Client Intake Questions 2022

Taxpayers Phone Number*
Please enter a valid phone number.Format: (000) 000-0000.
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

If yes, what is the property address
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)

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
Check (in mail)Direct Deposit
Name of Bank
Checking AccountSavings AccountOther
Routing Number
Bank Account Number

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

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

Cancelof

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

Cancelof
YesNo
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: