2025 Individual Tax Preparation Client Intake Form

2025 The Great Tax Return Individual Tax Preparation Client Intake Form

PLEASE FILL OUT ALL INFORMATION APPLICABLE
Filing Status*

SingleHead of HouseholdMarried Filing Separate*Married Filing JointQualifying Widower
*If you are filing married filing separate, you are still required to provide your spouse's driver's license and social security card. Your spouse's income is not required. Please upload a copy of identification in the upload section.

Income Outline (If it does not apply enter 0)*

	Total Number for Primary Taxpayer	Total Number for Spouse	Total Number for Dependents
W2s
1099 (NEC, MISC)
1099R (Pension,
1099-SSA

Do you want $3 to go to the Presidential Election Campaign Fund?*

YesNo
Are you a full-time student?*

YesNo
If the primary taxpayer was a part-time or full-time student, select the number of months.*
Are you totally and permanently disabled?*

YesNo
If yes, enter the number of months the tax payer was disabled.*
Are you legally blind?*

YesNo
Is this individual dependent of other?*

YesNo
Did you live in any other state during 2024?*

YesNo
Did you make money in any other state in 2024?*

YesNo
Did you purchase health insurance through healthcare.gov marketplace (Obama Care)?*

YesNo
If yes, did you receive a 1095-A Form from the marketplace?*

YesNo

Do you or your spouse owe any delinquent? Answer yes where applicable.*

Enter your dependents here*

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

Payment for Services
How would you like to pay for your tax preparation services?

Refund TransferOut of pocket

Bank Information (information provided will be entered if you are due a tax refund).
Account Number*
Reconfirm Account Number*
Routing Number*
Reconfirm Routing Number*

Acknowledgment & Signature
- I confirmed that all information I entered here is accurate and true.
- I allow The Great Tax Return to capture my sensitive data like personal identification, government identification, social security number (SSN), and other information.
- I have read the terms and conditions and privacy policy of The Great Tax Return.
- By signing below, you acknowledge that you have read and understood your responsibilities and our responsibilities in providing tax preparation services.
Date Signed*

MonthDayYear
Date
Taxpayer Signature*

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Date Signed

MonthDayYear
Date
Spouse Signature

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2025 The Great Tax Return Individual Tax Preparation Client Intake Form