• Tax Preparation Client Intake Form

  • Filing Status
    • Taxpayer Information 
    • Date of Birth
       - -
      2 digit month, 2 digit day, 4 digit year
    • Format: (000) 000-0000.
    • Are you a full-time student?
    • Are you totally and permanently disabled?
    • Are you legally blind?
    • Spouse Information 
    • Date of Birth
       - -
      2 digit month, 2 digit day, 4 digit year
    • Format: (000) 000-0000.
    • Are they a full-time student?
    • Are they totally and permanently disabled?
    • Are they legally blind?
    • Are they your dependent?
    • Dependents 
    • Enter your dependents here
      Rows
    • Does you, your spouse, and your dependents have health insurance within 12 months last year? If yes, who covers for it?
      Rows
    • Tax Related Questions 
    • Employment Status
    • Are you contributing to 401k or other pre-tax account?
    • Is this your first time opening a pre-tax account?
    • Please select what state return are you requesting?
    • Does your dependents have tuition expenses?
    • Do you have any expenses for child care?
    • Do you have energy star rated improvements to your home?
    • Are you currently renting?
    • What is the monthly rental amount?
    • Do you have your own home?
    • Do you have documents that shows you paid for property taxes?
    • Did you sell any stock?
    • Did you take money from your 401?
    • Did you pay your vehicle tax?
    • Do you have mortgage interest?
    • Do you have real estate tax?
    • Did you receive a federal tax last year?
    • Are you a victim of identity theft?
    • Expenses 

    • Please fill-up the information within the current year only.

    • General Expenses
      Rows
    • Acknowledgment & Signature 

    • CONSENT TO DISCLOSURE OF TAX RETURN INFORMATION

       

      For the purposes of this consent form, “we,” “us,” and “our” mean CALI TAX CONSLUTANTS LLC .

      Federal law requires this consent form be provided to you. Unless authorized by law, we cannot disclose your tax return information to third parties for purposes other than the preparation and filing of your tax return without your consent. If you consent to the disclosure of your tax return information, Federal law may not protect your tax return information from further use or distribution.

      You are not required to complete this form to engage in our tax preparation services. If we obtain your signature on this form by conditioning our services on your consent, your consent will not be valid. If you agree to the disclosure of your tax return information, 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.

      You have indicated that you are interested in receiving an Electronic Disbursement Service and/or Loan (or collectively, “Products or Services”) from Pathward, National Association. In order to provide you with the opportunity to apply for one of these Products or Services, we must disclose all of your tax return information necessary for evaluating the request to Pathward. If you request a more limited disclosure of tax return information, you will not be eligible to submit an application request for these Products or Services. If you would like us to disclose your tax return information for this purpose, please sign and date your consent to the disclosure of your tax return information.

      By signing below, you authorize us to disclose to Pathward all of your tax return information necessary for the evaluation and processing of your request for a Product or Service. You understand that if you are unwilling to authorize the disclosure and sharing of your tax return information with Pathward, you will not be able to obtain a Product or Service, but you may still choose to have your tax return prepared and filed by us for a fee.

      If you believe your tax return information has been disclosed or used improperly in a manner unauthorized by law or without your permission, you may contact the Treasury Inspector General for Tax Administration (TIGTA) by telephone at 1-800-366-4484, or by e-mail at complaints@tigta.treas.gov.

    • Date Signed
       - -
      2 digit month, 2 digit day, 4 digit year
    • Date Signed
       - -
      2 digit month, 2 digit day, 4 digit year
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