2023 Tax Preparation Client Intake Form

2023 Tax Preparation Client Intake Form
Are You a Returning Client?

YesNo
If You Were Referred, Please Type The Name of The Person That Referred You
Pick your Tax Preparer
Filing Status *

SingleHead of HouseholdMarried Filing SeparateMarried Filing JointQualifying Widower

Enter your dependents here

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

Are you contributing to 401k or other pre-tax account?

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

YesNo
Did you have any of the following income last year?

Interest/ Dividends (1099 INT, 1099 DIVUnemployment Compensationk1, Royalties, Lottery, DigitalDisability incomeOther
Does your dependents have tuition expenses?

YesNo
Do you have any expenses for child care?

YesNo
Did you purchase or install energy-efficient home items?

WindowsDoorsFurnaceOther
Do you have your own home?

YesNo
Do you have mortgage interest?

YesNo
Do you have documents that shows you paid for property taxes?

YesNo
Did you sell any stock?

YesNo
Did you take money from your 401?

YesNo
Did you pay your vehicle tax?

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 list if you have a IRS Pin number
Itemizing Expenses

ONLY COMPLETE IF YOU ARE NOT USING STANDARD DEDUTION

General Expenses (ONLY COMPLETE IF YOU ARE ITIMIZING)

	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
Investment Expenses
Supplies used as an eligible educator

Acknowledgment & Signature
- I confirmed that all information I entered here is accurate and true.
- I allow The Dependable Group LLC 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 The Dependable Group LLC.
- 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

Clear
Date Signed

MonthDayYear
Date
Spouse Signature

Clear
Should be Empty:

Itemizing Expenses