Eminent Tax Solutions Client Intake Form

What is the best time to reach you?
Which Tax Year Are You Filing? * Please Note: if you're filing more than one year you must complete an intake form for each individual tax year separately
Did you file a tax return last year?
Please upload a copy of your last year's tax return for reference:

Cancelof
- Filing Status
- Taxpayer Name
  
  First NameLast Name
- Taxpayer SSN
  example:000-00-0000
- Taxpayer Date OF Birth
  example:12/31/2000
- Taxpayer Phone Number
  Example: 222/326/4444
- Taxpayer Email
  Example: yourname@yahoo.com
- Taxpayer Address
  
  Street Address
  
  Street Address Line 2
  
  CityState / Province
  
  Postal / Zip Code
- Taxpayer Occupation
  Example: job title
- Spouse Name
- Spouse SSN
- Spouse Date of Birth
- Spouse Email
- Spouse Occupation
- Which tax document(s) you received (if any) in 2024?
  
  Other
- Business income received.
  Example:$15,000.00
- Please list all your business expenses here along with amounts
  Example: Advertisement $25.00
- Did you and your spouse live apart this year?
- Did you pay over half the expenses to maintain your home for the entire year?
- Did you support a child(ren)or family member at least 6 months out the year?
- Have you ever been denied the Earn Income Tax Credit or Child Tax Credit?
- If you've been denied/reduced a credit from a previous tax year explain what the credit/deduction was and why it was reduce, If Not applicable put N/A
- Can someone else claim you as a dependent?
- Did you receive any government assistance?
- Dependent #1 Name
  
  First NameLast Name
- Dependent #1 Date of Birth
- Dependent #1 SSN#
- Relationship to the dependent
- Dependent #2 Name
  
  First NameLast Name
- Dependent #2 SSN#
- Dependent #2 Date of Birth
- Relationship to the dependent
- Dependent #3 Name
  
  First NameLast Name
- Dependent #3 SSN#
- Dependent #3 Date of Birth
- Relationship to the dependent
- Dependent #4 Name
  
  First NameLast Name
- Dependent #4 SSN#
- Dependent #4 Date of Birth
- Relationship to the dependent
- If you have additional dependents, please list them here. Name, Date of Birth, SSNs and Relationship.
- Do you have any disabled dependents ? If so please list them here along with their Name, Date of Birth, SSNS, and relationship.
- Proof Dependent its Disabled
  
  Cancelof
- How many months did the dependent(s) live in the same home as you? The child must have lived with you for more than half of the year.
  Example: 12 Months
- Will any of the dependents listed be carried or is intended to be carried on another taxpayers return?
- Did any of your dependents work?
- If yes, did they earn more than $4,300 ?
- Are any dependent(s) in daycare? If yes, please upload the form that was provided to you from the daycare provider.
- Please upload a copy of your daycare form here.
  
  Cancelof
- Did you have health insurance
- Did you or your dependent receive Medicaid?
- Did you, your spouse or your dependent(s) receive health insurance through the Affordable Care Act/Marketplace(Obama Care)?
- Please upload your marketplace insurance 1095-A form.
  
  Cancelof
- Were you or any of your dependents enrolled in college in 2024?
- Do you have the 1098-T form for either you or your dependent(s)?
- Were you enrolled at least half time during the school year?
- Are you enrolled as undergraduate or graduate? Undergrad means you haven't obtained your bachelors degree.
- Was box 7 checked on your previous year 1098T?
- Did you pay out of pocket for any school expenses such as room and board? computers? etc. If so list your expenses.
- If you have your 1098-T form, please upload here.
  
  Cancelof
- Receipts for any additional expenses.
  
  Cancelof
- Which type of account would you like your refund deposited into?
- Name Of Bank?
- Routing Number
- Account Number
- Are you interested in the cash advance loan up to $7,500.00 upon bank approval?
- Upload Direct Deposit Form
  
  Cancelof
- Are you interested in Audit Protection for $45.00?
- Are you interested in Identity Theft Protection for $39.95?
- Are you interested in Bookkeeping Services? prepares invoices, expense reports, 1099s, receipts etc. for all small business owner. Rates vary.
- Were you issued an Identity Pin from the IRS
- Please list your pin here.
- Were any of your dependents issued an Identity Pin ? If so list their name and their Pin # here.
- Taxpayer’s Drivers License/State ID/Passport
  
  Cancelof
- Taxpayer and dependent(s) Social Security card(s)
  
  Cancelof
- Taxpayer/Spouse/Dependent(s) Birth Certificates
  
  Cancelof
- Proof of Residency: (Example): Leases,School Records,Vaccination Cards, Award Letters from Gov Assistance, etc. If filing Head of Household Lease Agreement/Utility Bill in your name is needed.
  
  Cancelof
- Taxpayer’s W-2s /1099’s/Unemployment(1099G)
  
  Cancelof
- Self-Employment only! Expenses log,Summary of income etc
  
  Cancelof
- Provide 1098-T, Child Care Forms, any other Government Documents, Alimony, Proof of Charitable Contributions, Taxes Paid, Medical/Dental Expenses
  
  Cancelof
- Additional Documents
  
  Cancelof
- Additional Documents
  
  Cancelof
- By signing below, I hereby certify the information provided above is true and accurate to the best of my knowledge. As the taxpayer, I have been informed that claiming a dependent for EITC/CTC/AOTC/HOH can result in audit, fines, and other consequences if the information provided is incorrect. Eminent Tax Co. will prepare your individual tax return from the information you furnished to us. You, the taxpayer, are ultimately responsible for the preparation and filing of your tax return. I, the Taxpayer named above, have provided to Eminent Tax Co. the attached tax information and to the best of my knowledge this information is true, correct, and complete.
- Date
  
  MonthDayYear
  Date
- Primary Taxpayers Signature
- Taxpayers Spouse Signature if applicable
- Date
  
  MonthDayYear
  Date
- Do you have any questions? If so type here.
- Should be Empty: