Tax Preparation Client Intake Form
Filing Status
*
Single
Head of Household
Married Filing Separate
Married Filing Joint
Qualifying Widower
Taxpayer Information
Name
*
First Name
Last Name
Age
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/Zip
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
Social Security #
Date of Birth
-
Month
-
Day
Year
Date
Phone Number
Please enter a valid phone number.
Email
example@example.com
Address
Street Address
City/State/Zip
City/State/Zip
State / Province
Occupation
Are they a full-time student?
Yes
No
Are they totally and permanently disabled?
Yes
No
Are they legally blind?
Yes
No
Dependents
Enter your dependents here
Name
Date of Birth
Relationship
Social Security #
1
2
3
4
5
6
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
Marketplace
Direct with Insurer
Medicare
Medicaid
Taxpayer
Yes
No
Spouse
Yes
No
Dependent 1
Yes
No
Dependent 2
Yes
No
Tax Related Questions
Employment Status
*
Employed
Unemployed
Self-employed
Retired
Are you contributing to 401k or other pre-tax account?
Yes
No
Do you need to file a State Return?
*
State return
Local
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 this property?
# of months
Do you own your home?
Yes
No
Did you sell any stock?
Yes
No
Did you take money from your 401k?
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
Do you have an IPPIN (Identity Protection Pin)?
*
Yes
No
How do you want your refund? Direct Deposit or loaded onto Netspend Card
Enter Direct Deposit Information
Routing #
Account #
Expenses
Please fill-up the information within the current year only.
Itemization: General Expenses
Amount
Medical Expenses
Dental Expenses
Insurance Premiums paid
Long Term Care Premiums
Prescription Drugs and Medications
Home Mortgage
Investment Interest
Cash Donations
Non-Cash Donations
Unreimbursed Business Expenses
Tax Preparation Fees
Investment Expenses
Additional comments
Income (select/upload all that apply)
Self-employment (select/upload all that apply)
File Upload- Please upload ALL Tax forms & ID or Drivers License
*
Browse Files
Drag and drop files here
Choose a file
Cancel
of
Acknowledgment & Signature
I confirmed that all information I entered here is accurate and true.
I allow ABC 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 ABC 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
Print
Submit
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