Client Intake Form
Filing Status
Single
Head of Household
Married Filing Separate
Married Filing Joint
Qualifying Widower
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
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Occupation
SSN
*
Spouse Information
Name
First Name
Last Name
Date of Birth
-
Month
-
Day
Year
Date
Phone Number
Please enter a valid phone number.
Occupation
SSN
Dependents
Enter your dependents here
Name
SSN
Date of Birth
Relationship
1
2
3
4
5
6
Tax Related Questions
Employment Status
*
Employed
Unemployed
Self-employed
Are you contributing to 401k or other pre-tax account?
Yes
No
Does your dependents have tuition expenses?
Yes
No
Do you have any expenses for child care?
Yes
No
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
Acknowledgment & Signature
By signing below, you acknowledge that all information entered is accurate and true.
Date Signed
-
Month
-
Day
Year
Date
Taxpayer Signature
*
Print
Submit
Submit
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