Miranda's Tax Preparation Client Intake Form
Filing Status
*
Single (Taxpayer is unmarried on the last day of the tax year)
Head of Household (Taxpayer is unmarried on the last day of the tax year, paid more than 50% of household costs, and has a qualifying dependent who lived with them for more than half the year)
Married Filing Separate (Taxpayer is legally married but chooses to file a separate return from their spouse)
Married Filing Joint (Taxpayer is legally married on the last day of the tax year and files a joint tax return with their spouse)
Qualifying Widower (Taxpayer's spouse passed away within the last two tax years, and the taxpayer maintains a home for a dependent child
Taxpayer Information
Name
*
First Name
Last Name
Social Security Number
*
Date of Birth
*
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
Are you totally and permanently disabled?
*
Yes
No
Are you legally blind?
*
Yes
No
Do you have an IRS PIN to prevent Fraud ? If so please provide the number.
*
UPLOAD PHOTO OF FRONT & BACK OF PHOTO I.D
*
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Spouse Information ( If your filing Joint)
Name
First Name
Last Name
SSN
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 they a full-time student?
Yes
No
Are they totally and permanently disabled?
Yes
No
Are they legally blind?
Yes
No
Are they your dependent?
Yes
No
Dependents
Enter your dependents here
Rows
Name
Date of Birth
Relationship
Social Security Number
1
2
3
4
5
6
7
8
Upload ALL Dependents Birth Certificates
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Upload ALL Dependents SSN Card
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Did the dependent have any income?
No
Yes ( Upload their Income statement)
Dependent Income Statement
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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
INCOME RELATED QUESTIONS:
Employment Status
*
Employed
Unemployed
Self-employed
If yes, please provide W-2 Forms.
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Did you receive compensation for independent contract work?
*
Yes
No
If yes, please provide 1099-NEC forms for non-employee compensation.
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Did you receive any miscellaneous income, such as from freelance work or prizes?
*
Yes
No
If yes, please provide 1099-MISC forms.
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Did you earn interest from savings accounts, CDs, or other investments?
*
Yes
No
If yes, please provide 1099-INT forms for interest income.
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Did you receive any dividends from stocks or mutual funds?
*
Yes
No
If yes, please provide 1099-DIV forms for dividend income.
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Did you collect unemployment benefits or receive a state tax refund?
*
Yes
No
If yes, please provide 1099-G forms.
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Did you receive any retirement income, pension payments, or IRA distributions?
Yes
No
If yes, please provide 1099-R forms.
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Did you sell any stocks, bonds, or other investments resulting in capital gains or losses?
Yes
No
If yes, please provide 1099-B forms for capital gains/losses.
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If yes, please provide your SSA-1099.
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Did you receive alimony payments this year?
Yes
No
Upload Alimony Agreement or Court Order:
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Do you earn rental income from any properties?
Yes
No
If yes, please provide documentation of rental income and related expenses.
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Are you self-employed or run a small business?
Yes
No
If yes, please provide income and expense documentation. (Business Profit & Loss Report)
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Did you receive income from partnerships, trusts, or S-corporations?
Yes
No
If yes, please provide your Form K-1.
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Did you have any other income, such as gambling winnings?
Yes
No
If yes, please provide Form W-2G
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DEDUCTIONS AND CREDITS
Did you get your federal tax return check last year?
Yes
No
Did you get your state refund check last year?
Yes
No
Do you own a home and pay mortgage interest?
Yes
No
Please provide Form 1098
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Do you have energy star rated improvements to your home?
Windows
Doors
Furnace
Other
Did you pay your vehicle tax?
Yes
No
Did you make any charitable contributions?
Yes
No
Please provide receipts for charitable donations
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Do you pay for childcare?
Yes
No
Please provide amounts and childcare provider info
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Do you have any medical or dental expenses to deduct?
Yes
No
Receipts for medical, dental, or prescription expenses. Statements from doctors, hospitals, or pharmacies showing payments. Health insurance statements showing amounts paid out-of-pocket. Mileage log or transportation receipts for travel to and from medical appointments (if applicable).
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Are you contributing to 401k or other pre-tax account?
Yes
No
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
HOW WOULD YOU LIKE TO PAY FOR YOUR TAX RETURN?
*
CASH TODAY TO TAX PREPARER
OUT OF REFUND (BANK CHARGES A FEE OF $44.95 TO PROCESS)
Bank account name
*
Bank account number
*
ConfirmBank account number
*
Bank account routing number
*
Confirm Bank account routing number
*
Do you want to purchase IRS Audit Protection for $79.95? If you decline, the tax preparer will not assist with IRS or state audits or amendments unless you pay the fee later. *
*
Yes, I want audit protection for $79.95.
No, I decline and understand future audits or amendments will not be handled without payment.
Acknowledgment & Signature
I confirmed that all information I entered here is accurate and true.
I allow this tax professional to capture my sensitive data like personal id, government id, and other information.
I have read the terms and conditions and privacy policy.
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
Submit
Should be Empty: