Client Intake Sheet

BEST TAX AND NOTARY FIRM CLIENT DATA SHEET

This form assists us in gathering your income tax information

WE MAY REQUEST A COPY OF YOUR LAST YEAR'S RETURN.

You will be asked to provide all tax forms necessary to complete an accurate income tax return.

HOW DID YOU HEAR ABOUT US?

Taxpayer Name

First NameLast Name

Taxpayers Address

City

State

Zip

Taxpayers Phone

Taxpayers Social Security Number

Taxpayer Date of Birth

Date

Taxpayer Email

example@example.com

Taxpayer, Can someone else claim you as a dependent?

YesNo

Spouse Name

Spouse Address

Spouse City

Spouse State

Spouse Zip

Spouse Phone

Spouse Social Security Number

Spouse Date of Birth

Date

Spouse Email

example@example.com

Spouse, Can someone else claim you as a dependent?

YesNo

IF YOU CHILD DID NOT LIVE WITH YOU BUT YOU ARE CLAIMING THEM AS YOUR DEPENDENT, CHECK HERE:Custodial parent must sign Form 8332 and/orCustodial Court Documents

Type option 1

1. Dependents name: Birthday: SS Number: Relationship: Months lived in home: College Student (Y/N); Disabled (Y/N)

2. Dependents name: Birthday: SS Number: Relationship: Months lived in home: College Student (Y/N); Disabled (Y/N)

3. Dependents name: Birthday: SS Number: Relationship: Months lived in home: College Student (Y/N); Disabled (Y/N)

4. Dependents name: Birthday: SS Number: Relationship: Months lived in home: College Student (Y/N); Disabled (Y/N)

5. Dependents name: Birthday: SS Number: Relationship: Months lived in home: College Student (Y/N); Disabled (Y/N)

By filling out this form, signing and returning it to Best Tax and Notary Firm electronic services you agree to include all accurate supporting documents Best Tax and Notary Firm for the sole purpose of completing your income tax forms. Best Tax and Notary Firm will not assume any responsibility or liability for falsified W2, income tax supporting documents or verbal falsifications. By having Best Tax and Notary Firm complete a tax return for you, you agree to provide accurate, truthful and current information and documents. Anything not complying with this will void any responsibly to Best Tax and Notary Firm. You agree to hold the company, its employees, partners and affiliates harmless and not liability for any fees, penalties and liens incurred in the future by falsified documents presented to Best Tax and Notary Firm or its personnel.

Taxpayer's Signature

Date

Spouse's Signature

Date