Ana Client Intake Form

CLIENT FORM
How did you hear about us?

FacebookInstagramReferralPrevious Client
Tax Preparer's Name
If someone referred you, please type his or her name here.
Email
example@example.com
TaxPayer's Name

First NameLast Name
Taxpayer's Phone Number*
Example: xxx-xxx-xxxx
Taxpayer's Job Title
Taxpayer's Date of Birth*
Example: 01/01/2001
Taxpayer's SSN
Example: xxx-xx-xxxx
Taxpayer's Email Address*
example@example.com
Spouse's Full Name
First Name
Spouse's SSN
Example: xxx-xx-xxxx
Name

First NameLast Name
Spouse's Phone Number
Example: xxx-xxx-xxxx
Spouse's Job Title
example@example.com
Home Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Are you self employed?*

YesNo
Did you and your spouse live apart during the year?*

YesNoNot Applicable
What is your marital status as of December*

Single (Not Married)Married living with SpouseMarried not living with spouse
Did you pay over half the expenses of maintaining your residence for the entire year?*

YesNo
Did you support a child or family member for more than 6 months out of the year?*

YesNo
If yes, did you live together at any time after June 30, 2024?*

YesNoNot Applicable
Are you on any Government Assistance*

YesNoNot Applicable
How many dependents are you claiming?*
Dependent #1

First NameLast Name
Dependent #1 Date of Birth
01/01/2001
Dependent #1 SSN
What is Dependent #1's Relationship to you (son, daughter, etc.)?
How many months did Dependent #1 live with you in 2023? (If all year, enter 12)
Are there any dependents in daycare? If yes, please upload the form you received from your daycare provider.

YesNo
Upload a copy of your daycare form here.

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How would you like to receive your tax refund?

Check (Only available for in office visits)Direct DepositDebit cardOther
Name of Bank
Which type of account would you like your refund deposited into?

Checking AccountSavings AccountOther
Routing Number
Bank Account Number
Can someone else claim you as a dependent?

YesNo
Did you have health insurance in 2024?

YesNo
Did you have health insurance for the entire year?

YesNo
Who was your insurance cover through in 2024?
Was your insurance through your employer?

YesNo
Was YOUR DEPENDENTS' insurance through your employer?

YesNoNot Applicable
Who was your Dependents insured with in 2024?
Upload Taxpayer & Dependent(s)Insurance Documents

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Have you ever been denied the Earned Tax Credit (EITC)?

YesNo
Were you or any of your dependents in college in 2024?

YesNo
Did you trade any Virtual Currency

YesNo
Do you have a 1098-T Form for either you or your dependents?

YesNo
If you have a 1098-T form, upload it here.

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Are you interested in AUDIT PROTECTION?

YesNo
Attention Business Owners
Biden has hired 87,000 new tax auditors to audit Earned Income and Child Tax Credit Clients, Schedule C Clients, and Education Credits, meaning everyone has a greater chance of being audited. To decrease your chances, please provide any documentation you have to support or proof that your dependents lived with you; if you are claiming education credits, please provide a 1098-T or proof of enrollment in school. Schedule C clients, please provide as much information as possible (EINs, receipts of income & expenses, a written statement of total revenue and expenses, cash apps, Zelle, or bank statement records).

My goal is to keep you and our company from any audits or questions, and with your help in providing as much information as you can, we can do that together.

We will add $99 audit protection for all Schedule C clients, and it is also recommended for anyone claiming any of the credits mentioned above!!!!!
Primary Taxpayer's Signature

Clear
I have attached or included with this form all W2s, 1099s, a copy of my identification and social security card if available as well as all other documents that are relevant to preparing my taxes.

I understand and agree that I will receive an email, call or text notification within 24 hours notifying me of my expected Federal & State Tax Outcome or an update if not completed.
Date

MonthDayYear
Date
Taxpayer's Signature (If no spouse, leave blank)

Clear
Spouse's Signature (If no spouse, leave blank)

Clear
Date

MonthDayYear
Date
Type a question
Date

MonthDayYear
Date
Taxpayer's Driver's License

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Taxpayer's and Dependent(s ) Social Security Card(s)

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Taxpayer's W-2/ 1099'S

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Dependent(s) Birth Certificate(s)

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Dependent(s) Proof of Residency (Lease/Utility Bill)

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Should be Empty:

CLIENT FORM

Attention Business Owners