Tax Preparation Client Intake Form
Please enter your tax preparer below
Filing Status
Single
Head of Household
Married Filing Separate
Married Filing Joint
Qualifying Widower
Taxpayer Information
Social Security Number
Name
First Name
Last Name
Age
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
Age
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
Dependents
Enter your dependents here
Name
Date of Birth
Social Security Number
Relationship
1
2
3
4
5
6
Are they a full-time student?
Yes
No
Are they totally and permanently disabled?
Yes
No
Does you, your spouse, and your dependents have health insurance within 12 months last year? If yes, who covers for it?
Yes/No
Employer
Spouse Ins
Exchange/ Marketplace
Direct with Insurer
Medicare
Medicaid
Taxpayer
Yes
No
Spouse
Yes
No
Tax Related Questions
Employment Status
Employed
Unemployed
Self-employed
Are you contributing to 401k or other pre-tax account?
Yes
No
Please select what state return are you requesting?
State return
School
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
Are you currently renting?
Yes
No
What is the monthly rental amount?
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
If you are self employed, please request the Schedule C Affidavit.
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
Total Expenses
Additional comments
Acknowledgment & Signature
I confirmed that all information I entered here is accurate and true.
I allow Numbers People LLC to capture my sensitive data like personal ID, government ID, and other information.
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
Please Upload W2, 1099, License, SSN, Birth Certificate, Banking, Mortgage, Interest, 1099-T and/or any other documents that may be pertinent to this tax return. (Encrypted Upload)
Browse Files
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Choose a file
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Have your ever received any PPP payments?
Yes
No
Do you need life insurance?
Yes
No
I'd like a quote
Are you interested in credit repair?
Yes
No
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