KRISSY'S KWIK TAX INTAKE FORM

TAXPAYER FULL NAME

TAXPAYER DOB

TAXPAYER SSN

TAXPAYER PHONE NUMBER

TAXPAYER FULL ADDRESS, INCLUDING CITY, STATE, ZIP AND COUNTY

TAXPAYER EMAIL ADDRESS

TAXPAYER OCCUPATION

TAXPAYER IPPIN (IF REQUIRED)

SPOUSE FULL NAME

SPOUSE DOB

SPOUSE SSN

SPOUSE PHONE NUMBER

SPOUSE EMAIL ADDRESS

SPOUSE OCCUPATION

SPOUSE IPPIN (IF REQUIRED)

HOW DID YOU HEAR ABOUT KRISSY'S KWIK TAX

DOES ANYONE ON THE RETURN HAVE HEALTH INSURANCE THROUGH THE MARKETPLACE? IF SO, PLEASE EMAIL THE 1095A HEALTHCARE FORM TO DFW@KWIKTAX.CO

FILING STATUS

CAN YOU OR YOUR SPOUSE BE CLAIMED AS A DEPENDENT ON ANOTHER RETURN?

DEPENDENT FULL NAME

DEPENDENT RELATIONSHIP

DEPENDENT SSN

DEPENDENT DOB

IS THE DEPENDENT A STUDENT OR DISABLED??

DEPENDENT FULL NAME

DEPENDENT RELATIONSHIP

DEPENDENT SSN

DEPENDENT DOB

IS THE DEPENDENT A STUDENT OR DISABLED?

DEPENDENT FULL NAME

DEPENDENT RELATIONSHIP

DEPENDENT SSN

DEPENDENT DOB

IS THE DEPENDENT A STUDENT OR DISABLED?

ADD ANY ADDITIONAL DEPENDENTS OR DEPENDENT'S IPPIN

SELF EMPLOYMENT BUSINESS NAME AND ADDRESS

BUSINESS EIN

BUSINESS INCOME

BUSINESS EXPENSES

IF FILING HEAD OF HOUSEHOLD, DO YOU MEET THE FOLLOWING QUALIFICATIONS? HAVE QUALIFYING CHILD OR RELATIVES AS A DEPENDENT. UNMARRIED ON THE LAST DAY OF THE YEAR. PAID MORE THAN HALF OF THE COST OF MAINTAINING A HOUSEHOLD FOR THE YEAR.

IF REQUESTING CHILD TAX CREDIT, DOES YOUR DEPENDENT MEET THESE QUALIFICATIONS? UNDER 17 AT THE END OF THE YEAR, YOUR CHILD, STEPCHILD, GRAND CHILD, SIBLING,NEPHEW, NIECE, OR FOSTERCHILD. LIVED WITH YOU FOR MORE THAN HALF THE YEAR. HAVE NOT PROVIDED MORE THAN HALF OR THEIR OWN FINANCIAL SUPPORT FOR THE YEAR. THEY ARE A US CITIZEN OR RESIDENT ALIEN.

IF REQUESTING ADDITIONAL CHILD TAX CREDIT, DOES YOUR DEPENDENT MEET THE FOLLOWING QUALIFICATIONS? US CITIZEN OR RESIDENT ALIEN, UNDER 16 AT THE END OF THE YEAR, LIVED WITH YOU FOR MORE THAN HALF THE YEAR, AND NOT PROVIDED MORE THAN HALF OF THEIR OWN SUPPORT FOR THE YEAR.

IF REQUESTING CREDIT FOR OTHER DEPENDENTS, DOES YOUR DEPENDENT MEET THE FOLLOWING QUALIFICATIONS? ADULT DEPENDENT SUCH AS A PARENT OR DISABLED CHILDREN, OR QUALIFYING CHILDREN WHO ARE OVER 16.

IF REQUESTING THE AMERICAN OPPORTUNITY CREDIT, DO YOU MEET THESE REQUIREMENTS? YOU PAID AN ELIGIBLE STUDENTS EDUCATION EXPENSES FOR HIGHER EDUCATION AT A COLLEGE OR UNIVERSITY. THE STUDENT MUST BE YOU, A SPOUSE, OR YOUR DEPENDENT.

IF REQUSTING EARNED INCOME CREDIT, DO YOU MEET THE FOLLOWING QUALIFICATIONS? HAVE EARNED INCOME, HAVE A VALID SSN, BE A US CITIZEN OR RESIDENT ALIEN ALL YEAR. MEED RULES IF SEPARATED AND NOT FILING A JOINT RETURN.

IF YOU HAVE BUSINESS INCOME AND EXPENSES, CAN YOU SEND AN EMAIL OR SUPPLY YOUR LIST OF INCOME AND EXPENSES?

FOR DIRECT DEPOSIT PLEASE ENTER YOUR ROUTING AND ACCOUNT NUMBER (CHECKING OR SAVINGS?)

ARE YOU INTERESTED IN APPLYING FOR A LOAN?

ARE YOU INTERESTED IN CREDIT REPAIR?

ARE YOU INTERESTED IN ADDING AUDIT PROTECTION FOR $99? (RECOMMENDED)

WOULD YOU LIKE TO PURCHASE LIFE INSURANCE OR FINANCIAL PLANNING SERVICES?

Would you like to receive your refund 5 days faster? The fee is $25 and your bank must participate. If they do not participate, you will not be charged.

Signature

CLIENT INTAKE SHEET