MOMO of Road To Riches Tax Preparation Client Intake Form

Dependents

Should only be listed if you take care of the dependent over half of the year
Image of Dependent's S.S.Card

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1. Dependent Information

GenderFirst NameMiddle NameLast NameSuffix
Date Of Birth

MonthDayYear
Date
Social Security Number
Do you want to enter another dependent?
2. Dependent Information

GenderFirst NameMiddle NameLast NameSuffix
Date Of Birth

MonthDayYear
Date
Social Security Number
Do you want to enter another dependent?
3. Dependent Information

GenderFirst NameMiddle NameLast NameSuffix
Date Of Birth

MonthDayYear
Date
Social Security Number
Do you want to enter another dependent?
4. Dependent Information

GenderFirst NameMiddle NameLast NameSuffix
Date Of Birth

MonthDayYear
Date
Social Security Number
Did you pay any child care expenses throughout the year ?

Child and Dependent Daycare Expenses

If the provider is a person, enter the care provider's SSN
Child Name Amount Paid

First NameAmount Paid
Provider Phone Number

Area CodePhone Number
Provider

NameTax ID #/ SSN
Provider Address

Street Address

Street Address Line 2

CityState

Zip Code
Upload photos of your W-2,1099,and ALL other documents

Attach an image of all documents that can be used to assist your tax preparer with the preparation of your tax return.
Upload

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Enter any additional information or comments that you would like the include for your tax preparer.
If you did not file your tax return with us last year, we recommend that you upload a copy of your previous year's tax return

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Do you have a business or were self employed?
Employer ID Number
EIN
What is the legal structure of your business?
E- Signature Below

By filling out this form, you are giving us permission to prepare your tax return and you are confirming that ALL information entered is accurate. If you have any questions do not hesitate to call our office at (682)246-1606 or email taxinfo@roadtorichestaxfirm.com.
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Welcome to Road To Riches Tax Firm.