Tax Preparation Client Intake Form
As a Personal Income Tax Client, we need to collect the following information from you in order to begin to prepare your income tax return. Please do not submit until you have everything received and ready.
Taxpayer Information
Name
*
First Name
Last Name
Age
*
Date of Birth
*
-
Month
-
Day
Year
Date
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Email
*
example@example.com
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Occupation
*
Are you a full-time student?
*
Yes
No
Are you totally and permanently disabled?
*
Yes
No
Are you legally blind?
*
Yes
No
Spouse Information
Name
First Name
Last Name
Age
Date of Birth
-
Month
-
Day
Year
Date
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Email
example@example.com
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Occupation
Are you a full-time student?
Yes
No
Are you totally and permanently disabled?
Yes
No
Are you legally blind?
Yes
No
Dependents
Enter your dependents here
Rows
Name
Date of Birth
Relationship
Did dependents live with the taxpayer for the whole year?
Can anyone else claim this dependent?
1
2
3
4
5
Did you, your spouse, and your dependents have health insurance within 12 months last year? If yes, who covers for it?
*
Rows
Yes/No
Employer
Spouse Ins
Exchange/ Marketplace
Direct with Insurer
Medicare
Medicaid
Taxpayer
Yes
No
Spouse
Yes
No
Dependent 1
Yes
No
Dependent 2
Yes
No
Dependent 3
Yes
No
Dependent 4
Yes
No
Dependent 5
Yes
No
Tax Due Diligence Questions
Employment Status
*
Employed
Unemployed
Self-employed
Did you and your spouse live apart anytime during 2024?
*
Yes
No
Do not apply to the taxpayer
Are you contributing to 401k or other pre-tax account?
*
Yes
No
Is this your first time opening a pre-tax account?
*
Yes
No
Do your dependents have tuition expenses?
*
Yes
No
Do you have any expenses for childcare?
*
Yes
No
Do you have energy star rated improvements to your home?
*
Windows
Doors
Furnace
Other
Are you currently renting?
*
Yes
No
What is the monthly rental amount?
*
How long have you lived at the property?
*
# of months
Do you have your own home?
*
Yes
No
Do you have documents that shows you paid for property taxes?
*
Yes
No
Did you sell any stock?
*
Yes
No
Did you take money from your 401?
*
Yes
No
Did you pay vehicle tax for 2024?
*
Yes
No
Do you have mortgage interest?
*
Yes
No
Do you have real estate tax?
*
Yes
No
Did you receive a federal tax last year?
*
Yes
No
Are you a victim of identity theft?
*
Yes
No
Enter IP Pin Below
Expenses
Please fill-up the information within the current year only.
General Expenses
Rows
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
Union Dues
Prior Year Tax Preparation Fees
Investment Expenses
Total Expenses
Additional comments
Acknowledgment & Signature
I confirmed that all information I entered here is accurate and true.
I allow Sims Business Services of Georgia, LLC to capture my sensitive data like government identification, social security and other information.
I have read the terms and conditions and privacy policy of Sims Business Services of Georgia, LLC.
By signing below, you acknowledge that you have read and understood your responsibilities and our responsibilities in doing this tax return.
Date Signed
*
-
Month
-
Day
Year
Date
Taxpayer Signature
Date Signed
-
Month
-
Day
Year
Date
Spouse Signature
Government Picture Identification - Taxpayer and Spouse
*
Type a question
Social Security Card - Taxpayer, Spouse & All Dependents
*
W-2's, 1099, marketplace, identity pin
*
How did you hear about us?
*
Please Select
Facebook
Instagram
TikTok
Internet
Client
Referred By
DateTime
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