Alaha’s Tax Preparation Client Intake Form
Tax Season 2025
Are You an Existing or New Client*
Please Select
Existing
New
Do You Have Any Unfiled Tax Returns from Previous Years?
Yes
No, All of my returns are up to date
IP PIN NUMBER*
Filing Status*
Single
Head of Household
Married Filing Separate
Married Filing Joint
Qualifying Widower
If Referred, Please List the Persons Name.
Taxpayer Information
Name*
First Name
Last Name
Social Security Number*
Date of Birth*
-
Month
-
Day
Year
Date
Phone Number*
Please enter a valid phone number.
Email*
example@example.com
Address*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Occupation*
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
Social Security Number*
Date of Birth*
-
Month
-
Day
Year
Date
Phone Number*
Please enter a valid phone number.
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 your dependents here*
Rows
Dependent’s Name
Date of Birth
Relationship
Social Security Number
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?
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
Tax Related Questions
Employment Status
Employed
Unemployed
Self-employed
*Did you receive the Market Place insurance (1095-A Health Insurance Marketplace statement)? If so, please include the form with your uploaded paperwork.
*
YES
NO
Are you contributing to 401k or other 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
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 401?
Yes
No
Did you pay your vehicle tax?
Yes
No
Do you have mortgage interest?
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
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
Investment Expenses
Total Expenses
Additional comments
**Where would you like your Tax Refund deposited?*
Please Select
CHECKING
SAVINGS
Bank Information Needed **
ROUTING NUMBER
ACCOUNT NUMBER
BANK NAME
State / Province
Divers License
Browse Files
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Choose a file
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of
Social Security Cards
Browse Files
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Choose a file
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of
Additional Paperwork-W2’s 1099 etc
Browse Files
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Choose a file
Cancel
of
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
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