2023 TAX PREP INTAKE FORM

2023 Tax Prep

INTAKE FORM
Submitted By:
Referred By:
Filing Status*

SingleHead of HouseholdMarried Filing SeparateMarried Filing JointlyQualifying Widower

Basic Information*

	Legal Name (First & Last)	SSN or TIN	DOB	Occupation
Taxpayer
Spouse

Other Information*

	Telephone #	E-mail Address	Status	ID Protection Pin (If issued by IRS)
Taxpayer
Spouse

Your Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Spouse Address (If different from yours)

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Do you want $3 of your Federal tax to go to the Presidential Election Campaign Fund?*

	YES	NO
Taxpayer
Spouse

Enter your dependents here

	Name	SSN	DOB	Months at Home	Status
1
2
3
4

Childcare Expenses for Children under 13 (Daycare, Babysitters, etc.):

	Provider Name	Provider Tax ID	Amount Paid	Type of Care	Did you use this provider to work or look for work?	Amount Was Paid with Dependent Care FSA
Provider 1
Provider 2
Provider 3
Provider 4

Employment Related Income

	Number of Forms Received in 2023
Taxpayer W2s
Spouse W2s
Dependents' W2s
Unemployment Income (1099-G)

Upload Employment Related Forms (W2s)

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Were there any births, deaths, marriages, divorces, or adoptions in your immediate family in 2023?

YesNo
Did you give a gift of more than $15,000 to anyone?

YesNo
Did you have any debts cancelled, forgiven, or refinanced?

YesNo
Did you go through bankruptcy proceedings?

YesNo
Did you withdraw or write checks from a mutual fund?

YesNo
Did you have any children under the age of 19 (or 23 if a student) with unearned (investment) income of more than $1,100?

YesNo
Did you purchase a new alternative technology or electric vehicle?

YesNo
Did you make energy efficient improvements to your home?

YesNo
Did you sell any homes or land?

YesNo
Did you receive any railroad (RRTA) benefits?

YesNo
Did you experience property damage due to storm, water, fire, accident or theft?

YesNo
Do you own more than $50,000 in foreign financial assets?

YesNo
Do you have a foreign bank account, trust, or business?

YesNo
Did you have more than $10,000 held in a foreign bank account any time during 2023?

YesNo
Are you an active member of the military?

YesNo
Are you an Armed Forces reservist, a qualified performing artist, a fee-basis state or local government official, or an individual with a disability claiming impairment-related work expenses?

YesNo
Self-Employment & "Side-Gig" Income Received (excluding rentals):

Non-Employee Compensation (1099-NEC)Other Income (1099-MISC)Other Income Not Included on 1099 (i.e. cash payments for services, bartering, venmo, etc.)Sole Proprietor (No Formal LLC)S-Corp (Or LLC Taxed as an S-Corp)Single Member LLC (No S-Corp)Partnership (K-1 from 1065)Business Mileage (See Below Worksheet)
Upload Self-Employment Info (1099s, K-1s, etc.) Will obtain bookkeeping records from you separately if needed.

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Business Mileage Worksheet (For Self-Employed, optional)

	Input Appropriate Answer
Year, Make, & Model of your Vehicle
Number of Miles Driven for Business
Number of Miles Driven in Total (Business + Personal)
Date vehicle placed into service for the business
Do you have written evidence to support your mileage (log, MileIQ, app, etc.)?
You can take standard mileage of 57.5 cents per mile, or fill in the below amounts:
Amount spent on oil changes, repairs, tires, car washes, maintenance, etc. - $
Amount spent on vehicle lease payments - $
Amount spent on vehicle loan interest - $
Purchase price of vehicle (including sales tax and dealer warranties) - $
Vehicle Registration cost - $
Cost of Car Insurance - $
Any other auto related expenses - $

Did you have any of the below investment income items?

REITs or other Trust IncomeRental Income (Including Vacation Rentals)Royalty Income (typically rec'd on a 1099)Interest & Dividend Income (1099-INT, 1099-OID, 1099-DIV)Income from sales of stock or other property (1099-B, 1099-S)Dates of acquisition and records of your cost or other basis in property you sold (if basis is not reported on 1099-B)Transactions involving cryptocurrency (Virtual currency)Bond Tax Credit (1097-BTC)Brokerage Statement (i.e. Fidelity, TD Ameritrade, Charles Schwab, etc.)
Upload Investment Income Forms or Spreadsheets From List Above

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Did you have any retirement/pension withdrawals (early or otherwise)?

YesNo
Retirement Income & Deductions:

Pension/IRA/annuity income (1099-R)Traditional IRA basis (i.e., amounts you contributed to the IRA that were already taxed)Social security/RRB income (SSA-1099, RRB-1099)Solo 401(k) contributions made (or desire to make)SEP IRA contributions (or desire to make)Individual IRA contributions (or desire to make)Form 5498 showing IRA contributionsBack Door Roth IRA conversion
Upload Retirement Income Forms

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Other Income:

Health Savings Account and long-term care reimbursements (1099-SA or 1099-LTC)Gambling income (W-2G or records showing income, as well as expense records)Jury duty recordsHobby income and expensesPrizes & AwardsRecord of alimony paid/received with ex-spouse’s name and SSNState tax refund (1099-G)Any other types of 1099s received not listed aboveRaising Animals or Growing CropsGravel, Timber, Minerals, Oil, Gas, Copyrights, or Patents
Upload Other Income Forms From List Above

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Housing Deductions:

Office in Home (for Self-Employed)Mortgage Interest Paid (Form 1098)Real Estate Property Taxes Paid (1098 if escrowed)Receipts for energy-saving home improvements (e.g., solar panels, solar water heater)All other 1098 series forms

Home Office Worksheet (For Self-Employed, optional)

	Home Office #1	Home Office #2 (IF YOU MOVED)
Was the home office used exclusively & regularly for business?
Do you use your home office as your principal place of business?
SqFt of Home Office
SqFt of Entire Home (Add unfinished SqFt if office is a separate structure or attic/garage)
Did you use your home as a daycare?
Did you use your home to store inventory?
Did you meet customers, patients, or clients in your home?
Did you use a separate structure on your property (attic, garage, ADU, etc.) for business?
Rent Paid - $
Mortgage Interest Paid (or upload 1098 above) - $
Property Taxes Paid (or upload 1098 above) - $
Amount Spent on Utilities (Gas, Water/Sewer, Electricity, Trash) - $
Amount Spend on Home Internet - $
Amount Spend on Home Phone (Landline) - $
Amount Spent on Repairs Excluding Landscaping (Entire Home) - $
Amount Spent on Repairs (Just For The Home Office) - $
Amount Spent on Remodeling (Entire Home) - $
Amount Spent on Remodeling (Just Home Office) - $
Purchase Price of Your Home and year purchased (optional)
Value of Just the Land (optional)
Amount Spent on Hazard Insurance (Homeowners or Renters Insurance) - $
Any Other Deductible Items (List Type and Amount Paid)

Upload Housing Deduction Forms (1098, Taxes, See Home Office Worksheet Below)

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Charitable Contributions (GoFundMe is not Eligible)

	Applicable?	Amount (or upload below)
Cash amounts donated to houses of worship, schools, other qualified charitable organizations
Records of non-cash charitable donations (Thrift Store donations, car donations, etc.)
Amounts of miles driven for charitable purposes
Appreciated stock donation (DAF)

Upload Charitable Donation Info:

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Did you have healthcare insurance for your family for the entire year?

YesNo
Did you apply for a health coverage exemption through the Marketplace Exchange?

YesNo

Healthcare Related Deductions and Forms:

	Applicable?	Amount (or upload below)
Amounts paid out of pocket (NOT with HSA) for healthcare (doctors, hospitals, lasik, eye care + glasses/contacts, acupuncture, chiropractors, dentists, birth control, fertility, breast pumps, pregnancy tests, alcoholism + drug addiction treatments, prostheses, bandages, hearing aids, learning disabilities, conferences, nursing homes, psychologists, tutoring for children with special needs, sterilization, smoking cessation, hard-of-hearing telephones and televisions, and more. see IRS pub. 502.
Form 1095-A if you enrolled in an insurance plan through the Marketplace (Exchange)
Amounts of miles driven for medical purposes
Form 5498-SA showing HSA contributions
HSA contributions made outside of your employer (often after year-end but before tax deadline)
Self-Employed Health Insurance: Amount paid out of pocket for premiums (if you did not qualify for coverage through your employer or your spouses employer, and excludes Christian Health-sharing ministries, which do not count as health insurance)
Insurance premiums paid out of pocket (amount not covered by your employer)
Cost of medical travel (lodging and meals)

Upload healthcare related forms

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Did you pay expenses for anyone in your family to attend classes beyond high school?

YesNo

Education Related Deductions & Forms:

	Applicable?	Amount (or upload below)
Forms 1098-T from educational institutions
Receipts that itemize qualified educational expenses
Records of any scholarships or fellowships you received
Form 1098-E if you paid student loan interest
Receipts for classroom expenses (for educators in grades K-12)
Form 1099-Q 529 Savings Account Distributions
529 Account Contributions (Deductible in Some States)

Upload Education Related Forms

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Other Deduction Information:

Invoice showing personal property tax on vehicles (value-based portion of vehicle registration)All other 5498 series forms (5498-QA, 5498-ESA)Federally Declared Disaster (FEMA assistance, property losses, insurance reimbursements, etc.)
Upload Other Deduction Information

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Record of Estimated Tax Payments Made (If Applicable):

	IRS Amount Paid	IRS Date Paid	State Amount Paid	State Date Paid
Q1 Payment (Due 04/15/2023)
Q2 Payment (Due 07/15/2023)
Q3 Payment (Due 09/15/2023)
Q4 Payment (Due 01/15/2023)

Identity Verification (Required)*

Photo of Driver's License for TaxpayerPhoto of Driver's License for Spouse
Upload Driver's Licenses

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Have you received any letters or notices from the IRS or State Tax Department?

YesNo
Upload any tax agency notices, statements, or letters

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How would you like to receive your refund (or pay your balance)?*

Direct Deposit for Refunds - Enter Bank Information BelowMailed Paper Check Refund - No Bank Information
Bank Account Number
Bank Routing Number
Additional comments
Acknowledgement & Signature
To the best of my knowledge the information enclosed in this client tax organizer is correct and includes all income, deductions, and other information necessary for the preparation of this year's income tax returns for which I have adequate records to substantiate in the event of an audit. I allow iManage Financials LLC to capture my sensitive data including but not limited to IDs, Social Security Number (SSN), tax forms, and other information.
Date Signed*

MonthDayYear
Date
Taxpayer Signature*

Clear
Date Signed

MonthDayYear
Date
Spouse Signature

Clear
Should be Empty:

2023 Tax Prep

Acknowledgement & Signature