Client Intake Form 2023

TAXPAYER CLIENT INTAKE/INTERVIEW FORM

PLEASE FILL OUT ALL INFORMATION APPLICABLE In order for us to file your federal and state return, we need the following information. The information you provide to us will remain confidential. We value you as our client and promise not to share your information with any third-party vendors. This questionnaire has been divided into sections and may take you up to 30 minutes to complete. Organize all your tax documents and save yourself the hassle of having to come to our location to get your taxes done.
You will need:

• Social security cards or ITIN letters for all persons on your tax return.

• Picture ID (such as valid, unexpired Driver's License or State ID) for you and your spouse & all adult dependents on your tax return.

• Birth Certificates for all minor dependents on your tax return.

All income documents.

Please complete all pages of this form. You are responsible for the information on your return. Please provide complete and accurate information.

If you have questions, please contact us anytime. Text OR CALL us at the office anytime with further question's for faster reply! (OFFICE) 678.259.0211
Taxpayer Name*

First NameLast NameSuffix
Social Security Number*
Date of Birth*

MonthDayYear
Occupation*
DID YOU FILE A 2022 TAX RETURN?YES OR NO*
NEW CLIENTS ONLY UPLOAD 2022 TAX RETURN

Cancelof
DRIVER LICENSE

Cancelof
SOCIAL SECURITY CARDS

Cancelof
PROOF OF ADDRESS

Cancelof
BUSINESS INCOME

Cancelof
COLLEGE CREDIT FORM 1098-T

Cancelof
Email*
example@example.com
Spouse Information(ONLY IF FILING TOGETHER)

First NameLast NameSuffix
Social Security Number
Date of Birth

MonthDayYear
HAVE YOU BEEN ISSUED A TAXPAYER IP PIN BY THE IRS?*
Yes or No
Occupation
Email
example@example.com
Phone Number
Please enter a valid phone number.
Address*

NO P O BOX/ PHYSICAL ADDRESS ONLY

Street Address Line 2

CityState / Province

Postal / Zip Code
Filing Status:*

SingleMarried Filing JointlyMarried Filing SeparatelyHead of HouseholdQualifying Widow
HEAD OF HOUSEHOLD FILERS MUST PRESENT ONE OF THE FOLLOWING TO FILE THIS STATUS. PICK ONE OF THE 3 OPTIONS THAT YOU WILL SUBMIT TO BE APPROVED TO FILE HEAD OF HOUSEHOLD.

LeaseUtility BillMortgage Statement
Dependent 1

First NameLast NameSuffix
Relationship
Social Security Number
Date of Birth

MonthDayYear
Dependent 2

First NameLast NameSuffix
Relationship
Social Security Number
Date of Birth

MonthDayYear
Dependent 3

First NameLast NameSuffix
Relationship
Date of Birth

MonthDayYear
Social Security Number
Dependent 4

First NameLast NameSuffix
Relationship
Date of Birth

MonthDayYear
Social Security Number
Dependent 5

First NameLast NameSuffix
Relationship
Date of Birth

MonthDayYear
Social Security Number
Dependent 6

First NameLast NameSuffix
Relationship
Date of Birth

MonthDayYear
Social Security Number
If claiming son/daughter, where is the other parent of the dependent/dependents? Is the other parent providing any financial support?
IF YOU ARE CLAIMING A DEPENDENT, PLEASE ANSWER THE QUESTIONS BELOW THAT PERTAINS TO YOUR DEPENDENT RELATIONSHIP. PER THE IRS REQUEST, WE MUST PROVE THAT NOBODY ELSE IS ELIGIBLE TO CLAIM YOUR DEPENDENT BUT YOURSELF.
If claiming niece, nephew, aunt, or uncle, how are you related to the dependent? Where are the parents to the dependent/dependents?
If claiming brother or sister, how are you related to the dependent? Why are the parents not claiming the dependent/dependents?
How can you prove residency of your qualifying children? * Medical Record School Records Landlord or Property Record Statements None Other:

How can you prove residency of your qualifying children? * Medical Record School Records Landlord or Property Record Statements None Other:
Did you pay someone to watch your child/children?

YESNOOther
Person or Daycare information need if a business the EIN or Social security number is required. If it's a change please provide if no change and you filed your taxes with us last year it's no need to provide information.

YESNOOther
Did you collect social security or retirement income?

YESNO
Did you purchase health insurance through healthcare.gov marketplace (Obama Care)?*

YesNo
If yes, did you receive a 1095-A Form from the marketplace?

YesNo
Were you ever disallowed the E.I.T.C prior to this year?*

YesNo
Did you receive unemployment compensation (1099-G) regular or PUA last year?*

YESNO
Did you make college tuition payments and received a 1098-T Form last year?*

YESNO
Did you receive unemployment compensation (1099-G) regular or PUA last year?*

YESNOOther
Do you have a business?*

YESNOOther
YESNOOther
Do you owe any delinquent:*

Child SupportAlimonyStudent LoansBack TaxesState TaxesNone of the above
How would you like to receive your refund?*

Refund Transfer Direct DepositRefund Transfer Debit CardRefund Transfer Paper Check

Bank Information

	Name of Bank	Routing Number	Account Number
ENTER BANK DATA

I, hereby, state that all the information above is true to the best of my knowledge and that I am allowing Certified Tax Pros LLC to prepare my taxes based on that fact. I understand that I am financially responsible for any outstanding balance due to any false information given. If there is a balance due, you must pay the tax preparation fee upfront. If for any reason you owe an entity and they take the entire refund, you are STILL responsible to pay the tax preparation fee for services rendered. *For any reason an amendment has to be filed with no fault of the tax preparer, an upfront fee of $99.00 is required! Please view your tax return, which is emailed to you (it is sent prior to submission). Any copy after the first copy is a fee of $10.00. ALL FEES (bank and service fees) are found in the return and are non-refundable nor negotiable! Please utilize www.irs.gov for all federal refund tracking. Please utilze your state Department of Revenue site for any State Refund tracking. Do NOT add the amounts together. Federal taxes are federal, and state taxes are state when tracking your status. Please allow 8 weeks to surpass from the date of submission before calling the IRS, if you have any tracking questions. For any direct assistance please email taxproshelp@icloud.com IRS Contact 800-829-1040 Please click this link to check your federal refund status. You will need your filing status, social security number, and the total amount of the refund before fees https://sa.www4.irs.gov/irfof/lang/en/irfofgetstatus.jsp
CONSENT TO DISCLOSURE OF TAX RETURN INFORMATION
For the purposes of this consent form, “we,” “us,” and “our” mean

Certified Tax Pros ___________________
(Printed Name of Tax Preparer)

Federal law requires this consent form be provided to you. Unless authorized by law, we cannot disclose your tax return information to third parties for purposes other than the preparation and filing of your tax return without your consent. If you consent to the disclosure of your tax return information, Federal law may not protect your tax return information from further use or distribution.

You are not required to complete this form to engage in our tax preparation services. If we obtain your signature on this form by conditioning our services on your consent, your consent will not be valid. If you agree to the disclosure of your tax return information, your consent is valid for the amount of time that you specify. If you do not specify the duration of your consent, your consent is valid for one year from the date of signature.

You have indicated that you are interested in receiving an Electronic Disbursement Service and/or Loan (or collectively, “Products or Services”) from Refund Advantage, a division of MetaBank, National Association. In order to provide you with the opportunity to apply for one of these Products or Services, we must disclose all of your 2023 tax return information necessary for evaluating the request to Refund Advantage. If you request a more limited disclosure of tax return information, you will not be eligible to submit an application request for these Products or Services. If you would like us to disclose your 2023 tax return information for this purpose, please sign and date your consent to the disclosure of your tax return information.

By signing below, you authorize us to disclose to Refund Advantage all of your 2023 tax return information necessary for the evaluation and processing of your request for a Product or Service. You understand that if you are unwilling to authorize the disclosure and sharing of your tax return information with Refund Advantage, you will not be able to obtain a Product or Service, but you may still choose to have your tax return prepared and filed by us for a fee.

Printed Name of Taxpayer: _____________________________________________________

Taxpayer Signature: ___________________________________ Date:_________________

Printed Name of Joint Taxpayer (if applicable): ______________________________________

Joint Taxpayer Signature (if applicable): ____________________ Date:_________________

If you believe your tax return information has been disclosed or used improperly in a manner unauthorized by law or without your permission, you may contact the Treasury Inspector General for Tax Administration (TIGTA) by telephone at 1-800-366-4484, or by e-mail at complaints@tigta.treas.gov.
Signature*

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MonthDayYear
Name

First NameLast Name
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TAXPAYER CLIENT INTAKE/INTERVIEW FORM

How can you prove residency of your qualifying children? * Medical Record School Records Landlord or Property Record Statements None Other: