Tax Client Intake Form
Personal Information
Name
*
First Name
Last Name
Date of Birth
*
-
Month
-
Day
Year
Date
SSN
*
Phone Number
*
Please enter a valid phone number.
Email
*
example@example.com
Current Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Filing Status
*
Single
Head of Household
Married Filing Separately
Married Filing Jointly
Citizenship & Residency Status (Select one)
*
Please Select
U.S. Citizen
Resident Alien
Non-Resident Alien
Occupation
*
Spouse Information
Name
First Name
Last Name
Date of Birth
-
Month
-
Day
Year
Date
SSN
Email
example@example.com
Phone Number
Please enter a valid phone number.
Current Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Occupation
Citizenship & Residency Status (Select one)
Please Select
U.S. Citizen
Resident Alien
Non-Resident Alien
Home Purchases & Refinances (2025)
Did you buy or refinance a home in 2025?
*
Yes, bought a home
Yes, refinanced
No
Upload Closing Disclosure (CD) and Form 1098 (mortgage interest statement):
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Did you pay discount points to reduce your interest rate?
Yes
No
Not sure
What month/year did you close on the property?
Is this your primary residence?
Yes
No
Vehicle Purchases (2025)
Did you purchase a vehicle in 2025?
*
Yes, new vehicle
Yes, used vehicle
No
What type of vehicle did you purchase?
Gas
Hybrid
Plug-in Hybrid
Fully Electric Vehicle (EV)
Was the vehicle used for business purposes?
Yes
No
Mixed use
If business or mixed use: What % of your total miles were business-related in 2025?
Do you have a mileage log?
Yes
No
Upload Purchase agreement, 1098-VLI (if received), Mileage log (if business use):
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EV Purchases (2025)
Did the dealer provide a Clean Vehicle Seller's Report?
Yes
No
Upload Seller's Report:
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Was the vehicle placed in service in 2025?
Yes
No
Was the vehicle purchased for personal use, business use, or both?
Personal
Business
Both
Crypto/Digital Assets (New 1099-DA)
Did you buy, sell, trade, exchange, or hold digital assets (crypto, NFTs, tokens) in 2025?
*
Yes
No
Please upload your exchange statements and any 1099-DA forms received:
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Additional Information
Are you claiming any dependents?
*
Yes
No
Enter your dependents here
Name
SSN
Date of Birth
Relationship
1
2
3
4
Does you, your spouse, and/or your dependents have health insurance within 12 months last year? If yes, who covers for it?
Yes/No
Employer
Exchange/ Marketplace
Direct with Insurer
Medicare
Medicaid
Taxpayer
Yes
No
Spouse
Yes
No
Dependent 1
Yes
No
Dependent 2
Yes
No
Dependent 3
Yes
No
Dependent 4
Yes
No
Do you have any expenses for child care?
Yes
No
How much did you pay in child care?
Please provide the name, address, and social security number or EIN # of your childcare
Are you currently renting?
Yes
No
What is the monthly rental amount?
Do you have your own home?
Yes
No
Do you have documents that shows you paid for property taxes?
Yes
No
Do you have mortgage interest?
Yes
No
Did you file a federal tax return for 2024?
*
Yes
No
Did you receive unemployment in 2025?
*
Yes
No
Did you purchase a health plan through the Health Insurance Marketplace in 2025?
*
Yes
No
Did you (or your spouse) take money out of a retirement account in 2025 (e.g., 401k, IRA, pension, annuity)?
*
Yes, I withdrew money from a retirement account
No, I did not
**You MUST submit form 1095-A below. If you have not received the form, call 1-800-318-2596.
Are you a victim of identity theft?
Yes
No
Upload picture of Drivers License, State ID, or Passport (include spouse if applicable)
*
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Upload ALL tax documents here:
*
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(W-2, 1099-NEC, 1099-INT, 1099-DIV, 1099-R, 1099-G, 1099-K, SSA-1099, 1095-A, etc.) Include spouse documents if filing jointly.
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Upload picture of Dependents Social Security Card(s)
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Upload SSN card or immigration/work authorization document
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General Expenses
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
Tax Preparation Fees
Investment Expenses
Referral Name (if applicable) and Additional Comments
If someone referred you, please enter their first name here, followed by any additional comments.
Acknowledgment & Signature
I confirmed that all information I entered here is accurate and true.
I allow Empire Tax Solutions 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 Empire Tax Solutions.
By signing below, you acknowledge that you have read and understood your responsibilities and our responsibilities in doing this tax return.
Client Signature
*
Date Signed
*
-
Month
-
Day
Year
Date
Spouse Signature
Date Signed
-
Month
-
Day
Year
Date
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