Tax Return Client Intake 2024 TAX YEAR

Tax Client Intake Form
Taxpayer Information
Filing Status

SingleMarried Filing JointlyMarried Filing SeparatelyHead of HouseholdQualifying Widow(er) with Dependent Children
If someone referred you, please type his or her name here.
Would you like to request a Refund Advance Loan? (additional fees apply)

YESNO
Clients Name

First NameLast Name
Clients Date of Birth*

MonthDayYear
Date
SSN*
Clients Occupation
Check all that apply:

Can you be claimed as a dependent on someone else's return.Were you over age 18 and a full-time student at an eligible educational institution.Taxpayer is blind.Taxpayer is deceased.Taxpayer or Spouse served in a combat zone during the current tax year.Taxpayer wishes to elect to use their 2019 earned income to figure their 2021 earned income credit and/or child tax credit.Taxpayer or Spouse was affected by a natural disaster during the current tax year.Taxpayer has received, sold, sent, exchanged, or otherwise acquired financial interest in virtual currency during the current tax year.Taxpayer prefers to receive written communications from the IRS in a language other than English.Taxpayer prefers to receive written communications from the IRS in an accessible format.
Check all that apply:

Can you be claimed as a dependent on someone else's returnWere you over age 18 and a full-time student at an eligible educational institution.Taxpayer is blind.Taxpayer is deceased.Taxpayer or Spouse served in a combat zone during the current tax year.Taxpayer wishes to elect to use their 2019 earned income to figure their 2021 earned income credit and/or child tax credit.Taxpayer or Spouse was affected by a natural disaster during the current tax year.Taxpayer has received, sold, sent, exchanged, or otherwise acquired financial interest in virtual currency during the current tax year.Taxpayer prefers to receive written communications from the IRS in a language other than English.Taxpayer prefers to receive written communications from the IRS in an accessible format.
Taxpayer Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Taxpayer Phone Number*
Taxpayer Email Address*
example@example.com
Please select all forms of that apply

W21099 NEC/1099 MISC (Independent Contractor)1099-R (Retirement Documents)1099-G (Unemployment)1099K (Third Party Credit Card Documents i.e. Square, CloverW2G (Gambling Winnings Documents)1099-CType option 91099-DIV1098-T (COLLEGE TUTION DOCUMENTS)1095-A (Market Place Health Insurance)

DEPENDENTS INFORMATION

	FULL DEPENDENT NAME	DATE OF BIRTH	SSN	# OF MONTHS DEPENDENT RESIDE WITH TAXPAYER	RELATIONSHIP	IP PIN
DEPENDENT 1
DEPENDENT 2
DEPENDENT 3
DEPENDENT 4
DEPENDENT 5

Where's the other parent, did they offer support for the dependent, if so explain?
Do you have a "Special Needs" child?

YesNo
Are there any dependents in daycare? If yes, please upload the form you receive from your daycare provider OR input name and address of daycare
Childcare Upload

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HEALTH INSURANCE COVERAGE:
DID YOU RECEIVED HEALTH COVERAGE (INSURANCE) THROUGH YOUR STATE MARKETPLACE OR HEALTHCARE.GOV? IF SO, PLEASE UPLOAD YOUR FORM 1095A
Please upload 1095A (For replacement call 1 (800) 318-2596 Ask for info over the phone, copy it down and submit)

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Wages and Salaries (Attach W-2's)

Interest Income (Attach 1099's) (List and identify as non-taxable Interest Income)

Unemployment Compensation Received (FORM 1099G) PLEASE UPLOAD FORM BELOW:
File Upload

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Were you, your spouse, or any dependent registered in college? Do you have a form 1098T?
File Upload

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If you would like your tax refund (if any) deposited directly into your bank

CheckingSavings
Bank Name
Your Account Number
Bank Routing Number
Business Income & Expenses (Sole Proprietorship, LLC)
Owner Name

First NameLast Name
Business name
Employer ID number (EIN OPTIONAL)
Business Type
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Are you trying to buy a new home within the next year?

YESNO
Please upload Driver License or State ID *

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Anything else we should know to prepare your taxes?
Take Photo of any Documents W2, Social Security card or Birth Certificate ANY DOCUMENTS(If you can't Upload)
Does anyone listed on the Tax Return have an Identity Pin? If so, please list the name and Identity Pin below:
Tax Return Preparation

We will prepare your tax return based on the information you provide. If your return is audited, you will be responsible for verifying the reported items. Please review the return carefully before signing to ensure the information is correct. Unless otherwise stated, the services for preparing your return do not include auditing, review, or any other form of verification or assurance.

Taxpayer Responsibilities

You agree to provide us with all income and deductible expense information. If you receive additional information after we commence work on your return, you will contact us immediately to ensure that your completed tax returns contain all relevant information. You affirm that all expenses or other deduction amounts are accurate and that you have all required supporting written records. In some cases, we may ask to review your documentation. You must be able to provide written records of all items included on your return if audited by either the IRS or state tax authority. We can provide guidance on what evidence is acceptable.

Before signing, carefully review the return to ensure the information is correct.

It is advisable to keep a copy of your tax return and any related tax documents. A fee may be assessed if you request a copy in the future.

By signing below, you acknowledge reading, understanding, and accepting your obligations and responsibilities.

For a joint return, both taxpayers must sign.

Consent for Payment

We value our relationship with our clients. We are in the business to provide you with the best service possible. We want to remind you that you are being provided a service and not a tax refund.

If you choose to have the tax preparation fees taken from your refund and your taxes are intercepted, YOU ARE STILL RESPONSIBLE FOR THE TAX PREPARATION FEES! By signing your return, you are agreeing to pay the tax preparation fees regardless of if your refund is released or not.

Upon our notification of your refund being intercepted, we will send you an invoice for payment. .

NOTE: The Department of Treasury's Financial Management Services (FMS) can offset ANY UNPAID federal or government debt against your refund WITHOUT prior notice.

Most commonly, the offset is taken for: Past due child support, Debts owed to a federal/ state agency, Unemployment debts owed to state, and/or past due federal student loans.

Payment for Tax Preparation Services: I acknowledge that I am engaging ONE STOP TAX LLC for the professional service of preparing my tax return. Payment is not contingent upon the approval or funding of my tax refund

Before signing, you can edit and add. Please check your email for the edit link after cliking save, then submit.

By signing below, I confirm that I have read and understand the terms of this ACH Authorization Form and agree to be bound by them.
Please submit selfie for ID verification to match submitted ID*
Date*

MonthDayYear
Date
Signature*

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Tax Client Intake Form

Taxpayer Information

HEALTH INSURANCE COVERAGE: