Individual Tax - New Client Form

Individual Tax - New Client Form
Filing Status

SingleHead of HouseholdMarried Filing SeparateMarried Filing JointQualifying Widower

Dependents
Are you claiming any dependents?

YesNo

Have you, your spouse, and your dependents had health insurance within 12 months in the last year?

YesNo

Expenses
Please fill in the information for expenses for the 2023 year only.

General Expenses

	Amount
Medical Expenses
Dental Expenses
Insurance Premiums paid
Long Term Care Premiums
Prescription Drugs and Medications
Home Mortgage
Investment Interest
Cash Contributions
Non-Cash Contributions
Unreimbursed Business Expenses
Property Taxes
Tax Preparation Fees
Investment Expenses

Total Expenses
Additional comments

Acknowledgement & Signature
By signing below, you acknowledge and confirm that all information you entered here is true and correct and related to the tax year 2023 (January 1, 2023 to December 31, 2023). You also permit Tax Time Services Inc. to capture and collect the information you entered in this form.
Date Signed

MonthDayYear
Date
Taxpayer Signature

Clear
Date Signed

MonthDayYear
Date
Spouse Signature (if applicable)

Clear
Should be Empty: