2024 TAX CLIENT INTAKE FORM

CLIENT INTAKE FORM

ALL CLIENTS PLEASE FILL OUT ALL INFORMATION APPLICABLE
Please select your Tax Preparer*

Terrelle ShepardFrances BurnettQuiana SchulerYudy Cabrales
Taxpayer Name*

First NameLast NameSuffix
Social Security Number*
Date of Birth*

MonthDayYear
Occupation*
Email*
example@example.com
Phone Number*
Please enter a valid phone number.
Please upload your 2 forms of identification*

EXAMPLE: Government ID, Drivers License, Passport, Social security card, birth certificate
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Spouse Information

First NameLast NameSuffix
Social Security Number
Date of Birth

MonthDayYear
Occupation
Phone Number
Please enter a valid phone number.
Email
example@example.com
SPOUSE, PLEASE UPLOAD 2 FORMS OF IDENTIFICATION

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Address*

NO P O BOX/ PHYSICAL ADDRESS ONLY

Street Address Line 2

CityState / Province

Postal / Zip Code
Filing Status:*

SingleMarried Filing JointlyMarried Filing SeparatelyHead of HouseholdQualifying Widow
HEAD OF HOUSEHOLD FILERS MUST PRESENT ONE OF THE FOLLOWING TO FILE THIS STATUS. PICK ONE OF THE 3 OPTIONS THAT YOU WILL SUBMIT TO BE APPROVED TO FILE HEAD OF HOUSEHOLD.

LeaseUtility BillMortgage Statement
Upload your head of household document

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Dependent 1

First NameLast NameSuffix
Social Security Number
Date of Birth

MonthDayYear
Relationship
Dependent 2

First NameLast NameSuffix
Social Security Number
Date of Birth

MonthDayYear
Relationship
Dependent 3

First NameLast NameSuffix
Date of Birth

MonthDayYear
Social Security Number
Relationship
Upload 2 forms of identification for your dependent/dependents.

EXAMPLE: SOCIAL SECURITY CARD, BIRTH CERTIFICATE, MEDICAL RECORD, SCHOOL ENROLLMENT FORM, PASSPORT
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IF YOU ARE CLAIMING A DEPENDENT, PLEASE ANSWER THE QUESTIONS BELOW THAT PERTAINS TO YOUR DEPENDENT RELATIONSHIP. PER THE IRS REQUEST, WE MUST PROVE THAT NOBODY ELSE IS ELIGIBLE TO CLAIM YOUR DEPENDENT BUT YOURSELF.
If claiming son/daughter, where is the other parent of the dependent/dependents? Is the other parent providing any financial support?
If claiming niece, nephew, aunt, or uncle, how are you related to the dependent? Where are the parents to the dependent/dependents?
If claiming brother or sister, how are you related to the dependent? Why are the parents not claiming the dependent/dependents?
Are you in the market to purchase a home in the next two years?*

YesNo
Do you need to file any prior years Tax Return? If So, upload required documents in the applicable section below*

YesNo
UPLOAD YOUR 2024 W2S, 1099-NEC, AND ANY OTHER INCOME DOCUMENT YOU NEED TO FILE.

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IF APPLICABLE, PLEASE UPLOAD YOUR 2023 W2S,1099 NEC, AND ANY OTHER INCOME DOCUMENT YOU NEED TO FILE

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IF APPLICABLE, PLEASE UPLOAD YOUR 2022 W2S, 1099-NEC, AND ANY OTHER INCOME DOCUMENT YOU NEED TO FILE.

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IF APPLICABLE, PLEASE UPLOAD YOUR 2021 W2S, 1099-NEC, AND ANY OTHER INCOME DOCUMENT YOU NEED TO FILE.

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IF YOU ARE FILING FOR TAX YEAR 2021, DID YOU RECEIVE AN ADVANCE CHILD TAX CREDIT?

YESNOI DO NOT KNOW
IF YES TO THE ABOVE QUESTION, HOW MUCH DID YOU RECEIVE FOR YOUR ADVANCE CHILD TAX CREDIT?
FOR THE TAX YEAR 2021, HOW MUCH DID YOU RECEIVE FOR THE THIRD ECONOMIC REBATE CREDIT (STIMULUS)? $1400 PER PERSON
IF APPLICABLE, PLEASE UPLOAD YOUR 2020, 2019 W2S, 1099-NEC, AND ANY OTHER INCOME DOCUMENT YOU NEED TO FILE.

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FOR THE TAX YEAR 2020, DID YOU RECEIVE THE FIRST AND SECOND ECONOMIC REBATE CREDIT (STIMULUS)?

PLEASE INPUT YOUR STIMULUS FOR 2020 BELOW

	AMOUNT OF FIRST STIMULUS	AMOUNT OF SECOND STIMULUS
2020

Did you pay someone to watch your child/children?

YESNO
Did you collect social security or retirement income?

YESNO
Did you purchase health insurance through healthcare.gov marketplace (Obama Care)?*

YesNo
If yes, did you receive a 1095-A Form from the marketplace?

YesNo
IF YES TO THE PREVIOUS QUESTION, PLEASE UPLOAD FORM 1095-A FROM THE HEALTHCARE MARKET PLACE.

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Were you ever disallowed the E.I.T.C prior to this year?*

YesNo
Did you receive unemployment compensation (1099-G) last year?*

YESNO
PLEASE UPLOAD YOUR UNEMPLOYMENT FORM 1099-G

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Did you make college tuition payments and received a 1098-T Form last year?*

YESNO
PLEASE UPLOAD YOUR 1098-T FORM FROM YOUR COLLEGE OR INSTITUTION

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Do you have any other income than your w-2(s)?*

YESNO
Do you have a six digit Identity Protection pin provided from the IRS? If you answer "NO" and your tax return is rejected due to missing IP PIN, an additional $50 charge will be due before your tax return is resubmitted to the IRS.*
If you answered yes to the question above please provide the IP pin.
PLEASE INPUT YOUR DEPENDENT NAME AND IP PIN IF YOUR DEPENDENT HAS ONE BELOW
Do you owe any delinquent:*

Child SupportAlimonyStudent LoansBack TaxesState TaxesIRSNONE OF THE ABOVE