Tax Preparation Client Intake Form
Established Grace Tax Preparation Services
Thank You for taking the time to complete your Client Intake Form. This information is critical to ensure your tax return is filed accurately. Please take your time and review all information before you submit. Please note that if documents are missing or information is incorrect this will result in a delay in processing your return. This intake form will take 20- 30 minutes to complete. * Please complete this form in its ENTIRETY and click SUBMIT when finished. ** Upload all documents at the end of the form. *** Please wait until you have ALL of your documents before submitting this form.
Note: If you are claiming any dependents, be sure to upload their SS CARDS, BIRTH CERTIFICATES, and all items that show their address is the same as yours. (e.g. school records, medical records, doctor bills, Medicaid Statement, Social Services Records, or anything that shows your child's name and current address).
How did you hear about us?
*
Please Select
Facebook
Instagram
Referral
Google
Yelp
Friend/Family Member
Which tax year are you filing for?
Please Select
2022
2023
2024
Did you file taxes last year (2023)?
Please Select
Yes
No
Did you get a refund or did you owe?
Please Select
Refund
Owed
Who did your taxes last year?
Date of Interview
-
Month
-
Day
Year
Date
Interview Setting:
In person
Virtual
Translator Used
Taxpayer Information
Name
*
First Name
Last Name
Age
*
Date of Birth
*
-
Month
-
Day
Year
Date
Phone Number
*
Please enter a valid phone number.
Email
*
example@example.com
Social Security Number
*
Example: xxx-xx-xxxx
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Occupation
Employer
Upload W2 Statement(s)
Browse Files
Drag and drop files here
Choose a file
Cancel
of
Upload 1099 or 1099NEC
Browse Files
Drag and drop files here
Choose a file
Cancel
of
Upload other miscellaneous income documents: 1099 INT, 1099 DIV or 1099Misc
Browse Files
Drag and drop files here
Choose a file
Cancel
of
Filing Status
Single
Head of Household
Married Filing Separate
Married Filing Joint
Qualifying Widower
Taxpayer's Driver's License/State ID
Browse Files
Drag and drop files here
Choose a file
* Please ensure all data can be clearly read.
Cancel
of
Please upload a Selfie to validate your identity and submitted ID
Browse Files
Drag and drop files here
Choose a file
* Take a Selfie while holding your ID close to your face. Please ensure data is clear and readable.
Cancel
of
Taxpayer's Social Security Card
Browse Files
Drag and drop files here
Choose a file
* Please ensure data can be clearly read.
Cancel
of
Were you and/ or your spouse issued an Identity Protection PIN (IP PIN) by the IRS?
Please Select
Yes
No
Were you and/ or your spouse previously issued an Identity Protection PIN:
Enter your six-digit PIN number
What is your five-digit e-file PIN:
Enter your five-digit PIN number. If unknown, please provide your AGI from your last year's tax return.
What is your spouse's five-digit e-file PIN:
Enter your five-digit PIN number. If unknown, please provide your AGI from your last year's tax return.
Are you or your spouse a full-time student?
Yes
No
Are you or your spouse totally and permanently disabled?
Yes
No
Are you or your spouse legally blind?
Yes
No
Can someone else claim you or your spouse as a dependent?
Yes
No
Do you or your spouse owe the IRS, Child Support or are either of you in default with Student Loans?
Yes
No
Have you or your spouse ever been disallowed for EITC/AOTC/CTC or ACTC?
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.
Email
example@example.com
Social Security Number
*
Example: xxx-xx-xxxx
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Occupation
Employer
Upload W2 Statement(s)
Browse Files
Drag and drop files here
Choose a file
Cancel
of
Spouse's Driver's License/State ID
Browse Files
Drag and drop files here
Choose a file
* Please ensure all data can be clearly read.
Cancel
of
Please upload a Selfie to validate your identity and submitted ID
Browse Files
Drag and drop files here
Choose a file
* Take a Selfie while holding your ID close to your face. Please ensure data is clear and readable.
Cancel
of
Spouse's Social Security Card
Browse Files
Drag and drop files here
Choose a file
* Please ensure data can be clearly read.
Cancel
of
Dependents
Enter your dependents here
Name
Date of Birth
Relationship
1
2
3
4
5
6
Does you, your spouse, and your dependents have health insurance within 12 months last year? If yes, who covers for it?
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 Related Questions
Are you contributing to 401k or other pre-tax account?
Yes
No
Is this your first time opening a pre-tax account?
Yes
No
Does 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?
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 401K?
Yes
No
Did you pay your vehicle tax?
Yes
No
Do you have a mortgage interest statement?
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
Expenses
Please fill-up the information within the current year only.
General Expenses
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
Acknowledgment & Signature
I confirmed that all information I entered here is accurate and true.
I allow ABC Financial to capture my sensitive data like personal id, government id, and other information.
I have read the terms and conditions and privacy policy of ABC Financial.
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
Print
Submit
Submit
Should be Empty: