Tax Preparation Client Intake Form

Tax Preparation Client Intake Form
Select your Tax Preparer*

Kay RhodesBrionna RhodesPorcha Dodson
Filing Status*

SingleHead of HouseholdMarried Filing SeparateMarried Filing JointQualifying Widower

Taxpayer Information
Name*

First NameLast Name
Date of Birth*

MonthDayYear
Date
Social Security number *
Are you permanently disabled?

YesNo
Phone Number
Please enter a valid phone number.
Email*
example@example.com
Address*

Street Address

Apt Number

CityState / Province

Postal / Zip Code
Occupation*
Are you a full-time student?

YesNo
School Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Email
example@example.com
Do you have health insurance marketplace 1095-A form ?*

YesNo
Are they permanently disabled?

YesNo

Dependents

Enter your dependents here

	Whole Name	Date of Birth	Relationship	Social Security Number	Disable
1
2
3

Does you, your spouse, and your dependents have health insurance within 12 months last year? If yes, who covers for it?

	Yes/No	Employer	Spouse Ins	Exchange/ Marketplace	Direct with Insurer	Medicare	Medicaid
Taxpayer
Dependent 1
Dependent 2
Dependent 3

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

General Expenses

	Amount
Medical Expenses
Dental Expenses
Non-Cash Contributions
Investment Expenses

Total Expenses

Acknowledgment & Signature
- I confirmed that all information I entered here is accurate and true.
- I authorize Trio Prestige Solutions LLC to collect and securely process my sensitive information, including personal identification, government-issued ID, Social Security number, and bank Account details
- If you are required to file a state income tax return, a state filing fee of $39.98 will be deducted from your state tax refund. The tax preparation fee will be deducted when your federal tax refund is issued.
  
  Failure to pay the required preparation fees may result in legal action, including a potential theft of services charge, which could be pursued in a court of law.
- I have read the terms and conditions and privacy policy of Trio Prestige solutions LLC.
- I agree that any tax preparation fees I have incurred will be paid in full to my tax preparer upon receipt of my tax refund.
- By signing below, you acknowledge that you have read and understood your responsibilities and our responsibilities in doing this tax return.
Initials*
Driver license | Gov. Identification
Social Security Card| All social together
W2s | 1099s | All W2s together
Taxpayer Signature

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Date Signed

MonthDayYear
Date
Should be Empty: