Tax Preparation Client Intake Form
Filing Status
Single
Head of Household
Married Filing Separate
Married Filing Joint
Qualifying Widower
I am not sure what filing status i qualify for
Taxpayer Information
Name
First Name
Last Name
Age
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
How do you earn income (employee, business owner, investor). please provide as much details as possible
Occupation
Are you a full-time student?
Yes
No
Are you totally and permanently disabled?
Yes
No
Are you legally blind?
Yes
No
Spouse Information
Name
First Name
Last Name
Age
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
1
2
3
4
5
6
Did you have any major expenses during the year? marriage, home purchase, new car or child care
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
Taxpayer
Yes
No
Spouse
Yes
No
Dependent 1
Yes
No
Dependent 2
Yes
No
Tax Related Questions
Employment Status
Employed
Unemployed
Self-employed
Did you earn overtime at your job?
Yes
No
Are you contributing to 401k or other pre-tax account?
Yes
No
Please select what state return are you requesting?
State return
School
Local
RITA
Country returns
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
Are you currently renting?
Yes
No
What is the monthly rental amount?
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 K?
Yes
No
Do you have mortgage interest?
Yes
No
Are you a business owner and what is the entity structure of your business
LLC (single member)
LLC (multiple member)
Corporation
Sole Proprietor (Have a side business but is not registered)
S-Corp (Tax Election
How do you maintain bookkeeping for your business ? And do you have all your financial statements (Profit and loss)
Yes
No
I may need your bookkeeping services
Expenses
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
Acknowledgment & Signature
Date Signed
-
Month
-
Day
Year
Date
Taxpayer Signature
Print
Submit
Submit
Should be Empty: