Client Intake Questions 2022

Client Intake Questions

www.ladynancetax.com
How did you hear about us?

ReferralCurrent ClientOnline/Social MediaOther
If someone referred you, please type his or her name

Tax Period(s) or Tax Year(s) for preparation:
Will you be purchasing a new home in the next 2 years?

YesNo

Taxpayers Name*

First NameLast Name

Taxpayers SSN*
Do not enter dashes

Taxpayers Date of Birth*
Example: 01/01/2001

Taxpayers Phone Number*
Please enter a valid phone number.
Taxpayers Email Address
example@example.com
Taxpayers Job Title
Taxpayers Drivers License Number*
Drivers License Issue Date*

MonthDayYear
Date
Drivers License Expiration Date*

MonthDayYear
Date

Spouse Name

First NameLast Name
Spouse SSN
xxx-xx-xxxx
Spouse Date of Birth
Example: 01/01/2001
Spouse Job Title
Spouse Email
example@example.com
Spouse Drivers License Number
DL Issue Date

MonthDayYear
Date
DL Expiration Date

MonthDayYear
Date

Are you self employed?

YesNo
Do you have a business?

YesNo
What type of Business?
Business Name
Business Tax ID
Business Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Do you have rental property?

YesNo

If yes, what is the property address
What type of property?

Single FamilyMulti-FamilyVacation/Short Term RentalCommercialLand
How many days was the property rented?
if full year, enter 365
Rental Income
Please list all rental expenses
Example: cleaning, repairs, management fees, mortgage interest, property tax, supplies, utilities, etc
How many dependents are you claiming?
Dependent #1

First NameLast Name
Dependent #1 Date of Birth
Example: 01/01/2001
Dependent #1 SSN
Example: xxx-xx-xxxx
What is Dependent #1's relationship to you?
Example: son, daughter, etc
How many months did Dependent #1 live with you in 2022? (If all year, enter 12)

Dependent #2

First NameLast Name
Dependent #2 Date of Birth
Example: 01/01/2001
Dependent #2 SSN
Example: xxx-xx-xxxx
How many months did Dependent #2 live with you? (if all year, enter 12)
What is Dependent #2's relationship to you?
Example: son, daughter, etc

Dependent #3

First NameLast Name
Dependent #3 Date of Birth
Example: 01/01/2001
How many months did Dependent #3 live with you? (if all year, enter 12)
Dependent #3 SSN
Example: xxx-xx-xxxx
What is Dependent #3's relationship to you?
Example: son, daughter, etc

Dependent #4

First NameLast Name
Dependent #4 Date of Birth
Example: 01/01/2001
Dependent #4 SSN
Example: xxx-xx-xxxx
What is Dependent #4's relationship to you?
Example: son, daughter, etc
How many months did Dependent #4 live with you? (if all year, enter 12)

Dependent #5

First NameLast Name
Dependent #5 Date of Birth
Dependent #5 SSN
What is Dependent #5's relationship to you?
Example: son, daughter, etc
How many months did Dependent #5 live with you? (if all year, enter 12)

Are any Dependents in Day Care?

YesNo
Upload a copy of your daycare statement here

Cancelof

Do you own your home?

YesNo
Upload Mortgage Interest Statement, RE Tax Statement

Cancelof

Enter the amount of cash charitable contributions
Contributions must be made to a 501(c)(3) organization - do not enter any politcal contributions
Enter the amount non-cash charitable contributions
Contributions must be made to a 501(c)(3) organization
How would you like to receive your tax refund?

Check (in mail)Direct Deposit
Name of Bank
What type of account would you like your refund deposited into?

Checking AccountSavings AccountOther
Routing Number
Bank Account Number

Were any of your dependents in college in 2023?

YesNo
Do you (or your spouse) have any student loan interest to claim?

YesNo
Please upload student loan interest statment

Cancelof
Do you have a 1098-T form for either you or your dependents?

YesNo
If you have a 1098-T, upload it here

Cancelof

Did you trade Virtual/Crypto Currency?

YesNo
Did you engage in any stock or exchange activity?

YesNo
If yes and received a 1099B, upload it here

Cancelof
Did you buy or sell Real Estate in 2023?

YesNo
If yes bought Real Estate, upload Closing Disclosure/HUD-1; if yes sold Real Estate, upload Form 1099-S

Cancelof

Did you receive notices from the IRS or State that you need assistance with?

YesNo
If yes, upload IRS or State Notice(s)/Letter(s)

Cancelof
Did you have foreign account that exceeds over $10,000?

YesNo
Did you make contributions for the 2023 tax year to an IRA account?

YesNo
If yes, please provide details and amount of contribution
CLIENT NON PAYMENT/OFFSET CLAUSE

At Lady Nance Tax, we strive to assist all of our clients with their tax needs, however we understand that situations arise. If your refund is offset by the IRS, student loans, child support or your check is mailed, you are still obligated to pay our company the fees associated with the filing and preparation of your tax return. By signing this agreement you acknowedge that if payment is not made in full with in 30 days, legal actions will be sought to resolve payment and information gathered for tax preparation can be used to collect unpaid fees.
Taxpayer Signature*

Clear
Date

MonthDayYear
Date
I am giving Lady Nance Tax and associated affiliates permission to prepare all forms related to my tax return and I have signed all necessary forms, and/or have provided permission, to file my income tax return electronically. I take full responsilbility for the accuracy of this client intake form and understand that Lady Nance Tax and associated affiliates hold no responsibility for any misrepresentations or false claims.
Taxpayer signature*

Clear
Spouse Signature

Clear
Date

MonthDayYear
Date
Additional information for tax preparation
Taxpayer/Spouse W-2's/1099's

Cancelof
Additional Forms and Documents (if new client, please upload a copy of your Prior Year tax return)

Cancelof
Should be Empty: