Tax Preparation Client Intake Form
Filing Status
*
Single
Head of Household
Married Filing Separate
Married Filing Joint
Qualifying Widower
What tax year is this submission for? (Please ensure that only documents for the selected tax year are attached. If you need multiple years filed, each year must be submitted as a separate request with its corresponding documents.)
2024 (Current)
2023
2022
2021
2020
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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
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
What county do they live in?
*
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.
Email
example@example.com
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Please Select
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
The Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
Brazil
Brunei
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos (Keeling) Islands
Colombia
Comoros
Congo
Cook Islands
Costa Rica
Cote d'Ivoire
Croatia
Cuba
Curaçao
Cyprus
Czech Republic
Democratic Republic of the Congo
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Polynesia
Gabon
The Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
North Korea
South Korea
Kosovo
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macau
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Nagorno-Karabakh
Namibia
Nauru
Nepal
Netherlands
Netherlands Antilles
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
Turkish Republic of Northern Cyprus
Northern Mariana
Norway
Oman
Pakistan
Palau
Palestine
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn Islands
Poland
Portugal
Puerto Rico
Qatar
Republic of the Congo
Romania
Russia
Rwanda
Saint Barthelemy
Saint Helena
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
Somaliland
South Africa
South Ossetia
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard
eSwatini
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Transnistria Pridnestrovie
Trinidad and Tobago
Tristan da Cunha
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
Uruguay
Uzbekistan
Vanuatu
Vatican City
Venezuela
Vietnam
British Virgin Islands
Isle of Man
US Virgin Islands
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Other
Country
What county do they live in?
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:
Name
Date of Birth
Relationship
SSN
1
2
3
4
5
6
If any of your dependents are disabled list them here:
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
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
Tax Related Questions
Were you audited by the IRS last year?
*
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 own your home?
*
Yes
No
Are you currently renting?
*
Yes
No
What is the monthly rental/mortgage amount?
*
How long have you lived at the property?
*
# of months
Do you have documents that shows you paid for property taxes?
*
Yes
No
Did you receive a federal tax last year?
*
Yes
No
Do you have an IP PIN?
*
Yes
No
Do you have any credits that were disallowed or reduced?
*
Yes
No
If you have any credits that were disallowed or reduced, please enter here.
2024 Identity Protection Pin and who it was issued to (if applicable)
Expenses
Please fill-up the information within the current year only.
Please upload proof of residency for each dependency.
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If you are filing Head of Houshold, what documents will you provide for proof of head of household?
Utility Bill
Rental Lease
Rent Receipts
Mortage Interest Payments
Property Tax Payments
Other
Please upload proof of Head of household, if applicable.
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Please upload your Drivers license/ID for you & your spouse (if applicable)
*
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Social Security Cards For Each Individual On The Return
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Please answers only if it applies to you
If your address is different than the one on your Government ID or Drivers License, please indicate the reason why.
Federal Financial Documents
Financial Tax Documents (W2,1099,Unemployment,ect)
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If you received a 1099G form for unemployment, please upload it here.
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If you received a 1098T form for school, please upload here.
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Do you need assistance with organizing your/side hustle business income & expenses?
Yes
No
Did you have a business in 2024? Includes 1099s, or side business. Ex. hair braiding, hair stylist, babysitting, uber, lyft, door dashing, & etc. If so, what is the name & nature of your business or side business? If you don't have a name, you can bypass the name.
Did you purchase a vehicle recently?
*
Yes
No
If yes, please list the year make and model of the vehicle.
Other Documents
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Do you want to apply for cash advance up to $7k. No credit check. You will be notified if you are approved within 24 hours.
*
Yes
No
How do you want to receive your refund?
*
Paper Check
Direct Deposit
Go2Bank Prepaid Debit Card
If you selected direct deposit, please enter your information below
Bank Name
Account Number
Confirm Account Number
Routing Number
Confirm Routing Number
Optimum Accounting Services, LLC
Will prepare your 2024 individual tax return from the information you furnished to us. You, the taxpayer, are ultimately responsible for the preparation and filing of your tax return. I, the Taxpayer (you), have provided to Optimum Accounting Services, LLC the attached tax information and to the best of my knowledge this information is true, correct, and complete.
Letter of Engagement
Thank you for choosing Optimum Accounting Services to assist you with your income tax preparation needs. We are committed to providing accurate and reliable services, and to ensure clarity in our professional relationship, please review the following details.
Scope of Services
We will prepare your income tax returns based solely on the information you provide. Upon completing your tax returns, we will return any original documents to you. While our office may retain electronic copies of certain documents for record-keeping purposes, you are responsible for maintaining all original records, receipts, canceled checks, and other documentation that support your income, deductions, and tax positions.These documents may include but are not limited to:Records supporting deductions for meals, travel, business expenses, charitable contributions, and vehicle use (if applicable).Bank and credit card statements or other financial records.It is your responsibility to retain these documents for at least five years after the filing or due date of your tax returns, as they may be required in the event of an audit or review by tax authorities.
Limitations of Our Services
Our work in preparing your tax returns does not include the identification or detection of errors, irregularities, or illegal acts, including fraud. We will exercise professional judgment to resolve any tax law ambiguities in your favor where possible and reasonable. However, we cannot guarantee that the positions taken will not be challenged by taxing authorities, nor can we predict the outcome of such challenges. Optimum Accounting Services, LLC cannot be held responsible for issues arising from incomplete or inaccurate information provided during the preparation process. It is critical that you disclose all income, expenses, and relevant details before filing.
Fees and Payment Terms
If you decide not to file your tax return after we have completed it, a fee of $150.00 will be charged for services rendered. This payment is due immediately .In the event of nonpayment for services, Optimum Accounting Services, LLC reserves the right to pursue legal action to collect any outstanding balance. You may also be responsible for reimbursing our firm for legal or collection costs incurred. Thank you again for entrusting Optimum Accounting Services, LLC with your tax preparation. We look forward to working with you and ensuring your financial success.
Acknowledgment & Signature
Date Signed
*
-
Month
-
Day
Year
Date
Taxpayer Signature
*
Date Signed
-
Month
-
Day
Year
Date
Spouse Signature
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