or your spouse adopted a child?
Were you or your spouse a full-time student in 2023?
Were you or our spouse totally or permanently disabled in 2023?
Do you or your spouse have Healthcare Insurance?

Rows	Yes	No	How many?
Self-Employment income?(Form 1099-MISC, Cash)
Unemployment Compensation? (Form 1099-G)
Social Security/Disability Income?
Distribution of Pension, Annuities, and/or IRA?
Other Income such as gambling,lottery,awards, or jury duty?
W-2? If so How Many

Rows	Yes	No
Alimony?
Post-secondary educational for yourself, spouse, or dependents? (Form 1098-T)
Medical Expenses? (Including health insurance premiums)
Charitable contributions?
Child or dependent care expenses such as daycare?
Supplies used as an eligible educator? (Teacher, teacher aide, or counselor)

Rows	Yes	No
Health Savings Account?
Have debt from a mortgage or credit card cancelled/forgiven by a commercial lender?
Buy, sell or have a foreclosure (COD) of your home? (Form 1099-A
Have EIC been disallowed in a prior year?
Purchase and install energy-efficient home items? (Such as windows,furnace, and insulation)
Live in an area that was affected by a natural disaster?
Receive the First Time Homebuyers credit in 2008?
Pay any student loan interest? (Form 1098-T)
Did you receive Health/Dental Insurance through Marketplace “Healthcare.gov” 1095-A

Spouse Information