CONTACT US
Phone: 904-699-3983 | Tax Year: 2024
CLIENT INTAKE FORM
(To Be Completed Before E-Filing Tax Return)
PERSONAL INFORMATION
To ensure we have the information we need to best serve you, please take a few minutes to fill out the form below. If you have any questions, please feel free to contact us at any time. Thank you!
Referred By:
Please Select
DYNASTY HAMILTON
HEAVEN DAWN
MONIQUE RUSSELL
CIARA BROWN
MARTI REED
SHANA BROWN
Ladana Hyman
Britain Davis
Winnifer Biegon
India Caldwell-Cox
Nicole Caligone
Courtney Butler
Select the name of your Tax Referrer
Today’s Date:
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Day
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Month
Year
Date
Client’s Full Legal Name:
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First Name
Last Name
Client’s Social Security Number:
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Client’s Date Of Birth:
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Day
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Month
Year
Date
Spouse’s Full Legal Name:
First Name
Last Name
Spouse’s Social Security Number:
Spouse’s Date Of Birth:
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Day
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Month
Year
Date
Current Address (please include zip code):
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Current Home Phone Number:
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Area Code
Phone Number
Current Cell Phone Number:
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Area Code
Phone Number
Spouse’s Cell Phone Number:
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Area Code
Phone Number
Email Address:
example@example.com
Spouse’s Email Address:
example@example.com
Current Occupation:
Your Spouse’s Current Occupation:
Have you been a victim of identity theft and been given an identity theft protection PIN by the IRS? If yes, enter the six digit identity protection PIN number.
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Has the spouse been a victim of identity theft and been given an identity theft protection PIN by the IRS? If yes, enter the six digit identity protection PIN number.
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Were you, your spouse, or any of your dependents Enrolled at least part time in an accredited College, Trade School or University in 2024?
Name of accredited College, Trade School or University?
What SCHOOL DISTRICT did you live in as of December 31, 2024?
Did you file your 2024 Tax Return ?
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Yes
No
Did you receive your expected refund ?
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Yes
No
Have you ever had EARNED INCOMECREDIT DISALLOWED by the IRS?
Yes
No
Was your tax return completely offset last year?
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Yes
No
Will you be filing more than one STATE return? If so, WHICH STATE
DEPENDENT INFORMATION
(To Be Completed By All Taxpayers With Dependents)
Are you claiming any dependents that you provided MORE THAN HALF the support for? If so, fill out their information below:
Dependent #1: Full Legal Name, Relationship to Taxpayer, Social Security Number, Date of Birth, Full Legal Name(s) of Biological Parent(s), How long did the dependent live in your home during the tax year?
Dependent #2: Full Legal Name, Relationship to Taxpayer, Social Security Number, Date of Birth, Full Legal Name(s) of Biological Parent(s), How long did the dependent live in your home during the tax year?
Dependent #3: Full Legal Name, Relationship to Taxpayer, Social Security Number, Date of Birth, Full Legal Name(s) of Biological Parent(s), How long did the dependent live in your home during the tax year?
Do you have joint custody of the above listed DEPENDENT(S)?
Yes
No
Do you have a signed IRS Form 8332?
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Yes
No
Per IRS new guidelines, please indicate where the dependent’s Non-Custodial parent/parents are and why they will not be filing this dependent?
Will you claim the CHILD CARE DEDUCTION for this Tax year? If so, Full Legal Name, Social Security (Tax ID), Address and Amount per child paid:
Do you receive ANY supplemental, Nontaxable income such as child support, Food stamps, Medicaid/ Medicare, TANF, Social security, or disability if so, how much?(Please list each type that applies along with the amount)
Have you traded, engaged in any stocks or any crypto currency (for example: Coinbase, Robinhood, Cashapp, etc?
Yes
No
REAL ESTATE AND VEHICLES
(To Be Completed By All Taxpayers With Dependents)
Are you a homeowner? Did you purchase your first home in 2024? Enter amount IF YES:
Did you pay real estate taxes in 2024? IF YES enter AMOUNT:
Did you pay Property Taxes for your home in 2024? Enter amount IF YES:
Did you pay Mortgage Interest for your home in 2024? Enter amount IF YES:
Did you make any ENERGY IMPROVEMENTS to your MAIN HOME in 2024? IF YES enter AMOUNT:
Did you pay upkeep and repair expenses for your home in 2024? If Yes enter AMOUNT:
Did you pay for Property Insurance for your home in 2024? IF YES enter AMOUNT:
Did you RENT? IF YES, how many months and the AMOUNT paid in 2024:
Did you pay renters insurance? AMOUNT paid in 2024:
Did you purchase a NEW VEHICLE after February 16, 2024? IF YES enter AMOUNT:
Amount, IF any personal property taxes:
Amount of any significant MEDICAL/ DENTAL expenses:
Amount IF any cash- non-cash contributions to CHARITY in 2024:
Amount IF any rental income property in 2024?
DISABLED
(To Be Completed By All Taxpayers With Dependents)
Are you, your spouse, or any dependent listed on your tax return disabled?
Yes
No
What is the nature of the disability?
Has this dependent been declared disabled by a physician? If so, can you provide documentation?
Are you or your spouse listed as the Social Security Representative Payee for this dependent?
Is this the dependent(s) expected to recover in the next year?
Yes
No
Will you claim the DEPENDENT CARE DEDUCTION for the disabled dependent If so, Full Legal Name, Social Security (Tax ID), Address and Amount per disabled dependent paid:
Did you pay out of pocket for any uncovered Medical Expenses for the disabled dependent, if so, enter the amount for the year?
Did you pay child support in 2023?
Did you have any PAST TAX RETURNS not get disbursed to you?
Taxpayer's Signature
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Taxpayer's Spouse’s Signature
Date
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Month
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Day
Year
Date
DIRECT DEPOSIT
(To Be Completed By All Taxpayers With Dependents)
Name of Bank:
Account Number:
Routing Number:
Signature of Taxpayer
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Date
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Month
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Day
Year
Date
REFERRAL SHEET
We continue to grow our business through loyal customers like you. Please look in your cellphones and provide us with at least 3 names and phone numbers of people needing assistance in preparing their taxes and getting back the maximum amount of money they are legally entitled as such it is imperative to us that you leave at least 1 referral:
Phone Number:
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Name:
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