Client Intake Form

1
Client Status * This field is required.Please select the option that best describes your relationship with Lavish Tax & Realty.
2
Tax Year* This field is required.Select the tax year you are filing for.
3
If you were referred, please type their name below.
4
Email Address * This field is required.
example@example.com
5
Personal Information* This field is required.
6
Address* This field is required.
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Please Select
Please Select
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
The Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
Brazil
Brunei
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos (Keeling) Islands
Colombia
Comoros
Congo
Cook Islands
Costa Rica
Cote d'Ivoire
Croatia
Cuba
Curaçao
Cyprus
Czech Republic
Democratic Republic of the Congo
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Polynesia
Gabon
The Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
North Korea
South Korea
Kosovo
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macau
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Nagorno-Karabakh
Namibia
Nauru
Nepal
Netherlands
Netherlands Antilles
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
Turkish Republic of Northern Cyprus
Northern Mariana
Norway
Oman
Pakistan
Palau
Palestine
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn Islands
Poland
Portugal
Puerto Rico
Qatar
Republic of the Congo
Romania
Russia
Rwanda
Saint Barthelemy
Saint Helena
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
Somaliland
South Africa
South Ossetia
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard
eSwatini
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Transnistria Pridnestrovie
Trinidad and Tobago
Tristan da Cunha
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
Uruguay
Uzbekistan
Vanuatu
Vatican City
Venezuela
Vietnam
British Virgin Islands
Isle of Man
US Virgin Islands
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Other
Country
7
Did you live in any other state in 2025?* This field is required.
YESNO
8
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Please Select
Please Select
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
The Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
Brazil
Brunei
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos (Keeling) Islands
Colombia
Comoros
Congo
Cook Islands
Costa Rica
Cote d'Ivoire
Croatia
Cuba
Curaçao
Cyprus
Czech Republic
Democratic Republic of the Congo
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Polynesia
Gabon
The Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
North Korea
South Korea
Kosovo
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macau
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Nagorno-Karabakh
Namibia
Nauru
Nepal
Netherlands
Netherlands Antilles
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
Turkish Republic of Northern Cyprus
Northern Mariana
Norway
Oman
Pakistan
Palau
Palestine
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn Islands
Poland
Portugal
Puerto Rico
Qatar
Republic of the Congo
Romania
Russia
Rwanda
Saint Barthelemy
Saint Helena
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
Somaliland
South Africa
South Ossetia
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard
eSwatini
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Transnistria Pridnestrovie
Trinidad and Tobago
Tristan da Cunha
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
Uruguay
Uzbekistan
Vanuatu
Vatican City
Venezuela
Vietnam
British Virgin Islands
Isle of Man
US Virgin Islands
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Other
Country
9
Do you or your children have Market Place Healthcare Insurance?* This field is required.Please provide your 1095A on the upload screen or you will be charged a $50 penalty.
YESNO
10
Do you have an Identity Protection Pin?* This field is required.
YESNO
11
Enter IPPIN below
12
Are you a full-time scholar enrolled in school or have a dependent enrolled?* This field is required.You will be required to upload a 1098T.
YESNO
13
Filing Status* This field is required.
Please Select
Please Select
Single (Not Married as of December 31st, 2024)
Head of Household (Supporting Documentation Required)
Married Filing Joint
Married Filing Separately
Qualifying Widow(er)
Unsure
14
Spouse Information
15
Head of Household Questionnaire
16
Were you pregnant between the months of July and December?Please be advised you will not be able to claim the pregnancy & the child.
YESNO
17
How many dependents are you claiming?* This field is required.
Please Select
Please Select
0
1
2
3
4
5
18
Dependent Information Please fill out all columns.
19
Dependent Care Provider
Name of Provider
Full Address
SSN, W9 or FEIN
Name of Dependent(s) who Received Care
Amount Paid
Please Select
Please Select
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
The Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
Brazil
Brunei
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos (Keeling) Islands
Colombia
Comoros
Congo
Cook Islands
Costa Rica
Cote d'Ivoire
Croatia
Cuba
Curaçao
Cyprus
Czech Republic
Democratic Republic of the Congo
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Polynesia
Gabon
The Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
North Korea
South Korea
Kosovo
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macau
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Nagorno-Karabakh
Namibia
Nauru
Nepal
Netherlands
Netherlands Antilles
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
Turkish Republic of Northern Cyprus
Northern Mariana
Norway
Oman
Pakistan
Palau
Palestine
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn Islands
Poland
Portugal
Puerto Rico
Qatar
Republic of the Congo
Romania
Russia
Rwanda
Saint Barthelemy
Saint Helena
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
Somaliland
South Africa
South Ossetia
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard
eSwatini
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Transnistria Pridnestrovie
Trinidad and Tobago
Tristan da Cunha
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
Uruguay
Uzbekistan
Vanuatu
Vatican City
Venezuela
Vietnam
British Virgin Islands
Isle of Man
US Virgin Islands
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Other
Country
20
If you are claiming any dependents outside your son or daughter, please explain why the parent is unable to claim them.
Huge
Large
Normal
Small
Ok
Ok
21
Income & Wage Questionnaire* This field is required.
Please Select
Please Select
Yes
No
Unsure
Did you work a job at any time during the tax year?
Please Select
Please Select
Yes
No
Did you start or do you own your own business?
Please Select
Please Select
Yes
No
Did you do any contract/self-employment work?
Please Select
Please Select
Yes
No
Unsure
Did you receive unemployment or paid any unemployment back?
22
Self-Employment
23
List Expenses & AmountsDo you have detailed records to substantiate these expenses?
Huge
Large
Normal
Small
Ok
Ok
24
Income & Wages* This field is required.Select All That Apply
W2 - Wages Income
1099NEC - Contractor Income
1098T - College Credit
1099G - Unemployment
Self Employed - Profit & Loss Stmt
1099R; 1099INT; 1099DIV
No Income
25
Additional Expenses
Amount
Medical Expenses
Row 0, Column 0
Dental Expenses
Row 1, Column 0
Insurance Premiums Paid
Row 2, Column 0
Long Term Care Premiums
Row 3, Column 0
Home Mortgage
Row 4, Column 0
Investment Interest
Row 5, Column 0
Cash Contributions
Row 6, Column 0
Non-Cash Contributions
Row 7, Column 0
Medical Expenses
Dental Expenses
Insurance Premiums Paid
Long Term Care Premiums
Home Mortgage
Investment Interest
Cash Contributions
Non-Cash Contributions
Amount
Row 0, Column 0
Amount
Row 1, Column 0
Amount
Row 2, Column 0
Amount
Row 3, Column 0
Amount
Row 4, Column 0
Amount
Row 5, Column 0
Amount
Row 6, Column 0
Amount
Row 7, Column 0
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Due Diligence * This field is required.Not Applicable, Yes, or No
27
In the event of an audit, can you prove financial responsibility and residency for the dependents being claimed?* This field is required.
YESNO
28
Which documents can you provide?* This field is required.Select All That Apply
Please Select
Lease
Utility Bill
Medical Records
School Records
Benefit Statements (TANF, Disability, ETC)
Birth Certificate
29
Do you or your spouse owe any of the following offsets?* This field is required.Select All That Apply
Please Select
None
Unsure
Taxes (Federal or State)
Child Support
Student Loans
Alimony
30
Due Diligence * This field is required.Not Applicable, Yes, or No
31
Are you interested in a Cash Advance?* This field is required.
YESNO
32
Cash Advance Options
prevnext( X )
My Bag
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My Bag
Great Product Name
$20
Quantity:1
Size:Small
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Great Product Name
$20
Quantity:1
Size:Small
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Great Product Name
$20
Quantity:1
Size:Small
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Great Product Name
$20
Quantity:1
Size:Small
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ORDER SUMMARY
Total costUSD
Interest Free Loan
Up to $1,000.00
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Back
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1
2
3
4
5
6
7
8
9
10
Quantity
Interest Loan
This loan is offered in amounts of 25%, 50%, or 75% of your expected tax refund up to $7,000. Some loans are interest bearing and will have an annual APR.
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Back
Decline
DECLINE
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Total
33
Refund Transfer Options* This field is required.Select One
Check (the amount of your refund, less filing fees - prepared in office for pick up)
Debit Card (the amount of your refund, less filing fees - loaded to card issued by Lavish T&R)
Direct Deposit (the amount of your refund, less filing fees - deposited into bank account provided)
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Banking Information* This field is required.
Checking or Savings
Routing Number
Account Number
35
Payment Responsibility & Authorization Agreement⚠️ REFUND OFFSETS DO NOT WAIVE FEES Lavish Tax & Realty (“Lavish T&R”) is committed to assisting clients with their tax preparation needs; however, certain circumstances may affect the timing or delivery of tax refunds. You acknowledge and agree that tax preparation fees remain due and payable regardless of refund status, including but not limited to situations where your refund is reduced or offset by the IRS, applied to student loans or child support obligations, delayed, or issued by mailed check. By signing this agreement, you agree to remit full payment of all outstanding tax preparation fees to Lavish T&R within 30 days of return completion or IRS notice. If payment is not received within this timeframe, you acknowledge and agree that legal action may be pursued to recover the balance owed, including any allowable collection costs. Authorization & Responsibility Acknowledgment You authorize Lavish T&R and its affiliated preparers to prepare all required federal and state tax forms related to your tax return and confirm that you have signed all necessary authorizations to permit electronic filing. You further acknowledge that you are solely responsible for the accuracy and completeness of all information provided on your client intake form and supporting documents. You agree that Lavish T&R and its affiliates are not responsible for any errors, penalties, or consequences resulting from misrepresentation, omissions, or false information supplied by you.
36
Profit & Loss Statement & Audit Responsibility* This field is required.By signing this intake form, the taxpayer acknowledges and agrees that all income, expenses, deductions, and figures reported on the Profit & Loss statement are provided by the taxpayer and are the taxpayer’s sole responsibility. In the event of an audit, examination, inquiry, or request for verification by the IRS or any state or local taxing authority, the taxpayer understands and agrees that they are solely responsible for providing all required documentation, including but not limited to receipts, bank statements, invoices, mileage logs, and other supporting records. The tax preparer does not maintain, store, or provide documentation on behalf of the taxpayer and is not responsible for responding to audits, substantiating expenses, or supplying records unless a separate written audit representation agreement has been executed. The taxpayer further agrees to hold the tax preparer harmless from any penalties, interest, adjustments, or liabilities resulting from missing, incomplete, or inaccurate documentation.
37
Tax Preparation Engagement & Disclosure Statement* This field is required.Scope of Services Lavish Tax & Realty (“Lavish T&R”) will prepare your federal and applicable state income tax returns based solely on the information you provide. This intake form is designed to help ensure all relevant information is collected. If any required information is missing, you may submit it at a later time so that we may estimate your tax liability for extension purposes, if applicable. Taxpayer Responsibilities You are solely responsible for providing complete, accurate, and truthful information necessary to prepare your tax returns. While Lavish T&R may provide organizers, checklists, or requests for additional details, you acknowledge and affirm that all information submitted is accurate and complete to the best of your knowledge. Lavish T&R will not audit, verify, or independently validate the information you provide. We may, however, request clarification if information appears inconsistent, incorrect, or incomplete. Our services do not include procedures designed to detect errors, fraud, or irregularities. You retain final responsibility for your tax returns and are required to carefully review them prior to signing and filing. Record-Keeping & Documentation You are responsible for maintaining all documents and records that support income, deductions, credits, and payments reported on your tax return. Certain items are subject to specific IRS substantiation requirements, including but not limited to automobile expenses, meals, entertainment, and charitable contributions exceeding $250. Your signature confirms that Lavish T&R has advised you of these record-keeping requirements. In the event of an audit, examination, or inquiry by the IRS or any state or local taxing authority, you are solely responsible for providing all requested documentation and receipts. Audit representation services are not included unless separately agreed to in writing. Rejected Returns & Resubmission Fee If your tax return is rejected due to missing or incomplete information that was requested on this intake form but not provided, a $100 resubmission fee will be assessed. Tax Positions & Professional Standards When tax law is unclear or subject to differing interpretations, Lavish T&R will use professional judgment to determine a reasonable and supportable position. Certain positions may require disclosure under applicable law. Lavish T&R is not a law firm and does not provide legal opinions; however, we may explain the tax consequences of various positions. We will adopt positions you request provided they comply with applicable laws, regulations, and professional ethical standards. If you request an unsupported position or refuse required disclosures, Lavish T&R reserves the right to withdraw from the engagement. In such cases, you agree to pay all fees incurred based on time expended at standard rates, plus any out-of-pocket expenses through the date of withdrawal. Errors, Fraud, or Illegal Acts Our engagement does not include an obligation to identify errors, fraud, or illegal acts. If, during the course of our work, we become aware of any material errors or potential illegal activity, we will notify you promptly. Taxpayer Acknowledgment & Authorization By signing this intake form, you confirm that all information provided to Lavish T&R is true and accurate to the best of your knowledge. You understand that you are responsible for maintaining supporting documentation and acknowledge that knowingly providing false information to the IRS may result in civil and/or criminal penalties, including fines, restitution, and imprisonment. You agree to release and hold harmless Lavish T&R and its preparers from any liability arising from errors or omissions due to incorrect, incomplete, or misleading information you provided. You authorize Lavish T&R to prepare and file your tax return on your behalf. Fees & Payment Terms Fees are based on time spent preparing your return unless otherwise agreed upon in advance. Tax preparation fees remain due even if your refund is subject to an offset. If fees are to be paid from a refund that is offset, payment is due within 60 days of the IRS notice. Accounts more than 90 days past due may be subject to collection action, including court filings, with all associated costs added to the balance. By signing this engagement, you agree to indemnify and hold harmless Lavish Tax & Realty from any liability, cost, or expense arising from misrepresentation or omission of information you supplied. Thank you for trusting Lavish Tax & Realty with your tax and payroll needs. Yours Truly, L.A. Lavish Tax & Realty
38
Date Signed * This field is required.
39
Type a question
Choose All Supporting Documents
Valid State ID or License
Row 0, Column 0
Social Security Card
Row 1, Column 0
Birth Certificate
Row 2, Column 0
Last Year Return
Row 3, Column 0
W2, 1099G, 1099R
Row 4, Column 0
Medical Bills
Row 5, Column 0
1095A Healthcare Form
Row 6, Column 0
1098T, 1098E, 1099INT
Row 7, Column 0
Childcare Statement
Row 8, Column 0
Business Receipts
Row 9, Column 0
Valid State ID or License
Social Security Card
Birth Certificate
Last Year Return
W2, 1099G, 1099R
Medical Bills
1095A Healthcare Form
1098T, 1098E, 1099INT
Childcare Statement
Business Receipts
Choose All Supporting Documents
Row 0, Column 0
Choose All Supporting Documents
Row 1, Column 0
Choose All Supporting Documents
Row 2, Column 0
Choose All Supporting Documents
Row 3, Column 0
Choose All Supporting Documents
Row 4, Column 0
Choose All Supporting Documents
Row 5, Column 0
Choose All Supporting Documents
Row 6, Column 0
Choose All Supporting Documents
Row 7, Column 0
Choose All Supporting Documents
Row 8, Column 0
Choose All Supporting Documents
Row 9, Column 0
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