2023 Intake Forms

2023 Tax Intake Form

TAXPAYER
Social Security Number*
Name*

First NameLast Name
MI
Date of Birth*

MonthDayYear
Date
Date of Death

MonthDayYear
Date
Work Phone
Cell/Other Phone*
Occupation*
Email*
example@example.com
Legally Blind?*

YesNo
Dependent of Other?*

YesNo
SPOUSE
Social Security Number
First Name
MI
Last Name
Date of Birth

MonthDayYear
Date
Date of Death

MonthDayYear
Date
Work Phone
Please enter a valid phone number.
Cell/Other Phone
Occupation
Email
example@example.com
Legally Blind?

YesNo
Dependent of Other?

YesNo
Filing Status*

SingleMarried Filing JointMarried Filing SeparatelyHead of HouseholdQualifying Widower
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
County*
DEPENDENTS
First, Middle initial, Last Name /D.O.B /Social Security Number /Relationship
AFFORDABLE CARE ACT
Did everyone on this tax return have health insurance all 12 months last year?*

YesNO
If no, were you exempt?*

YesNo
If yes, Coverage through
Taxpayer *
Spouse*
Dependent 1*
Dependent 2*
Dependent 3*
Dependent 4*
**If not covered for all 12 months, Please provide Form 1095-A & complete Affordable Care Detail Intake Form.
REFUND TYPE
The following products require fees paid at time of service:*

E-FILE (DIRECT DEPOSITE): Your refund will be deposited into your savings or checking account directly from IRS approximately 10-14 days after your return is accepted by IRS.3-4 WEEKS E-FILE (CHECK): Your refund will be mailed to you directly from IRS in approximately 3 4 weeks after your return is accepted electronically by the IRS.MAIL A PAPER RETURN: Your refund will be mailed to you directly from IRS in approximately 6-8- weeks after your mail your return to the IRS
How do you want your refund? (Select one of the following)*

7-14 days (RT Refund Transfer: Check) In about 7-14 days from the date your return is accepted electronically by the IRS, you receive a check for the amount your refund less filing fees. (Check will be available in our office)7-14 days (RT Refund Transfer: Debit Card) In about 7-14 days from the date your refund is accepted electronically by the IRS, for the amount your refund less filing fees will be deposited onto the debit card we issued you.7-14 days(RT Refund Transfer: Direct Deposit): In about 7-14 days from the date your refund is accepted electronically by the IRS, for the amount your refund less filing fees will be deposited into your bank account.N/A
Signature*

Clear
Date*

MonthDayYear
Date
Tax Client Photo ID and Voided Check - Required!
Taxpayer Name*
Taxpayer SSN*
Photo ID #1 -REQUIRED*

Cancelof
1 Other Form of ID

Cancelof
Spouse Name
Spouse SSN
PHOTO ID #1- REQUIRED

Cancelof
1 Other Form of ID

Cancelof
Place Voided Check Here (only if you selected Direct deposit on page - 2)

Cancelof
I hereby authorize the use of this identification above to electronically file my federal tax return according to IRS publication 1345
Taxpayer Signature*

Clear
Date*

MonthDayYear
Date
Spouse Signature

Clear
Date

MonthDayYear
Date
Due Diligence Questionnairee
How many people live with you?*
Adults?*
Children?*
Did anyone else help support your during the year?*

YesNo
If yes, who? (If Not Applicable type NA)*
How much$?*
Are any of the Dependents being claimed NOT your Son or Daughter?*

YesNo
If Yes, Provide proof of financial responsibility or residency (i.e copy of lease, medical records, school records, food stamps or benefit statements)

Cancelof
If Yes, Why are parents not claiming the child? (Please explain and list the child's name(s) if more than one listed on the return)
Did you have any other income during the year? (Child support, alimony)*

YesNo
If yes, Please specify
If claiming the Education Credit - Please list the years you have used on prior returns: If used more than four (4) years, we will convert it from the American Opportunity Credit to the Lifetime Learning Credit, which has no expiration in years.
Other comments
Please send Tax Documents to: info@atoandsolutionsgroup.com
Should be Empty:

2023 Tax Intake Form

SPOUSE

DEPENDENTS

AFFORDABLE CARE ACT

REFUND TYPE

Tax Client Photo ID and Voided Check - Required!

Due Diligence Questionnairee