Tax Preparation Client Intake Form
Filing Status
Single
Head of Household
Married Filing Separate
Married Filing Joint
Qualifying Widower
Taxpayer Information
Name
*
First Name
Last Name
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
*
Identity Protection PIN
If the IRS has assigned, please enter.
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
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 they a full-time student?
Yes
No
Are they totally and permanently disabled?
Yes
No
Are they legally blind?
Yes
No
Are they your dependent?
Yes
No
Dependents
Enter Dependent Information
Rows
First Name
Last Name
SSN/TIN
Date of Birth
Relationship
Number of Months Living With You
Identity ProtectionPIN
Dependent Care?
1
Son
Daughter
Stepchild
Foster Child
Brother
Sister
Step Brother
Step Sister
Half Brother
Half Sister
Grandchild
Niece
Nephew
Parent
Grandparent
Aunt
Uncle
Other
1
2
3
4
5
6
7
8
9
10
11
12
2
Son
Daughter
Stepchild
Foster Child
Brother
Sister
Step Brother
Step Sister
Half Brother
Half Sister
Grandchild
Niece
Nephew
Parent
Grandparent
Aunt
Uncle
Other
1
2
3
4
5
6
7
8
9
10
11
12
3
Son
Daughter
Stepchild
Foster Child
Brother
Sister
Step Brother
Step Sister
Half Brother
Half Sister
Grandchild
Niece
Nephew
Parent
Grandparent
Aunt
Uncle
Other
1
2
3
4
5
6
7
8
9
10
11
12
4
Son
Daughter
Stepchild
Foster Child
Brother
Sister
Step Brother
Step Sister
Half Brother
Half Sister
Grandchild
Niece
Nephew
Parent
Grandparent
Aunt
Uncle
Other
1
2
3
4
5
6
7
8
9
10
11
12
5
Son
Daughter
Stepchild
Foster Child
Brother
Sister
Step Brother
Step Sister
Half Brother
Half Sister
Grandchild
Niece
Nephew
Parent
Grandparent
Aunt
Uncle
Other
1
2
3
4
5
6
7
8
9
10
11
12
6
Son
Daughter
Stepchild
Foster Child
Brother
Sister
Step Brother
Step Sister
Half Brother
Half Sister
Grandchild
Niece
Nephew
Parent
Grandparent
Aunt
Uncle
Other
1
2
3
4
5
6
7
8
9
10
11
12
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
Dependent 6
Yes
No
Tax Related Questions
Employment Status
Employed
Unemployed
Self-employed
Are you contributing to 401k or other pre-tax account?
Yes
No
Is this your first time opening a pre-tax account?
Yes
No
Did you take any money from your 401k?
Yes
No
Do your dependents have tuition expenses?
Yes
No
Do you have any expenses for child care?
Yes
No
Do you have energy star rated improvements to your home?
Windows
Doors
Furnace
Other
Are you currently renting your house?
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
Do you have mortgage interest?
Yes
No
Did you sell any stock?
Yes
No
Did you pay your vehicle tax?
Yes
No
Did you receive a federal tax refund last year?
Yes
No
Are you a victim of identity theft?
Yes
No
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
Tax Preparation Fees
Investment Expenses
Total Expenses
Additional comments
Self-Employment Information
Business Name
Business EIN
Business Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Please describe what your business does:
Accounting Method:
Cash
Accrual
Other
Did you materially participate in the operation of the business?
Yes
No
Did you start or acquire this business this year?
Yes
No
Did you make any payments this year that would require you to file Form(s) 1099?
Yes
No
Self-Employment Income
Rows
Amount
Gross Receipts
Other Income
Total Self-Employment Income
Please describe Other Income:
Self-Employment Expenses
Rows
Amount
Advertising
Car & Truck Expenses
Commissions & Fees
Contract Labor
Depletion
Depreciation
Employee Benefit Programs
Insurance
Mortgage
Legal and Professional Services
Office Expenses
Pension and Profit-Sharing Plans
Rent or Lease
Repairs and Maintenance
Supplies
Taxes and Licenses
Travel
Meals
Utilities
Wages
Other Expenses
Total Self-Employment Expenses
Please describe Other Expenses:
Do you have a home office? Space must be used exclusively for the business and cannot have an office elsewhere.
Yes
No
Do you have a personal vehicle that is being used for business purposes?
Yes
No
Acknowledgment & Signature
I confirmed that all information I entered here is accurate and true.
I allow Bischoff Bookkeeping and Tax Advisory, PLLC to capture my sensitive data like personal id, government id, and other information.
I have read the terms and conditions and privacy policy of Bischoff Bookkeeping and Tax Advisory, PLLC.
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
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