Tax Preparation Client Intake Form
Blessed Financial Services
Filing Status
*
Single
Head of Household
Married Filing Separate
Married Filing Joint
Qualifying Widower
Taxpayer Information
Name
*
First Name
Last Name
Taxpayer Social Security Number
*
Date of Birth
*
-
Month
-
Day
Year
Date
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Email
*
example@example.com
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Occupation
*
Are you a full-time student?
*
Yes
No
Spouse Information (Required if MFJ, or MFS)
Name
First Name
Last Name
Taxpayer Social Security Number
Date of Birth
-
Month
-
Day
Year
Date
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Email
example@example.com
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Employment Status
*
Employed
Unemployed
Self-employed
Occupation
Are they a full-time student?
Yes
No
Dependents (If you have dependents please fill out completely)
Enter your dependents here
Rows
Name
Date of Birth
Relationship
Dependent Social
1
2
3
4
5
6
Does you, your spouse, and your dependents have health insurance within 12 months last year? If yes, who covers for it?
Rows
Yes/No
Employer
Spouse Ins
Exchange/ Marketplace
Direct with Insurer
Medicare
Medicaid
Taxpayer
Yes
No
Spouse
Yes
No
Dependent 1
Yes
No
Dependent 2
Yes
No
Dependent 3
Yes
No
Dependent 4
Yes
No
Dependent 5
Yes
No
Tax Related Questions
Are you contributing to 401k or other pre-tax account?
*
Yes
No
Is this your first time opening a pre-tax account?
*
Yes
No
Does your dependents have tuition expenses?
*
Yes
No
Do you have any expenses for child care?
*
Yes
No
Are you currently renting?
*
Yes
No
Do you have your own home?
*
Yes
No
Do you have documents that shows you paid for property taxes?
*
Yes
No
Did you sell any stock?
*
Yes
No
Did you take money from your 401?
*
Yes
No
Did you pay your vehicle tax?
*
Yes
No
Do you have mortgage interest?
*
Yes
No
Do you have real estate tax?
*
Yes
No
Did you receive a federal tax last year?
*
Yes
No
Do you have an IPPIN?
*
Yes
No
Do you owe the IRS?
*
Yes
No
Tax Documents You Are Uploading
*
W2's
Identification
Social Security Cards
Birth Certificates
1099's
1098s
Utility Bills
Other Tax Forms
Please upload all W2s, ID, Social Security Cards, Dependent Social Security Cards, Birth Certificates, School Records, Utility Bill, 1099s, 1098s, etc.
*
Browse Files
Drag and drop files here
Choose a file
Cancel
of
Would you like to receive your Refund via Direct Deposit? If yes, please enter information below.
*
Yes
No
Routing number:
Account Number:
Acknowledgment & Signature
I confirmed that all information I entered here is accurate and true.
I allow Blessed Financial Services to capture my sensitive data like personal id, government id, and other information.
I have read the terms and conditions and privacy policy of Blessed Financial Services.
By signing below, you acknowledge that you have read and understood your responsibilities and our responsibilities in doing this tax return.
Date Signed
-
Month
-
Day
Year
Date
Taxpayer Signature
Date Signed
-
Month
-
Day
Year
Date
Spouse Signature
Print
Submit
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