2024-2025 Intake Form

2024-2025 Intake Form

Thank you so much for choosing Prosperity 93 Consultants! Please complete the below questions as accurately as possible. If you have any questions or concerns, please call us 346-529-7228
Tax preparer name
How did you hear about us?

FacebookInstagramPrevious clientReferral
If referred, please enter your referrals name here
Are you trying to buy a home within the next 2 years?

YesNo
Are you interested in credit repair?

YesNo
- Taxpayer first and last name
  
  First NameLast Name
- Date of birth
  
  MonthDayYear
  Date
- Taxpayer SSN
- Taxpayer phone number
  Please enter a valid phone number.
- Taxpayer job title
- Taxpayer email
  example@example.com
- Taxpayer address
  
  Street Address
  
  Street Address Line 2
  
  CityState / Province
  
  Postal / Zip Code
- Taxpayer spouses full name
  
  First NameLast Name
- Spouse DOB
  
  MonthDayYear
  Date
- Spouse SSN
- Spouse Phone Number
  Please enter a valid phone number.
- Spouse job title
- Spouse email
  example@example.com
- Spouse address (if different from taxpayer address)
  
  Street Address
  
  Street Address Line 2
  
  CityState / Province
  
  Postal / Zip Code
- Taxpayers drivers license
  
  Cancelof
- Primary taxpayers SSC
  
  Cancelof
- Taxpayers W-2/1099
  
  Cancelof
- Are you self employed?
  
  YesNo
- Did you and your spouse live apart during the year?
  
  YesNo
- What is your marital status as of December?
  
  Single (Not married)Married living with spouseMarried not living with spouse
- Did you pay over half the expenses of maintaining your residence for the entire year?
  
  YesNo
- Did you support a child or family member for more than 6 months out of the year?
  
  YesNo
- If yes, did you live together at any time after June 30, 2019?
  
  YesNoN/A
- Are you on any Government Assistance
  
  YesNoN/A
- Can someone else claim you as a dependent?
  
  YesNo
- Did you have health insurance in 2019?
  
  YesNo
- Did you have health insurance in for the entire year?
  
  YesNo
- Who was your insurance coverage through in 2019?
  
  MarketplaceEmployerMedicaidOther
- Was your insurance through your employer?
  
  YesNo
- Who was your dependents insured with in 2019?
  
  MarketplaceEmployerMedicaidOther
- Upload tax payer insurance documents here
  
  Cancelof
- Have you ever been denied the Earned Tax Credit (EITC)?
  
  YesNo
- Were you or any of your dependents in college in 2019?
  
  YesNo
- Did you trade any Virtual Currency?
  
  YesNo
- Do you have a 1098-T Form for either you or your dependents?
  
  YesNo
- If yes, please upload 1098-T here
  
  Cancelof
- Are you interested in audit protection?
  
  YesNo
- How many dependents are you claiming?
  
  012345
- Dependent #1 first and last name
  
  First NameLast Name
- Dependent #1 DOB
  
  MonthDayYear
  Date
- Dependent #1 SSN
- Your relation to dependent #1
- How many months did Dependent #1 live with you in 2019?
  If all year, enter 12 months
- Dependent #1 social security card
  
  Cancelof
- Dependent #1 birth certificate
  
  Cancelof
- Dependent #2 first and last name
  
  First NameLast Name
- Dependent #2 DOB
  
  MonthDayYear
  Date
- Dependent #1 SSN
- Your relation to dependent #2
- How many months did Dependent #2 live with you in 2019?
  If all year, enter 12 months
- Dependent #2 social security card
  
  Cancelof
- Dependent #2 birth certificate
  
  Cancelof
- Dependent #3 first and last name
  
  First NameLast Name
- Dependent #3 DOB
  
  MonthDayYear
  Date
- Dependent #3 SSN
- Your relation to dependent #3
- How many months did Dependent #3 live with you in 2019?
  If all year, enter 12 months
- Dependent #3 social security card
  
  Cancelof
- Dependent #3 birth certificate
  
  Cancelof
- Dependent #4 first and last name
  
  First NameLast Name
- Dependent #4 DOB
  
  MonthDayYear
  Date
- Dependent #4 SSN
- Relation to dependent #4
- How many months did Dependent #4 live with you in 2019?
  If all year, enter 12 months
- Dependent #4 social security card
  
  Cancelof
- Dependent #4 birth certificate
  
  Cancelof
- Dependent #5
  
  First NameLast Name
- Dependent #5 DOB
  
  MonthDayYear
  Date
- Dependent #5 SSN
- Relation to dependent #5
- How many months did Dependent #5 live with you in 2019?
  If all year, enter 12 months
- Dependent #5 social security card
  
  Cancelof
- Dependent #5 birth certificate
  
  Cancelof
- Are there any dependents in daycare? If yes, please upload the form you received from your daycare provider.
  
  Cancelof
- Upload dependent #1 insurance documents
  
  Cancelof
- Upload dependent #2 insurance documents
  
  Cancelof
- Upload dependent #3 insurance documents
  
  Cancelof
- Upload dependent #4 insurance documents
  
  Cancelof
- Upload dependent #5 insurance documents
  
  Cancelof
- Dependents proof of residency (Lease/Utility bill)
  
  Cancelof
- How would you like to receive your refund?
  
  Check (Only available for in-office visits)Direct deposit
- Name of bank
- Which type of account would you like your refund deposited into?
  
  CheckingSavings
- Routing number
- Confirm routing number
- Account bank number
- Confirm bank account number
- CLIENT NON PAYMENT/OFFSET CLAUSE
  
  At Prosperity 93 Consultants LLC, we strive to assist all of our clients in their tax needs, howwever 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 filing your tax return.
  
  By signing this agreement you acknowledge that if payment is not made in full with in 30 days legal actions will be sought to resolve payment.
  
  -
  
  I am giving Prosperity 93 Consultants LLC permission to prepare all forms related to my tax return; to apply for and secure RAC's and RAL's on my behalf; and sign all necessary forms and file my taxes electronically. I take full responsibility for the accuracy of this form and understand that Prosperity 93 Consultants LLC and/or associated affiliates hold no responsibility for any misrepresentation or false claims.
- Full name of taxpayer
  
  First NameLast Name
- Taxpayer signature
  
  Powered by Jotform SignClear
- Date
  
  MonthDayYear
  Date
- Full name of taxpayer spouse
  
  First NameLast Name
- Spouse signature
  
  Powered by Jotform SignClear
- Date
  
  MonthDayYear
  Date
- ADDITIONAL SERVICES
  
  At Prosperity 93 Consultants LLC, we do more than just taxes. Please check below if you would be interested in any of the additional services we provide. We will schedule a time to speak with you ar a later time.
  
  Call us! (346) 529-7228
  
  Find us on Facebook! Prosperity 93 Consultants
  
  Follow us on Instagram! @Prosperity.93
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