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CLIENT INTAKE FORM
How did you hear about us?
Facebook
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Referral
Previous Client
Type of client
New
Returning
Who is the tax preparer your currently working with to file your tax return ? Please list their first and last name
Jermesha Manning
Taurion Hope
Aaliyah Whiters-Rucker
Alexus Maddox
Alnar Johnson
Breanna Carter
Courtney Thompkins
Danielle Elliott
Danielle Jackson
Darniesha Eiland
Diamond Young
Faith Smith
Hassan Lee
Kandace Martin
Keyondra Richardson
Kiana Fleming
Kiana Mcnair
Kiara Hickman
Lacynthia Smith
Lina Miller
Mieysha Freeman
Perry Wilson
Rahnika Johnson
Rashawn Crumpton
Regine Johnson
Sabria Hanna
Shanae Flowers
Shonteea Rogers
Tashonda Mccarthey
Taylor Greer
Tolonda Downs
Victoria Riley
Johnetta Mason
Other
If someone referred you, please type his or her name here.
What is the best day & time to contact you?
Are you up to date with all of your tax filings
yes
no
Did you file a 2024 tax return?
Yes
No
Unsure
Taxpayer Information
Tax Payers Name
First Name
Last Name
Taxpayer's Phone Number
*
Example: xxx-xxx-xxxx
Taxpayer's Job Title
Taxpayer's Date of Birth
*
Example: 01/01/2001
Taxpayer's SSN
Example: xxx-xx-xxxx
Taxpayer's Email Address
*
Spouse's Full Name
First Name
Spouse's SSN
Example: xxx-xx-xxxx
Name
First Name
Last Name
Spouse's Date of Birth
Example: 01/01/2001
Spouse's Phone Number
Example: xxx-xxx-xxxx
Spouse's Email Address
Example: example@example.com
Taxpayer's SSN
Example: xxx-xx-xxxx
Spouse's Job Title
Address
Home Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Due Diligence Questions
Are you self employed?
*
Yes
No
Did you and your spouse live apart during the year?
*
Yes
No
Not Applicable
If you own your home, have you received form 1098 from your mortgage lender
Yes
No
What is your marital status as of December
*
Single (Not Married)
Married living with Spouse
Married not living with spouse
Did you pay over half the expenses of maintaining your residence for the entire year?
*
Yes
No
Did you support a child or family member for more than 6 months out of the year?
*
Yes
No
If yes, did you live together at any time after June 30, 2024
*
Yes
No
Not Applicable
Have you ever been denied the Earned Tax Credit (EITC)?
Yes
No
Are you on any Government Assistance
*
Yes
No
Not Applicable
Can someone else claim you as a dependent?
Yes
No
Dependent Information
How many dependents are you claiming?
*
Please Select
0
1
2
3
4
5
Has anyone claimed the dependents in the last three years. If so list the taxpayers name and relationship to the dependent.
Yes
No
Other
Dependent #1
First Name
Last Name
Dependent #1 Date of Birth
01/01/2001
Dependent #1 SSN
What is Dependent #1's Relationship to you (son, daughter, etc.)?
How many months did Dependent #1 live with you in 2024 ? ( If all year, enter 12)
Dependent #2
First Name
Last Name
Dependent #2 Date of Birth
Example: 01/01/2001
Dependent #2 SSN
Dependent #2s SSN
Example: xxx-xx-xxxx
How many months did Dependent #2 live with you in 2024 ? ( If all year, enter 12)
What is Dependent #2's Relationship to you (son, daughter, etc.)?
Dependent #3
First Name
Last Name
Dependent #3's Date of Birth
01/01/2001
How many months did Dependent #3 live with you in 2024 ? (If all year, enter 12)
Dependent #3s SSN
Example: xxx-xx-xxxx
Dependent's #3 SSN
What is Dependent #3's Relationship to you (son, daughter, etc.)?
Are there any dependents in daycare? If yes, please upload the form you received from your daycare provider.
Yes
No
Upload a copy of your daycare form here.
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Banking Information
How would you like to receive your tax refund?
Check (Only available for in office visits)
Direct Deposit
Green Dot Card
Name of Bank
Which type of account would you like your refund deposited into?
Checking Account
Savings Account
Routing Number
Bank Account Number
Health Insurance Information
Did you have health insurance in 2024 ?
Yes
No
Did you have health insurance for the entire year?
Yes
No
Who was your insurance coverage through in 2024 ?
Please Select
The Market Place
Employer
Medicaid
Was your insurance through Medicaid?
Yes
No
Was your insurance through the Affordable Care Act (The Marketplace)?
Yes
No
Did your dependents have health insurance for the entire year?
Yes
No
Not Appliable
Who was your Dependents insured with in 2023?
Please Select
Employer
Market Place
Medicaid
Upload Taxpayer & Dependent(s)Insurance Documents
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College Credit
Were you or any of your dependents in college in 2024 ?
Yes
No
Did you or your spouse make payments on your student loans in 2024?
Yes
No
Do you have a 1098-T Form for either you or your dependents?
Yes
No
If you have a 1098-T form, upload it here.
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Virtual Currency
Did you trade any Virtual Currency
Yes
No
Misc Services
Do you currently owe any debt to any federal agencies such as student loans, city tickets, child support, food stamps etc ?
Yes
No
Not sure
Has the irs ever denied you from claiming a tax credit before ?
Yes
No
Child tax credit
Earned income credit
American opportunity (school credit)
Did you receive any unemployment benefits in 2024?
Yes
No
Have you ever been audited by the irs before ?
Yes
no
IRS Identity PIN Information
Were you issued an Identity Pin from the IRS
Yes
No
Identity Pin if Applicable
Taxpayer Signature (Required)
Date
-
Month
-
Day
Year
Date
Primary Taxpayer's Signature
Taxpayer's Signature (If no spouse, leave blank)
Date
-
Month
-
Day
Year
Date
Need to ask a Question??
If you have questions, please type them here.
Documents to be Uploaded-Please upload ALL requested info
Taxpayer's Driver's License
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Taxpayer's and Dependent(s ) Social Security Card(s)
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Taxpayer's W-2/ 1099'S/
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Only as it applies: Self-Employment Expense Log, Summary if Income, Business License, Bank Statements, receipts, etc
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Dependent(s) Birth Certificate(s) (LONG FORM)
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Dependent(s) Proof of Residency (Lease/Report Card/ School Demographic)
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Type of client
New
Returning
Healthcare Card for Taxpayer(s) and Dependent (s)
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