KMC Taxpayer Intake Form
Filing Status
Single
Head of Household
Married Filing Separate
Married Filing Joint
Qualifying Widower
Unsure
Taxpayer Information
Name
*
First Name
Last Name
Age
Date of Birth
*
-
Month
-
Day
Year
Date
Phone Number
*
Please enter a valid phone number.
Email
*
example@example.com
Do you Consent to text/email communications from KMC?
*
Please Select
Yes
No
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 dependents?
Yes
No
Spouse Information (If Applicable)
Name
First Name
Last Name
Age
Date of Birth
-
Month
-
Day
Year
Date
Phone Number
Please enter a valid phone number.
Email
example@example.com
Do you Consent to text/email communications from KMC?
Please Select
Yes
No
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
Tax Related Questions
Employment Status
*
Employed
Unemployed
Self-employed
Have you or your spouse ever been a victim of tax identity theft?
Yes
No
If you or your spouse have been a victim of tax identity theft, do you have your IP Pin from the IRS?
Yes
No
N/A
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 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 K?
Yes
No
Additional comments
Acknowledgment & Signature
I confirmed that all information I entered here is accurate and true.
I allow King's Mirakles Consultants LLC to capture my sensitive data including photo identification, confirmation of dependent identity, etc.
I have read the terms and conditions and privacy policy of King's Mirakles Consultants LLC.
I understand that I must complete this intake form as well as the provided intake packet prior to the preparation of my tax return. Failure to complete both will delay tax processing times.
I understand that the burden of proof is on the taxpayer; any information provided will be used and considered true and accurate. In the event of an audit, I understand that it is my responsibility to prove all information provided during intake.
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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Submit
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