Client Intake Agreement & Acknowledgment

Obsidian Tax Service Firm – Client Agreement & Acknowledgment
Thank you for choosing Obsidian Tax Service Firm! We are thrilled to have the opportunity to assist you and are committed to providing you with the best service possible. To get started, please complete the intake form with as much detail as you can. This will help us understand your needs and ensure we provide the most accurate assistance.

If you have any questions or require assistance while filling out the form, please don't hesitate to reach out. You can contact us via email at info@obsidiantsf.com or give us a call at 682-243-5096. We’re always here to help and look forward to serving you!
How did you hear about Obsidian Tax Service Firm. Select One

FACEBOOKINSTAGRAMRETURNING CLIENTWORD OF MOUTHREFERRALONLINE DIRECTORY- www.blacktaxprofessionals.com
If you're a Referral, please provide the name and phone number of the person who referred you.
Name

First NameLast Name
HAVE YOU COMPLETED THE TAXESTOGO APP?
WHAT IS YOUR EMAIL ADDRESS AND TAX CODE FROM THE TAXESTOGO APP
CHOOSE YOUR TAX PROFESSIONAL
Filing Status

Single: This status applies to individuals who are unmarried, divorced, or legally separated as of the last day of the tax year. Eligibility: You must not qualify for any other filing status.Head of Household: This status is for unmarried individuals who support a dependent, such as a child or other relative, for more than half of the year. Eligibility: You must be unmarried or considered unmarried on the last day of the year, and you must provide more than half the financial support for a qualifying dependent. Advantages: This status typically provides a lower tax rate and a higher standard deduction compared to Single status.Married Filing Jointly: This status applies to married couples who choose to file their taxes together as a couple. Eligibility: Both spouses must agree to file a joint return, and they are both responsible for the accuracy of the tax return and any tax liabilities. Advantages: This status often provides the lowest tax rates and eligibility for certain tax credits and deductions.Married Filing Separately: This status applies to married individuals who choose to file separate tax returns instead of a joint return. Eligibility: Married couples can choose this status, but it often results in higher taxes and fewer credits or deductions. Disadvantages: If you file separately, you may lose eligibility for certain tax benefits (e.g., the Earned Income Tax Credit) and have limited deductions for student loan interest.Qualifying Widow(er) with Dependent Child This status is for individuals whose spouse has passed away within the last two years and who are still providing support for a dependent child. Eligibility: You must have a dependent child and not remarried. This status allows you to use the same tax rates as Married Filing Jointly. Advantages: This status provides the same tax benefits and deductions as Married Filing Jointly for up to two years after the spouse's death.
If you are anyone in your household have a debt with the IRS, Offce Of Attorney General (Child Support), Unemployment, Social Security Administration, Student Loans and/or Bankruptcy, you are still responsible for fees due to Obsidian Tax Service Firm at the time of services and must advise the tax professional of any and all debt. In addition, if you receive your check by mail and fail to pay your tax preparer fees you be subject to criminal charges (theft by services) which is classified as a felony. Obsidian Tax Service Firm has also partnered with Santa Barbara Bank and Refund Advantage Bank to implement (AUTO COLLECT) which allows us to collect tax preparer and filing fees if fees were not deducted from taxpayer's refund.
Do you or anyone in your household owe money please select which one(s). listed below? If so,

IRSOffice Of The Attorney GeneralSocial Security AdministrationStudent LoansBankruptcy
If you owe to any of the entities listed above, how much?
ARE YOU SELF-EMPLOYED, W2, OR BOTH?

Name*

First NameLast Name
Taxpayer Age*
Date of Birth*

MonthDayYear
Date
Phone Number*
Please enter a valid phone number.
Email*
example@example.com
Social security Number*
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Occupation
Please Provide Your Obsidian Tax Preparer Full Name:*
Do you have an IP PIN? Please provide.
Select All That Apply*

Are You a Full-Time Student?Are You Totally and Permanently Disabled?Are You Legally Blind?Did You File Taxes Last Year?If So, Did You Receive a Tax Return?

Name

First NameLast Name
Age
Date of Birth

MonthDayYear
Date
Phone Number
Please enter a valid phone number.
Email
example@example.com
Social Security Number
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Occupation
Select All That Apply

Are You a Full-Time Student?Are You Totally and Permanently Disabled?Are You Legally Blind?Did You File Taxes Last Year?If So, Did You Receive a Tax Return?

Does you, your spouse, and your dependents have health insurance within 12 months last year? If yes, who covers for it?

	Yes/No	Employer	Spouse Ins	Exchange/ Marketplace	Direct with Insurer	Medicare	Medicaid
Taxpayer
Spouse
Dependent 1
Dependent 2
Dependent 3
Dependent 4
Dependent 5

Do you have any expenses for child care?

YesNo
Please Provide Day Care Provider Name
Day Care Provider Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Day Care Provider Phone Number
Please enter a valid phone number.
Day Care Provider EIN/Tax ID Number
Do you own your home?

YesNo
Do you have documents that show you paid for property taxes?

YesNo
Select All That Apply

Did You Sell Any Stock?Did You Take Money From Your 401K?Do You Have Mortgage Interest?

Did you receive any W2's?

YesNo
Please Provide Bank Information: Bank Name
Please Provide Bank Information: Routing Number
Please Provide Bank Information: Account Number
Security Question: Mother's Maiden Name?

Business Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
EIN
Business Type
Total Business Wages

Business Expenses

	Amount
Advertising
Car and Truck Expenses
Commissions and Fees
Contract Labor
Depletion
Depreciation
Employee Benefit Program
Insurance
Interest
Mortgage
Legal and Professional Services
Office Expense
Pension and Profit Sharing Plans
Rent or Lease
Vehicles
Machinery and Equipment
Other Business Property
Repairs and Maintenance
Supplies
Taxes and Licenses
Travel
Meals
Wages
Other Expenses

Total Business Expense

General Expenses for Itemizing Deductions

	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
Charitable Donations

Total Itemized Deductions
Additional comments

We, at Obsidian Tax Service Firm, would like to extend our sincerest THANK YOU for choosing us to assist you with your tax filing this season.

In order to minimize any potential misunderstandings or miscommunications, we have outlined key information about the services we will provide. Please note that this section must be signed before we can begin preparing your tax return. We also recommend you keep a copy for your records.

Scope of Services:
We will prepare your federal and/or state income tax returns based on the information you provide to us.
While we will not audit the documents you submit, we may verify or ask for clarification regarding the details you provide.

Client Responsibilities:
It is your responsibility to maintain and keep all supporting documents for your records.
Should you have any questions regarding your records, feel free to reach out for assistance.

Data Protection & Delivery:
To protect your sensitive information, we will deliver client copies of your tax return either in person or via email.

Important Notice:
Audits will be at an all-time high this filing season. Please ensure that all supporting documentation is accurate and readily available.
We cannot begin preparing your return without the necessary supporting documentation.

Accuracy of Information: I have provided accurate, complete, and truthful information to the best of my knowledge. I understand that it is my responsibility to ensure the accuracy of the details I have provided in this form and any supporting documents.

Tax Preparation Services: I understand that the tax preparation services being provided by Obsidian Tax Service Firm are for the purpose of assisting me in preparing and filing my federal, state, and local tax returns. I agree to cooperate fully with the tax preparer and provide all necessary documentation.

Tax Liability: I understand that it is my responsibility to pay any taxes owed to the IRS or state taxing authorities. I acknowledge that the tax preparer cannot guarantee any specific tax outcomes or refunds.

Electronic Filing: I consent to the electronic filing of my tax return, if applicable, and understand that I will receive an electronic copy of my tax return and supporting documents.

Fees and Payments: I acknowledge that I am responsible for paying any agreed-upon fees for tax preparation services, which may include preparation fees, filing fees, and other charges associated with the preparation of my tax return.

Retention of Documents: I understand that my tax documents may be retained for the duration required by law and that I can request copies of my tax return or any related documents at any time.

Acknowledgment & Agreement:
By signing below, you confirm that:

You have fully read and understood all the details outlined above.
You are in agreement with Obsidian Tax Service Firm proceeding with the preparation of your tax return, ensuring that it is filed with all available deductions based on your unique filing situation.
You acknowledge that Obsidian Tax Service Firm cannot guarantee the outcome of your return after it is submitted to the IRS, and that any offsets will not relieve you of your obligation to pay for the services provided.
TAXPAYER AGREEMENT*

I agree to the terms and conditions outlined in this form
Date Signed*

MonthDayYear
Date
SPOUSE AGREEMENT*

I agree to the terms and conditions outlined in this form
Date Signed

MonthDayYear
Date

Thank you for choosing Obsidian Tax Service Firm, LLC!

Customer service phone: 682-243-5096

Customer service email: info@obsidiantsf.com

www.obsidiantsf.com

Hours of operation:

Monday-Saturday 8:30am-10:30pm

Sunday- CLOSED!
Should be Empty:

Obsidian Tax Service Firm – Client Agreement & Acknowledgment

If you have any questions or require assistance while filling out the form, please don't hesitate to reach out. You can contact us via email at info@obsidiantsf.com or give us a call at 682-243-5096. We’re always here to help and look forward to serving you!

If you're a Referral, please provide the name and phone number of the person who referred you.

If you answered "Yes" to any Question listed above, please provide dependent(s) information below!

Relationship Test

Determination Of Eligibility To Claim Qualifying Child

Credits For Qualifying Relative(s)

Child Tax Credit/Additional Child Tax Credit

Education Credits (Lifetime Learning/American Opportunity)

Self Employed

Schedule A (Itemized Deductions)

Healthcare Insurance (Affordable Care Act)