Ceaser And Associates Financial 2024 Intake Form

Ceaser & Associates Financial 2024 Client Intake Form

Please fill this form out to the best of your ability! If you have any questions please call your tax preparer or call 404-254-9156.
7216 CONSENT TO USE AND DISCLOSURE OF THE TAX RETURN Page- 1

For the purposes of this consent form, “we,” “us,” and “our” mean
(Printed name of Tax Preparer)____________ Federal law requires this consent form be provided to you (“you” refers to each taxpayer, if more
than one). Unless authorized by law, we cannot disclose your tax return information to third parties for purposes other than the preparation and filing of your tax return without your consent. If you consent to the disclosure of your tax return information, Federal law may not protect your tax return information from further use or distribution. You are not required to complete this form to engage in our tax preparation services. If we obtain your signature on this form by conditioning our services on your consent, your consent will not
be valid. If you agree to the disclosure of your tax return information, your consent is valid for the amount of time that you specify. If you do not specify the duration of your consent, your consent is valid for one year from the date of signature.
You have indicated that you are interested in receiving a Refund Advance Loan product from First Century Bank, N.A. (“Bank”). In order to provide you with the opportunity to apply for this Refund Advance Loan product, we must disclose all of your 2024 tax return information necessary for evaluating the request to Bank or its service provider, Green Dot Corporation. If you request a more limited disclosure of tax return information, you will not be eligible to submit an application request for this Refund Advance Loan product. If you would like us to disclose your 2024 tax return information to Bank for this purpose, please sign and date your consent to
the disclosure of your tax return information to Bank.

By signing below, you authorize us to disclose to Bank all of your 2024 tax return information necessary for the evaluation and processing of your request for a Refund Advance Loan product. You understand that if you are unwilling to authorize the disclosure and sharing of your tax return information with Bank, you will not be able to obtain a Refund Advance Loan product from Bank, but you may still choose to have your tax return prepared and filed by us for a fee.
Taxpayer Name*

First NameLast Name
Taxpayer Signature*

Clear
Spouse Name

First NameLast Name
Spouse Signature

Clear
SingleHead of HouseholdMarried Filing SeparateMarried Filing JointQualifying Widower
Who is Your Tax Professional?

Name*

First NameLast Name
Age*
Date of Birth*

MonthDayYear
Date
Phone Number*
Please enter a valid phone number.Format: (000) 000-0000.
Email*
example@example.com
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Occupation
YesNo
YesNo
YesNo

Name

First NameLast Name
Age
Date of Birth

MonthDayYear
Date
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Email
example@example.com
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Occupation
YesNo
YesNo
YesNo
YesNo

Enter your dependents here

Rows	Name	Date of Birth	Relationship
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
Spouse
Dependent 1
Dependent 2
Dependent 3
Dependent 4
Dependent 5

Please fill-up the information within the current year only.

General Expenses

Rows	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

Total Expenses

Fill out COMPLETELY or mark “N/A”. DO NOT leave blank. Use a separate worksheet for EACH SCH - C

**Please Note: If possible, it is preferred a bank statement, P&L and balance sheet be provided by the client. If available, write “see
next page” below and stick under this page. If NOT AVAILABLE, please use the input sheet below. You may be required to provide
proof of all income & expenses claimed below.
YesNo
Business Name
Business Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Business Expenses

Rows	Amount
Advertising
Repairs & Maintenance
Auto Expense
Supplies
Commissions
Taxes & Licenses
Contract Labor
Travel
Depletion
Meals (Total):
Employee Benefit Program
Utilities
Insurance (other than health)
Other
Interest
Mortgage
Legal & Professional
Office Expense
Pension & Profit Sharing
Rent or Lease
Vehicles
Machinery
Other:

Total Expenses
Total Income - Total Expenses
Additional comments

7-14 days (RT Refund Transfer: Check)7-14 days (RT Refund Transfer: Debit Card)7-14 days (RT Refund Transfer: Direct Deposit)
YesNo
The Following products require fees paid at the time of the service:

• E-file: Direct Deposit

Your refund will be deposited into your savings or checking account directly from IRS
approximately 10-14 days after your return is accepted by IRS.

• 3-4 Weeks (E-file: Check)

Your refund will be mailed to you directly from IRS in approximately 3-4- weeks after your return is accepted electronically by the IRS.

• Mail a paper return

Your refund will be mailed to you directly from IRS in approximately 6-8- weeks after your mail your return to the IRS.

SINGLE/INDIVIDUAL FILER MARRIED - NO DEPENDENTS

Picture Identification Social Security Card Banking Information Prior Year Tax Return W2s

1099s

LLC/SCHEDULE C RETURNS

Business License
Articles of Formation
Profit & Loss Statement
Business Receipts, depending on business/revenue size Monthly Bank Statements
Prior Year Return

S-CORP RETURNS

Business License
Articles of Formation
Prior Year Tax Return
FORM 2553- S-Corp Election Balance sheet and income statement Monthly Bank Statements

Profit and loss statement
1099 forms received (if applicable)
Payroll records
Schedule K-1 (Form 1120S) for each shareholder, detailing their share of income, deductions, and credits
Proof of health insurance coverage for shareholders (if applicable)

SINGLE - HEAD OF HOUSEHOLD

Picture Identification
Birth Certificates of Dependents Social Security Cards
Banking Information
Prior Year Tax Return
1099s
W2s

NONPROFIT RETURNS

Business License
Articles of Incorporation
IRS 501(c)(3) approval letter
Profit & Loss Statements
Balance Sheet
Prior Three Years Tax Returns
Board of Directors Name, Address, Titles
Business Plan with Organization Mission Statement Donation records (receipts, donor acknowledgment letters)
Grant agreements and funding documentation. Fundraising event income and related expenses. Payroll records for any employees (including 1099s for contractors)
Documentation of board meetings, including minutes and resolutions.
List of major donors and contributions received, if necessary for reporting
Records of any in-kind donations
Documentation of programs and services provided, including impact metrics
PLEASE UPLOAD ALL DOCUMENTS TO TAXES TO GO!

CLICK LINK HERE > https://taxestogo.com/App/Download/81164

- I confirmed that all information I entered here is accurate and true.
- I confirm that any fees not paid with refund transfer will be the resposibility of me ( tax client) and paid in full within 30 days of service.
- I allow Ceaser & Associates Financial Firm to capture my sensitive data like personal id, government id, social security number and other information.
- I have read the terms and conditions and privacy policy of Ceaser & Associates Financial Firm.
- By signing below, you acknowledge that you have read and understood your responsibilities and our responsibilities in doing this tax return.
Type a question
Date Signed*

MonthDayYear
Date
Taxpayer Signature*

Clear
Date Signed

MonthDayYear
Date
Spouse Signature

Clear
Should be Empty:

Ceaser & Associates Financial 2024 Client Intake Form