Tax Preparation Client Intake Form
Filing Status
Single
Head of Household
Married Filing Separate
Married Filing Joint
Qualifying Widower
Tax Preparer Name
*
Taxpayer Information
Name
First Name
Last Name
Age
Date of Birth
-
Month
-
Day
Year
Date
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Email
example@example.com
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Do you have a IP PIN? If so please provide.
Occupation
Are you a full-time student?
Yes
No
Are you totally and permanently disabled?
Yes
No
Are you legally blind?
Yes
No
Upload Taxpayer I.D
*
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Upload Tax Payer Social Security Card
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Spouse Information
Name
First Name
Last Name
Age
Date of Birth
-
Month
-
Day
Year
Date
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Email
example@example.com
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Do your spouse have an IP PIN? If so please provide.
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
Other
Upload Spouse I.D
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Upload Spouse Social Security Card
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Dependents
Enter your dependents here
Rows
Name
Date of Birth
Relationship
1
2
3
4
5
6
Does you, your spouse, and your dependents have health insurance within 12 months last year? If yes, who covers for it?
Rows
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
Do they have a IP PIN? If so please provide number and dependents name.
Upload Birth Certificate(s) - Dependents
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Upload Social Security Card(s) - Dependents
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Tax Related Questions
Employment Status
Employed
Unemployed
Self-employed
Are you contributing to 401k or other pre-tax account?
Yes
No
Is this your first time opening a pre-tax account?
Yes
No
Please select what state return are you requesting?
State return
School
Local
RITA
Country returns
Does your dependents have tuition expenses?
Yes
No
If anyone, Attended College Please Upload 1098-T Documents
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Do you have any expenses for child care?
Yes
No
Please Provide Day Care Provider Name
Day Care Provider Address
Day Care Provider Phone Number
Day Care Provider EIN/Tax ID Number
Please Upload Day Care Invoices
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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
Please Upload Property Tax Documents
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Please Upload 1099-R, 1099-INT or any Other Supporting Documents
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Do you have mortgage interest?
Yes
No
Do you have real estate tax?
Yes
No
Did you sell any stock?
Yes
No
Did you take money from your 401k?
Yes
No
Did you pay your vehicle tax?
Yes
No
Did you receive a federal tax last year?
Yes
No
In previous years did you have to verify your identity?
Yes
No
Are you a victim of identity theft?
Yes
No
Do you have marketplace health insurance?
Yes
No
Did you receive any W2's?
Yes
No
Upload your Pay Stub for ESTIMATE!!!
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Please Upload All W2's
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Upload Any Additional Income Documents
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Expenses
Please fill-up the information within the current year only.
General Expenses
Rows
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
Please Provide Bank Information: Bank Name
Please Provide Bank Information: Routing Number
Please Provide Bank Information: Account Number
Security Question: Mother's Maiden Name?
What city were you born?
Self Employment
Business Name
Business Address
EIN
Business Type
Total Business Wages
Total Business Expenses
Upload Any 1099's and Other Business Income Documents
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Upload Profit & Loss Statement
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Acknowledgment & Signature
I confirmed that all information I entered here is accurate and true.
I allow Top Tier Taxes to capture my sensitive data like personal ID, government ID, and other information.
I have read the terms and conditions and privacy policy of Top Tier Taxes.
By signing below, you acknowledge that you have read and understood your responsibilities and our responsibilities in doing this tax return.
I hereby authorize the use of this identification and signature below to electronically file my federal tax return according to IRS publication 1345.
Date Signed
-
Month
-
Day
Year
Date
Taxpayer Signature
Date Signed
-
Month
-
Day
Year
Date
Spouse Signature
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