New Tax Client Intake Form 2023

New Tax Client Intake Form 2023

PLEASE FILL OUT INFORMATION COMPLETLY
Are you filing jointly?*

YesNo
Tax Payer Name*

First NameLast Name
Spouse Name

First NameLast Name
Tax Payer SSN*
Spouse SSN
Tax Payer Occupation*
Spouse Occupation
Tax Payer Phone Number*

Area CodePhone Number
Spouse Phone Number

Area CodePhone Number
Tax Payer Date of Birth*

MonthDayYear
Date
Email*
example@example.com
Spouse Date of Birth

MonthDayYear
Date
Tax Payer Address*

Street Address

County

CityState / Province

Postal / Zip Code
Spouse Address (Enter "SAME" if same as Tax Payer Address)

Street Address

County

CityState / Province

Postal / Zip Code
Was this your address all of 2023? If no, please enter previous address
Tax Payer Driver's License Information*
Spouse Driver's License Information*
Marital Status at 12/31/2023*

SingleMarriedSeparatedWidow(er) with Qualifying DependentRegistered Domestic Partnership
Do you owe any of these back taxes that might offset your refund?*

NoChild supportFederal or state taxesOther
Have you received any notices from the IRS or state revenue department within the past year?*

YesNo
Were you disallowed the Earned Income Tax Credit prior to this year?*

YesNo
Do you owe student loans that are in default status?*

YesNoNot sure
Are you claiming any dependents?*

YesNo
Dependent 1
Dependent 2
Dependent 3
Dependent 4
Do any of the children have a disability*

YesNoN/A
Is it anticipated that a different taxpayer will seek to claim a child listed above as their dependent for tax year 2023?*

YesNoN/A
Lifestyle and Taxes- Select all that apply
Children and Education- Select all that apply
Business- Select all that apply
Do you want to apply for Refund Advance?*

YesNo
If you need to itemize deductions, please provide amounts and/or receipts to your Tax Specialist. These amounts can include, but are not limited to, Medical Expenses, Taxes Paid, Interest Paid, Charitable Contributions, Casualty and Theft Losses and other Miscellaneous Itemized Deductions.

Please provide to your Tax Specialist all forms W2, 1099-INT, 1099-DIV, 1099-R, 1099-MISC, and other income reporting statements. Social security cards, unexpired goverment issued ID, utility bill or lease for someone claiming Head of Household.
PRIVACY POLICY

The nature of our work requires us to collect certain nonpublic information. We collect financial and persoanl information from applications, worksheets, reporting statements, and other forms, as well as interviews and conversations with our clients and affiliates. We mat also review banking and credit card information about our clients int he performance of receipt of payment. Under our policy, all information we obtain about you will be provided by you or obtained with your permission.

Our firm has procedures and policies in pklace to protect your confidential information. We restrict access to your confidential information to those within our firm who need to know in order to provide you with services. We will not disclose your personal information to a third party without your permission, except where required by law. We maintain physical, electronic, and procedural safeguards in compliance with federal regulations that protect your personal infromation from unauthorized access
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I agree that all information provided is true and factual. I understand that falsifying information is against the law. I agree that upon completion of my tax return, if my return is intercepted and not paid, I am responsible for all preparation fees to be paid to my Tax Specialist*

I AgreeI Disagree
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