Fill out the questions on this intake form truthfully and to the best of your ability.
Name associate that's filing you.
Filing Status
Single
Head of Household
Married Filing Separate
Married Filing Joint
Qualifying Widower
What year you need to file?
2023
2022
2021
2020
If somebody referred you, please type his or her name here.
Taxpayer Information
Name
First Name
Last Name
Date of Birth
-
Month
-
Day
Year
Date
Phone Number
Please enter a valid phone number.
Email
example@example.com
SSN
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Occupation
If you used an IP PIN in prior years, you'll need one again this year to complete your filing. (Enter IP PIN below)
SPOUSE INFORMATION
IF THIS SECTION DOES NOT APPLY TO YOU, PLEASE SKIP TO THE NEXT SECTION.
Name
First Name
Last Name
Age
Date of Birth
-
Month
-
Day
Year
Date
Phone Number
Please enter a valid phone number.
Email
example@example.com
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Occupation
SSN
Dependents
IF THIS SECTION DOES NOT APPLY TO YOU, PLEASE SKIP TO THE NEXT SECTION.
Enter your dependents here :
Name
SSN
Date of Birth
Relationship
1
2
3
4
5
6
Does you, your spouse, and your dependents have health insurance within 12 months last year? If yes, who covers for it?
Yes/No
Employer
Spouse Ins
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
Dependent 5
Yes
No
Does your dependents have tuition expenses?
Yes
No
Can somebody claim you as a dependent?
Yes
No
Do you have any expenses for child care? If, yes please upload the form you recieved for your daycare provider.
Yes
No
If requested by the IRS, do you have documentation ( I.e. receipts, records) to substantiate your eligibility for the Child Tax Credit, Earned Income Tax Credit and/or Head of Household filing Status?
Yes
No
WHAT IS YOUR EMPLOYMENT STATUS ?
IF THIS SECTION DOES NOT APPLY TO YOU, PLEAS.E SKIP TO THE NEXT SECTION.
Employed ( W2, 1099, ETC)
Self Employed ( Business, Side Business, Etc
Unemployed
INCOME
IF THIS SECTION DOES NOT APPLY TO YOU, PLEASE SKIP TO THE NEXT SECTION.
Please select all forms of Income.
W2
1099-SSA
1099-DIV
1099-MISC
1099-K
W2G
1099R
1099G
1099C
Do you plan on purchasing a home in the next 2 years?
Yes
No
Are you a full-time student?
Yes
No
Are you contributing to 401k or other pre-tax account?
Yes
No
Do you have your own home?
Yes
No
Do you have mortgage interest?
Yes
No
Do you have real estate tax?
Yes
No
Do you owe any tax obligations or child support? If so how much?
N/A
Owe between 100 - 1,000
1,000 - 5,000
5,000 +
Do you owe any student loans?
Yes
No
Did you get unemployment? Please have accurate amount to prevent IRS delay for you refund.
Yes
No
Deductions : Please Provide All Documentation
IF THIS SECTION DOES NOT APPLY TO YOU, PLEASE SKIP TO THE NEXT SECTION.
Adjustments (PLEASE select all that apply)
Medical Saving Account
Health Saving Account
IRA Deduction
Student Loan Int Deduction
Educator Expense
Penalty on Withdraw of Saving
Alimony Paid
Other
Itemized Deductions (PLEASE select all that apply)
Medical and Dental Expenses
Taxes You Paid
Mortgage Interest and Expenses
Gifts To Charity
Other
BUSINESS INFORMATION (Schedule C- Self Employment / Side Business) 1099 independent Contractor Lyft, MUA, Hair Stylist, Uber and ETC).
IF THIS SECTION DOES NOT APPLY TO YOU, PLEASE SKIP TO THE NEXT SECTION.
Name of Business
EIN Number
Business Address
Street Business
Street Address Line 2
City
State / Province
Postal / Zip Code
Gross Income
USD ($)
Amount(USD)
Advertising
Travel
Rent/Lease
Meals
Supplies
Taxes
Wages
License
Office Supplies
Labor
Equipment
Utilities
Commission
Insurance
Legal Fees
Repairs
Vehicle Mileage
Misc
UPLOAD DOCUMENTS
Taxpayer's ID and/or Driver's License & Birth Certificate.
Browse Files
Drag and drop files here
Choose a file
Cancel
of
Taxpayer's Dependent SSN & Birth certificate.
Browse Files
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of
Tax Payer's W2, 1099 , 1098T AND ETC.
Browse Files
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Choose a file
Cancel
of
If you filing HOH (Head of Household) any supporting documents. Lease Agreement or Utility Bill.
Browse Files
Drag and drop files here
Choose a file
Cancel
of
Self Employment Expense Log.
Browse Files
Drag and drop files here
Choose a file
Cancel
of
Direct Deposit Information
Routing number
Bank Account Number
Acknowledgment & Signature
I hereby declare that the information provided is true and correct.
I understand that if I receive a letter from the IRS to contact my tax preparer for assistance.
I understand that tax preparer "Joy Scott" will charge a fee up to 15% percent depending on which year you are filing.
I understand that I AM RESPONSIBLE FOR KEEPING TRACK OF MY RETURN.
I allow Exclusive Wealth Solutions to capture my sensitive data like personal id, government id, social security number (SSN), and other information.
I understand that Joy Scott is not responsible for how fast/slow the IRS takes to process my return.
By signing below, you acknowledge that you have read and understood your responsibilities and our responsibilities in doing this tax return.
IP PIN
Date Signed
*
-
Month
-
Day
Year
Date
Date Signed
-
Month
-
Day
Year
Date
Spouse Signature
Taxpayer Signature
*
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