Tax Preparation Client Intake Form
Each adult over the age of 18 must fill out a separate form. Also for each tax year , you will have to submit a new form. If something does not pertain to you please enter N/A.
Desired Filing Status
*
Single
Head of Household
Married Filing Separate
Married Filing Joint
Qualifying Widower
Taxpayer 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
DL # Issue Date and Exp Date
*
Occupation
*
Are you a full-time student?
*
Yes
No
Are you totally and permanently disabled?
*
Yes
No
Are you legally blind?
*
Yes
No
New Clients upload a copy of last years tax return.
Browse Files
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Choose a file
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of
Are you applying for a refund advance loan?
*
Please Select
Yes
No
Would you like to opt in to the fast forward program where you would receive your refund 5 days sooner? Please note there is a $25 fee that will be added to your bank fees if you decide to opt in.
*
Yes
No
Did you receive your refund from last year?
*
Yes
No
I'm still waiting on them
Have you ever been disallowed the CTC or the EIC credit in the past?
*
Yes
No
Have you, your spouse , or any of your dependents served in the US Military? If so , please list the name of the person who served?
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
Are they a full-time student?
Yes
No
Are they totally and permanently disabled?
Yes
No
Are they legally blind?
Yes
No
Are they your dependent?
Yes
No
Dependents
Enter your dependents here
Name
Date of Birth
Relationship
1
2
3
4
5
6
If the dependent is not your biological child, please explain why the parents or guardian isn't claiming the dependent? Enter N/A if it does not apply.
Is any of your dependents permanently disabled? If so please list their name.
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
Dependent 1
Yes
No
Dependent 2
Yes
No
Dependent 3
Yes
No
Dependent 4
Yes
No
Dependent 5
Yes
No
Tax Related Questions
Employment Status
*
Employed
Disabled
Self-employed
Please enter your Business name and EIN number as well as the type of business you are or things you sell (business owners only)
Are you contributing to 401k or other pre-tax account?
Yes
No
Please select what returns you are requesting?
*
State return
School
Local
RITA
Federal
Are any of your dependents permanently disabled or legally blind? If so list which one below.
Does your dependents have tuition expenses?
Yes
No
Do you have any expenses for child care or dependent care?
Yes
No
If you have dependent care expenses, please estimate and list the amount you paid for the year for each individual. Also enter the name, address, and social security number or ein number of the provider.
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 ?
*
What is your landlord name and address?
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
How much were your property taxes this year? And how much is your property tax value?
Approx. How much did you pay to your home heating provider for heat this year? And who is your home heating provider (ex. DTE Energy, Consumers)
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
Do you plan on purchasing a home via mortgage or leasing/financing a car this upcoming year?
*
Yes
No
Will your tax return be offset or do you owe any debts?
*
Offset
Owe Debts
No Debts or Offsets
Are you a victim of identity theft?
*
Yes
No
If you have been assigned an IP PIN for the current tax year please enter it below.
Browse Files
Drag and drop files here
Choose a file
Cancel
of
Please enter the rout ing and acc ount num ber where you would like to receive your refund as well as the ba nks name. ( yes I know there are errors in the spelling but it was neccessary to avoid any flagging)
If you do not want to use your own account or do not have one, please choose from the availble refund options below.
Check printed in office and handed to you or mailed if your are not local
Office provided prepaid debit card to be handed to you or mailed if you are not local
Please choose the tax preparer you are interested in servicing you
*
Davena Knight - Owner- davenaknight@serenetaxservice.com
Latosha Moore- latoshamoore@serenetaxservice.com
Donsha Crutcher- donshacrutcher@serenetaxservice.com
Victoria Foster- victoriafoster@serenetaxservice.com
Sierra Cody - sierracody@serenetaxservice.com
Jenean Payne
How did you hear about us? If someone referred you please enter their name below.
*
Additional comments
Acknowledgement and Signature Page will be sent in a follow up email.
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