Client Intake Form

1
How did you hear about us?
Facebook
Instagram
Referral
2
If someone referred you, please type his or her name here.
3
Did you file a 2024 tax return?* This field is required.
Yes
No
Unsure
4
Filing Status:* This field is required.
Single
Head of Household
Married Filing Separate
Married Filing Jointly
Qualifying Surviving Spouse
5
Tax Payers Name* This field is required.
First Name
Last Name
6
Taxpayer's Date of Birth* This field is required.
Date
Month
Day
Year
7
Taxpayer's SSN* This field is required.
Example: xxx-xx-xxxx
8
Taxpayer's Phone Number* This field is required.
Example: xxx-xxx-xxxx
9
Taxpayer's Job Title
10
Taxpayer's Email Address* This field is required.
example@example.com
11
What is your marital status as of December* This field is required.
Single (Not Married)
Married living with Spouse
Married not living with spouse
12
Did you and your spouse live apart during the year?* This field is required.
Yes
No
Not Applicable
13
Spouse's Full Name* This field is required.
Full Name
14
Spouse's SSN* This field is required.
Example: xxx-xx-xxxx
15
Spouse's Date of Birth* This field is required.
Date
Month
Day
Year
16
Spouse's Job Title
example@example.com
17
Home Address* This field is required.
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Please Select
Please Select
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
The Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
Brazil
Brunei
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos (Keeling) Islands
Colombia
Comoros
Congo
Cook Islands
Costa Rica
Cote d'Ivoire
Croatia
Cuba
Curaçao
Cyprus
Czech Republic
Democratic Republic of the Congo
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Polynesia
Gabon
The Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
North Korea
South Korea
Kosovo
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macau
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Nagorno-Karabakh
Namibia
Nauru
Nepal
Netherlands
Netherlands Antilles
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
Turkish Republic of Northern Cyprus
Northern Mariana
Norway
Oman
Pakistan
Palau
Palestine
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn Islands
Poland
Portugal
Puerto Rico
Qatar
Republic of the Congo
Romania
Russia
Rwanda
Saint Barthelemy
Saint Helena
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
Somaliland
South Africa
South Ossetia
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard
eSwatini
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Transnistria Pridnestrovie
Trinidad and Tobago
Tristan da Cunha
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
Uruguay
Uzbekistan
Vanuatu
Vatican City
Venezuela
Vietnam
British Virgin Islands
Isle of Man
US Virgin Islands
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Other
Country
18
Did you pay over half the expenses of maintaining your home for the entire year?* This field is required.
Yes
No
19
Did you support a child or family member for more than 6 months out of the year?* This field is required.
Yes
No
20
How many dependents are you claiming?* This field is required.
0
1
2
3
4
5
21
Dependent #1* This field is required.
First Name
Last Name
22
Dependent #1 Date of Birth* This field is required.
01/01/2001
23
Dependent #1 SSN* This field is required.
24
What is Dependent #1's Relationship to you (son, daughter, etc.)?* This field is required.
25
How many months did Dependent #1 live with you in 2025? (If all year, enter 12)* This field is required.
26
Dependent #2
First Name
Last Name
27
Dependent #2 Date of Birth* This field is required.
Example: 01/01/2001
28
Dependent #2 SSN* This field is required.
29
What is Dependent #2's Relationship to you (son, daughter, etc.)?* This field is required.
30
How many months did Dependent #2 live with you in 2025? (If all year, enter 12)* This field is required.
31
Dependent #3* This field is required.
First Name
Last Name
32
Dependent #3's Date of Birth * This field is required.
01/01/2001
33
Dependent #3s SSN* This field is required.
Example: xxx-xx-xxxx
34
What is Dependent #3's Relationship to you (son, daughter, etc.)?* This field is required.
35
How many months did Dependent #3 live with you in 2025? (If all year, enter 12)* This field is required.
36
Dependent #4's First Name* This field is required.
First Name
37
Dependent #4's Last Name* This field is required.
Last Name
38
Dependent #4's Date of Birth * This field is required.
01/01/2001
39
Dependent #4's SSN* This field is required.
Example: xxx-xx-xxxx
40
What is Dependent #4's Relationship to you (son, daughter, etc.)?* This field is required.
41
How many months did Dependent #4 live with you in 2025? (If all year, enter 12)* This field is required.
42
Dependent #5's First Name* This field is required.
First Name
43
Dependent #5's Last Name* This field is required.
Last Name
44
Dependent #5's Date of Birth * This field is required.
01/01/2001
45
Dependent #5's SSN* This field is required.
Example: xxx-xx-xxxx
46
What is Dependent #5's Relationship to you (son, daughter, etc.)?* This field is required.
47
How many months did Dependent #5 live with you in 2025? (If all year, enter 12)* This field is required.
48
Can someone else claim you as a dependent?* This field is required.
Yes
No
49
Are there any dependents in daycare? If yes, please upload the form you received from your daycare provider.
Yes
No
50
Upload a copy of your daycare form here.
Drag and drop files here
Select files to upload
Max. file size: 10.6MB
Cancelof
51
Were you or any of your dependents in college in 2025?
Yes
No
52
Do you have a 1098-T Form for either you or your dependents?
Yes
No
53
If you have a 1098-T form, upload it here.
Drag and drop files here
Select files to upload
Max. file size: 10.6MB
Cancelof
54
Did you have Marketplace health insurance in 2025? (health insurance through your state)* This field is required.
Yes
No
55
Upload Form 1095-A
Drag and drop files here
Select files to upload
Max. file size: 10.6MB
Cancelof
56
Healthcare Card for Taxpayer(s) and Dependent (s)
Drag and drop files here
Select files to upload
Max. file size: 10.6MB
Cancelof
57
Have you ever been denied the Earned Income Tax Credit (EITC)?
Yes
No
58
Did you trade any Virtual Currency?
Yes
No
59
Are you self employed?* This field is required.
Yes
No
60
Only as it applies: Self-Employment Expense Log, Summary if Income, Business License, Bank Statements, receipts, etc
Drag and drop files here
Select files to upload
Max. file size: 10.6MB
Cancelof
61
Are you interested in AUDIT PROTECTION?
Yes
No
62
Taxpayer's Driver's License
Drag and drop files here
Select files to upload
Max. file size: 10.6MB
Cancelof
63
Taxpayer's and Dependent(s) Social Security Card(s)
Drag and drop files here
Select files to upload
Max. file size: 10.6MB
Cancelof
64
Taxpayer's W-2/ 1099'S/ETC
Drag and drop files here
Select files to upload
Max. file size: 10.6MB
Cancelof
65
Dependent(s) Birth Certificate(s)
Drag and drop files here
Select files to upload
Max. file size: 10.6MB
Cancelof
66
Dependent(s) Proof of Residency (Lease/Utility Bill)
Drag and drop files here
Select files to upload
Max. file size: 10.6MB
Cancelof
67
How would you like to receive your tax refund?* This field is required.
Bank Product: Direct Deposit
Bank Product: Printed Check
Efile: Direct Deposit
Efile: Paper Check
Paper Return
68
Would you like to apply for a cash advance?* This field is required.
Yes, up to $6,000
Yes, $1,000 up to $6,000
No
69
Name of Bank* This field is required.
70
Which type of account would you like your refund deposited into?* This field is required.
Checking Account
Savings Account
Other
71
Routing Number
72
Bank Account Number
73
You certify that all answers on this form are, to the best of your knowledge, true, correct and complete.*
Yes
No
74
Due Diligence Agreement:

By signing below, the client affirms that all information, figures, documents, and responses provided are true, correct, and complete to the best of their knowledge. The client acknowledges that LAT Financial Group and its affiliate TC3Three Enterprises rely exclusively on the information supplied by the client in preparing tax-related services.

The client further acknowledges that, in the event of an IRS or state audit, inquiry, or examination, the client is solely responsible for maintaining and providing adequate documentation and substantiation to support the amounts and representations provided. The client releases and holds harmless LAT Financial Group and its affiliate TC3Three Enterprises from any liability, penalties, interest, or adverse outcomes resulting from inaccurate, incomplete, or misleading information supplied by the client.

Abandonment Clause:

By signing below, the client acknowledges and agrees that if the client fails to respond, provide requested documentation, or complete required actions within 48 hours, the engagement will be deemed inactive or terminated for failure to proceed. In such event, the client expressly authorizes a non-refundable $99 fee to be charged via ACH to the payment method on file, representing administrative time, work performed, and opportunity costs. This fee does not guarantee completion, filing, or continuation of services.
75
Primary Taxpayer's Signature* This field is required.
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76
Date* This field is required.
Date
Month
Day
Year
77
Spouse's Signature (If no spouse, leave blank)
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78
Date
Date
Month
Day
Year
Should be Empty: