Tax Year: 2024 Tax Preparation Client Intake Form

Tax Preparation Client Intake Form
Filing Status*

SingleHead of HouseholdMarried Filing SeparateMarried Filing JointQualifying Widower

Enter your dependents here

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

IF YOU PURCHASED HEALTH INSURANCE VIA THE MARKET PLACE YOU ARE
REQUIRED TO PROVIDE A COPY OF YOUR 1095A.

Household Income

Please enter Household income for each month income was received/made.

Enter Household Income

Total amount
By signing below, I hereby certify the information given above is true and accurate to the best of my knowledge.*

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Standard dependents

NON STANDARD DEPENDENTS (Grandchild, niece, nephew, stepchild, foster child, etc.):

	Name of child:	Why aren’t parents claiming child?	How long has child lived with you?	Did parent send fund to help support child?	Do you have: Court documentation of custody?	Document proving relationship to child?
Non-standard Dependent 1
Non-standard Dependent 2
Non-standard Dependent 3

ADULT DEPENDANTS

	Who is the dependent?	Where do they live?	Is dependent disabled?	Why are they not filing their own return?	Can anyone else claim this dependent?
Adult Dependent 1
Adult Dependent 2
Adult Dependent 3

By signing below, I hereby certify the information given above is true and accurate to the best of my knowledge.*

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Student Acknowledgment Form
I *   for the 2023 school year.
I attended.   school name
My scholar status was:
Did you receive a 1098-T form?   YES   NO
Below are my total educational expenses:

Books:
Supplies (on-campus):
Supplies (off-campus):
Other expense:
I certify that allof the information found on this form is true and to the best of my knowledge.I understand it is my responsibility to have all valid documents and orreceipts, as required to apply for any type of school credit. By signing below,I certify all information is true, valid, and to the best of my knowledge. Iaccept full responsibility of the statements mentioned above. Any and alldisputes regarding this matter shall be forwarded to me with the informationfound on my tax returns forms.*

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Date*

MonthDayYear
Date

General Expenses

	Amount
Medical Expenses
Dental Expenses
Insurance Premiums paid
Long Term Care Premiums
Prescription Drugs and Medications
Home Mortgage
Investment Interest
Investment Expenses (Other than K-1)
Cash Contributions
Non-Cash Contributions
Volunteer Mileage Driven
Unreimbursed Business Expenses
Union Dues
Tax Preparation Fees
Investment Expenses
Gambling Losses (Due to extent of winnings)
Other

Total Expenses
CASUALTY & THEFT LOSSES: If you had any casualty or theft losses during the year, please provide detail below, including date, description, amount of casualty or loss, any insurance reimbursement & basis in the property.
By signing below, I hereby certify the information given above is true and accurate to the best of my knowledge.*

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Document upload
How would you like your refund?*
If you selected direct deposit,please upload bank deposit form.

Cancelof
Identification (Taxpayer, spouse, dependents)*

Cancelof
SSN (Taxpayer, spouse, dependents)*

Cancelof
W2'S 1099'S and all other income documents

Cancelof
1095-A form

Cancelof
1098-T form

Cancelof
Provide proof of financial responsibility or residency FOR Dependents being claimed THAT ARE NOT YOUR CHILD(i.e copy of lease, medical records, school records, food stamps or benefit statements)

Cancelof
Head Of Household Filers Must Provide One Of The Following To File This Status. Pick One Of The 3 Options: Lease, Mortgage statement or utility bill

Cancelof
1095-A form

Cancelof

Acknowledgment & Signature
• I confirmed that all information I entered here is accurate and true.
• I allow Jasnee Wren with Maximum Tax Professional to capture my sensitive data like personal id, government id, social security number (SSN), and other information.
• I hereby authorize the use of this identification above to electronically file my federal tax return according to IRS publication 1345.
• By signing below, you acknowledge that you have read and understood your responsibilities and our responsibilities in doing this tax return.
E-Sign Consent:

• By signing below, I hereby, {taxpayerName} give Jasnee Wren with Maximum Tax Professional Permission to Sign, Date, And Submit My 2023 Tax return electronically on my behalf.
Date Signed

MonthDayYear
Date
Taxpayer Signature

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Date Signed

MonthDayYear
Date
Spouse Signature

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Should be Empty:

	Amount
Advertising
Repair & Maintenance:
Auto Expense:
Supplies:
Commissions:
Taxes & Licenses:
Contract Labor
Travel:
Depletion
Meals (Total):
Employee Benefit Program:
Utilities:
Insurance (other than health)
Interest (Mortgage)
Legal and Professional
Office Expense
Pension & Profit sharing
Rent or lease(Vehicles, Machinery, other)

Tax Preparation Client Intake Form