Tax Client Intake Form

Tax Client Intake Interview Sheet
Please fill the form Below
Your Full Name
Date of Birth

MonthDayYear
Date
Social Security Number
Spouse Full Name
Date of Birth

MonthDayYear
Date
Social Security Number
Cell Phone Number
Format: (000) 000-0000.
Home Phone Number
Format: (000) 000-0000.
E-mail
example@example.com
Mailing Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Are you filing s a return with your spouse
Last Year You Were
Last Year Your Spouse Was
As of December 31 what was your marital status
Did you or spouse pay any medical or dental expenses in 2024 ( this does not include insurance premiums)
Did you are spouse receive unemployment benefits in 2024
Do you own or rent
List the names of

-- Everyone who live with you ( other than spouse) -- Anyone you supported but did not live with you
SSN Number: Social Insurance Number First NameLast NameDate of BirthSon / Daughter / Parent, etc.. Relationship
SSN Number: Social Insurence NumberFirst NameLast NameDate of BirthSon / Daughter / Parent, etc. Relationship
SSN Number: Social Insurence NumberFirst NameLast NameDate of BirthSon / Daughter / Parent, etc. Relationship
SSN Number: Social Insurence NumberFirst NameLast NameDateSon / Daughter / Parent, etc Relationship
Did you pay someone to watch your child/children*
Did You Collect social security or retirement income*
Did you purchase Health Insurance Market Place (Obama Care)
If yes, Did you receive a 1095-A form from Market Place*
Were you ever disallowed the EITC prior to this year*
Did You make College Tuition payments and received a 1098-T form last year*
Do you have any other income other than your W-2*
Do you owe any delinquent:*
Did you file Taxes 2024
Were you affected by a natural disaster in 2024
If Yes what is the city and state of the disaster? Did you have Insurance to cover the damage? Damage amount
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Previous Year Return

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Signature
Date

MonthDayYear
Date
Should be Empty:

Tax Client Intake Interview Sheet

List the names of