R&B TAX SOLUTIONS-- Secure Tax Intake Form

R&B INSURANCE AND TAX SOLUTIONS LLC

Tax Document Submission
Personal Information

Identification, Social Security Cards, Birth, Death, Marriage, Adoption Certificates
Taxpayer Information

Please provide your legal information exactly as it appears on your Social Security card.
Select Your Preparer
Taxpayer Name*

First NameMiddle NameLast Name
Your Date of Birth

MonthDayYear
Date
Your SSN
Taxpayer Email*
example@example.com
Taxpayer Phone Number*

Area CodePhone Number
Best Contact Method

EmailTextPhone
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Taxpayer ID/ Drivers License

Upload Drivers License

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Taxpayer SSC

Upload SS Card

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Where you a client last year?

YesNo
What is your marital status as of December 31?

SingleMarriedLegally SeperatedDivorcedWidowed
Household Information

This section helps determine your filing status, dependents, and tax credits.
Spouse Information
Spouse Name

First NameLast Name
Spouse SSN
Spouse Date of Birth

MonthDayYear
Date
Did your spouse live with you all year?

YesNo
Spouse ID

Upload Spouse ID

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Upload Spouse Social Security Card

Upload Spouse SS Card

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Do you have any dependents ?

YesNo
Dependents
Dependent SSN:
Upload SS Cards for ALL Dependents

Click to Upload ALL Dependent SSC
Upload SS Cards for each Dependent listed above Cancelof
Upload Other Supporting Documents (if applicable)

Click to Upload Supporting Documents
Optional Cancelof
Income Information

Select all income types you received for the tax year and upload the related documents.
Options

W-2 (Employment)1099-NEC (Independent Contractor)1099-MISC1099-KInterest (1099-INT)Dividends (1099-DIV)Retirement / Pension (1099-R)Social Security (SSA-1099)Unemployment (1099-G)Business Income (Schedule C)Rental Income (Schedule E)Stocks / Crypto (1099-B)Partnership / S-Corp (K-1)Other Income
Upload W-2 (s)

Upload a W-2(s)

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Upload 1099-NEC / 1099-MISC / 1099-K

Upload 1099-NEC/MISC/K

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Upload Interest / Dividend Statements (1099-INT / 1099-DIV)

Upload 1099-INT/DIV

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Upload Retirement / Pension Statements (1099-R)

Upload 1099-R

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Upload SS Statement (SSA-1099)

Upload SSA-1099

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Upload Unemployment Statement (1099-G)

Upload 1099-G

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Upload Brokerage / Crypto Statements (1099-B / CSV)

Upload 1099-B

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Upload K-1(s)

Upload K-1(s)

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Upload Other Income Documentation

Upload Other Income Docs

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Business / Self-Employment Income (Schedule C)
Business Name (or “Self” if no registered business)
Business EIN (if any)
Business Start Date

MonthDayYear
Date
Type of Business / Industry
Hair stylist, truck driver, consultant, etc.
Gross Income
Upload Business Income Documents

Upload Business Income
Upload 1099s, invoices, or income summaries Cancelof
Upload Expense Summary or Bank Statements

Upload Business Expenses
Upload expense summary, bank statements, or bookkeeping reports Cancelof
Rental Income - Complete this section only if you received rental income during the tax year.
Add Your Rental Properties (if any)
Upload Rental Income & Exp Upload Prior Depreciation (if avail)

Upload Rental Income & Expenses

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Credits, Education & Health Coverage

This section helps determine eligibility for tax credits and required health coverage reporting.
Which of the following applied to you during the tax year? (Check all that apply)

I paid for childcare so I could work or attend schoolI paid college or vocational school tuitionI paid student loan interestI purchased health insurance through the MarketplaceI received advance premium tax creditsNone of the above
Child & Dependent Care Expenses
Did you pay for childcare so you could work or attend school?

YesNo
Name of childcare provider
Provider EIN or SSN (if available)
Total childcare expenses paid
Upload childcare receipts or statements

Upload Child Care

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Education Expenses
Student name
Name of school or institution
Upload Form 1098-T

Upload 1098-T

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Student Loan Interest
Did you pay student loan interest?

YesNo
Upload Form 1098-E

Upload 1098-T

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Health Insurance Coverage (ACA / Marketplace)
Did you or anyone in your household have health insurance through the Marketplace?

YesNo
Upload Form 1095-A

Upload a 1095-A

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Banking Information & Authorizations

Please review and complete the information below to authorize tax preparation services.
How would you like to receive your refund?

Direct DepositPaper CheckNot Sure / Let My Preparer Decide
Name of Bank
Routing Number
Account Number
Account Type

CheckingSaving
Consents & Acknowledgements
Taxpayer Acknowledgement*

I certify that the information provided is true, correct, and complete to the best of my knowledge.
Authorization to Prepare Return*

I authorize R&B Insurance and Tax Solutions to prepare and file my tax return using the information I have provided. 1
Consent to Electronic Filing*

I consent to electronic filing of my tax return with the IRS and applicable state agencies.
Signature & Certification
Taxpayer Signature*

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Date Signed

MonthDayYear
Date

CONSENT TO USE OF TAX RETURN INFORMATION
For the purposes of this consent form, “we,” “us,” and “our” mean
__JARVIS R BARNES___
(Printed Name of Tax Preparer)
Federal law requires this consent form be provided to you. Unless authorized by law, we cannot use your tax return information for purposes other than the preparation and filing of your tax return without your consent.
You are not required to complete this form to engage in our tax return preparation services. If we obtain your signature on this form by conditioning our tax preparation services on your consent, your consent will not be valid. Your consent is valid for the amount of time that you specify. If you do not specify the duration of your consent, your consent is valid for one year from
the date of signature. If you do not consent, you may still have your tax return prepared and electronically filed by us for a fee.

For your convenience, we have entered into an arrangement with third parties to provide qualifying taxpayers with the opportunity to apply for an Electronic Refund Disbursement Service and/or Loan product. To determine whether these products may be available to you, we will need to use your tax return information in order to calculate the amount of your anticipated refund.

If you would like us to use your tax return information to determine whether these products may be available to you while we are preparing your return, please sign and date this consent to the use of your tax return information.
By signing below, you authorize us to use the information you provide to us during the preparation of your 2025 tax return to determine whether to present you with the opportunity to apply for these products and services.
Signature*

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R&B INSURANCE AND TAX SOLUTIONS LLC

Personal Information

Taxpayer Information

Household Information

Income Information

Credits, Education & Health Coverage

Banking Information & Authorizations

Signature & Certification