BGA Tax Preparation Client Intake Form
Filing Status
*
Single
Head of Household
Married Filing Separate
Married Filing Joint
Qualifying Widower
Whose preparing your Tax Return
*
Please Select
Bennie J
Eric Love-Jones
Do IRS require you to file with IP PIN? If so, type below
Taxpayer Information
Name
*
First Name
Last Name
Social Security #
*
Date of Birth
*
-
Month
-
Day
Year
Date
Phone Number
*
Please enter a valid phone number.
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
Name
First Name
Last Name
Social Security #
Date of Birth
-
Month
-
Day
Year
Date
Phone Number
Please enter a valid phone number.
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 your dependent?
Yes
No
Dependents
Enter your dependents here
Full Name
Date of Birth
SS#
Relationship
1
2
3
4
5
6
Tax Related Questions
Employment Status
*
Employed
Unemployed
Self-employed
Are you contributing to 401k or other pre-tax account?
*
Yes
No
Does your dependents have tuition expenses?
*
Yes
No
Do you have any expenses for child care?
*
Yes
No
Do you have energy star rated improvements to your home?
Windows
Doors
Furnace
Other
How long have you lived at the property?
*
# of months
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
Expenses
Please fill-up the information within the current year only.
General Expenses
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
Additional comments
Acknowledgment & Signature
I confirmed that all information I entered here is accurate and true.
I allow BGA Financial to capture my sensitive data like personal id, government id, and other information.
I have read the terms and conditions and privacy policy of BGA Financial.
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
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BUSINESS GROSS & EXPENSES
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