Client Intake Form 2024

  • Client Intake Form 2025

    PLEASE FILL OUT ALL INFORMATION APPLICABLE
  • Date of Birth*
     - -
  • Format: (000) 000-0000.
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  • Date of Birth
     - -
  • Format: (000) 000-0000.
  • Are you married
  • Filing Status:*
  • Do you own or rent?
  • HEAD OF HOUSEHOLD FILERS MUST PRESENT ONE OF THE FOLLOWING TO FILE THIS STATUS. PICK ONE OF THE 3 OPTIONS THAT YOU WILL SUBMIT TO BE APPROVED TO FILE HEAD OF HOUSEHOLD.
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  • Date of Birth
     - -
  • Date of Birth
     - -
  • Date of Birth
     - -
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  • IF  CLAIMING A DEPENDENT, PLEASE ANSWER THE FOLLOWING QUESTIONS BELOW THAT PERTAINS TO YOU AND DEPENDENT RELATIONSHIP. PER THE IRS REQUEST, WE MUST PROVIDE PROVE THAT YOU ARE ELIGIBLE TO CLAIM SAID DEPENDENT.

  • Does the other parent make enough to support the child?
  • Do you receive any other income such as child support, alimony, social security?
  • Do you receive assistance from the county or state?
  • Did you pay someone to watch your child/children?
  • Did you collect social security or retirement income?
  • Did you purchase health insurance through healthcare.gov marketplace (Obama Care)?*
  • If yes, did you receive a 1095-A Form from the marketplace?
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  • Were you ever disallowed the E.I.T.C prior to this year?*
  • Did you receive unemployment compensation (1099-G) regular or PUA last year?*
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  • Did you make college tuition payments and received a 1098-T Form last year?*
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  • Do you have any other income than your w-2(s)?*
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  • Do you owe any delinquent:*
  • Would you like to apply for an advance?
  • How would you like to receive your refund?*
  • Rows
  • DO YOU HAVE A BUSINESS? ANSWER THE QUESTION SPECIFIC TO YOUR BUSINESS ENTITY REGISTERED WITH THE SECRETARY OF STATE:*
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  • I give A.R. Financial permission to use my social security number to access the Federal Offset Agency. I understand that this information is needed to process my completed return and to ensure that I do not have any previous debts with a federal agency that could reduce my 2023 income tax refund amount. I also understand that my information will not be used to access any other systems or without my knowledge. Additionally, if in the event that I am filing as a self-employed individual. I acknowledge that a W-2 will not be received from any employer. In this instance if a W-2 is received, AR Financial and A Tax Services will not be held liable for any associated penalties, audits, or fines as it relates to compliance with IRS regulations.

  • Date
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