Intake Form

Intake Form
LETTER OF ENGAGMENT

OUR RESPONSIBILITIES

Our work (whether consultation, tax return, tax plan or related product) is based on data you provide.

• We are not responsible to audit or verify the data that you give to us.

• We may ask for clarification of your data or additional information.

• We are not responsible to discover fraud or other irregularities, should any exist.

• We will work to find all the credits and deductions you are legally entitled to.

YOUR RESPONSIBILITIES

• To provide all the information required for a complete and accurate finished product.The IRS and state taxing authorities impose penalties for certain offenses, including understatement of income, filing after the deadline, underpaying estimated taxes, or under withholding taxes (If you would like more information, please contact us.) They can also select any return for examination.

PRIVACY POLICY

Tax preparers are bound by professional standards of confidentiality. Therefore, we have always protected your right to privacy. For current and former clients, we do not disclose any nonpublic personal information obtained in the course of our practice except as required or permitted by law, and as is necessary to properly provide our services to you.

TYPES OF NONPUBLIC INFORMATION WE COLLECT

• To provide this information in a timely manner.

• To retain, with the completed work, all the documents, cancelled checks and other data that form the basis of income and deductions since

you may later have to provide them to a taxing authority.

• To carefully review all work completed by our office before you sign. You have the final responsibility for anything submitted to a taxing authority.

• You are responsible not to commit fraud.

• You are responsible to let us know if you received a Form 1099-K, and Form 1099-G Unemployment.

PENALTIES, EXAMINATIONS AND NOTICES

We collect nonpublic personal information about you that is provided to us by you or obtained by us with your authorization.

Parties to Whom We Disclose Information. We make available information to our employees and to nonaffiliated third parties who need to know that information to assist us in providing services to you. In all such situations, we require a contractual agreement that includes procedural safeguards that protect the confidential nature of the information being shared.

PROTECTING THE CONFIDENTIALITY & SECURITY OF CURRENT AND FORMER CLIENT INFORMATION.

We retain records relating to professional services that we provide so that we are better able to assist you with your professional needs and, in some cases, to comply with professional guidelines. In order to guard your nonpublic personal information, we maintain physical, electronic, and procedural safeguards that comply with our professional standards.

OUR FEES

We invoice for time spent, depending on schedules and forms completed and out-of-pocket expenses incurred. Our rates vary depending on the nature of the work performed. We may invoice for partially completed work that is placed on extension or remains undone.

TAX DOCUMENTS

All clients are provided a copy of their tax documents at the conclusion of their tax preparation, if return is e-filed to the IRS. Tax documents are issued via email or in office only. In order to provide you with a copy of your tax documents, tax return must be e-filed and submitted to the IRS. Any additional copies of your e-filed tax documents are $50 per year.

*A retainer will be required when working on ALL tax returns and before undertaking projects for new clients.

ARBITRATION

If a dispute arises out of or relates to this contract or engagement letter, or the obligations of the parties therein, and if the dispute cannot be settled through negotiation, the parties agree first to try in good faith to settle the dispute by mediation administered by the American Arbitration Association under its commercial Mediation Rules before resorting to arbitration, litigation, or some other dispute resolution procedure.

AGREEMENT

The foregoing is in accordance with my (our) understanding of your engagement to provide tax and financial services and you are hereby advised that each item of revenue or expense can be substantiated by receipts, cancelled checks, or other documents. This information is true, correct, and complete to the best of my (our) knowledge. Further, it is my (our) understanding that these terms will continue to be in force for the succeeding years of our engagement.
TAX PAYER SIGNATURE
DATE SIGNED

MonthDayYear
Date

First Name*
Last Name*
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Tax Payer*

Rows	Date of birth	Job Title	Phone Number	Social Security Number	State Issued ID/DL Number
Tax Payer Information

Email
example@example.com
Spouse First and Last Name

First NameLast Name

Spouse Information

Rows	Date of birth	Job Title	Phone Number	Social Security Number	State Issued ID/DL Number
Spouse Information

Address

Street Address

Apt #

CityState / Province

Postal / Zip Code
Email
example@example.com

Check if you or your spouse were in 2025:

Rows	A U.S. citizen	In the U.S. on a visa	A full-time student	Legally blind	Totally and permanently disabled	Issued an identity protection PIN (IPPIN)	Owners or holders of any digital assets	Had Marketplace Insurance/Obama Care?
Tax Payer
Spouse

7-14 days (RT Refund Transfer: Check)In about 7-14 days from the date your return is accepted electronically by the IRS, you receive a check for the amount your refund less filing fees. (Check will be available in our office)7-14 days (RT Refund Transfer: Debit Card) In about 7-14 days from the date your refund is accepted electronically by the IRS, for the amount your refund less filing fees will be deposited onto the debit card we issued you.7-14 days (RT Refund Transfer: Direct Deposit) In about 7-14 days from the date your refund is accepted electronically by the IRS, for the amount your refund less filing fees will be deposited into your bank account.
Interest Loan (Loan amount up to $1,000)Interest Loan (Loan amount up to $7,000)NONE
DIRECT DEPOSIT INFORMATION
Checking or Saving Account?
Bank Name:
Account Number
Routing Number

Would you like to receive written communications from the IRS in a language other than English ?

Rows	What language
Tax Payer
Spouse

Would you like information on how to vote and/or how to register to vote?

Rows	Yes	No
Tax Payer
Spouse

Would you, or your spouse if married filing jointly, like $3 to go to the Presidential Election Campaign Fund?

Rows	Yes	No
Tax Payer
Spouse

As of December 31, 2025, what was your marital status?

Rows	Never Married	Married	Divorced	Date of final decree	Legally Separated but not Divorced	Date of separate maintenance decree	If married, were you married for all of 2025	Did you live with your spouse during any part of the last six months of 2025	Legally Separated but not Divorced	Date of separate maintenance decree	Widowed	Year of spouse’s death
Tax Payer

List the names below of everyone who lived with you last year (except your spouse) AND anyone you supported but did not live with you last year.

Rows	Name (first, last)	Date of birth (mm/dd/yy)	Divorced	Relationship to you (child, parent, none, etc.)	Number of months lived in your home in 2025	Single or Married as of 12/31/2025 (S/M)	U.S. Citizen	Resident of U.S., Canada or Mexico	Full-time student	Totally and permanently disabled	Issued IP PIN	Social Security Number
1
2
3
4

Upload ALL government issued ID or Drivers License

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Upload Social Security Cards for you, spouse and dependents*

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Please upload Proof of Residency for each dependent( Physical, Report card, Government Benefit letter Etc.) *

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Please upload proof of head of household, if applicable.(Lease agreement, Utility Bill Etc.)*

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Upload Birth Certificates for all dependents

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If you do not have a copy of Birth Certificates for any dependents, list dependent name and why you cannot provide the birth certificate
Income:

Answer the following questions on the left side of this page. Check only the boxes that apply to you and/or your spouse.

Received money from any of the following in 2025:

Rows	Tax Payer	Spouse
(B) Wages as a part-time or full-time employee
(B/A) Tips
(B/A) Retirement account, pension or annuity proceeds
(B) Disability benefits (such as payments from insurance and worker's compensation)
(B) Social Security or Railroad Retirement Benefits
(B) Unemployment benefits
(B) Refund of state or local income tax
(B) Interest or dividends (bank account, bonds, etc.)
(A) Sale of stocks, bonds or real estate
Did you report a loss on last year’s return
(B) Alimony
(A/M) Income from renting out your house or a room in your house
If yes, did you use the dwelling unit as a personal residence and rent it for fewer than 15 days
Income from renting personal property such as a vehicle
(B) Gambling winnings, including lottery
(A) Payments for contract or self-employment work
Did you report a loss on last year's return
Any other money received during the year? (example: cash payments, jury duty, awards, digital assets, royalties, union strike benefits)

Upload W2 forms or any income received

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Please upload all documents required that you answered yes to above; SSA-1099(social security), 1099-G(unemployment), 1098-T(tuition), Business income & expenses, 1099-MISC(business), and 1095-A(marketplace insurance).

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Expenses and Tax Related Events:

Answer the questions on the left side of this page. Check only the boxes that apply to you and/or your spouse.

Paid any of the following expenses to itemize in 2025?

Rows	Tax Payer	Spouse
(A) Mortgage Interest
(A) Taxes: state, local, real estate, sales, etc.
(A) Medical, dental, prescription expenses
(A) Charitable contributions

Paid any of these expenses in 2025?

Rows	Tax Payer	Spouse
(B) Student loan interest
(B) Child and dependent care
(B/A) Contributions to a retirement account
(B) School supplies by a teacher, teacher’s aide or other educator
(B) Alimony payments (do not include child support)

Did any of the following happen during 2025?

Rows	Tax Payer	Spouse
(B) You or someone in your family took educational classes (technical school, college, job related, etc.)
(A) Sell a home
(B/A) Contributions to a retirement account
(A) Have a health savings account (HSA)
(A) Purchase health insurance through the Marketplace (Exchange)
(A) Purchase and install energy-efficient home items (example: windows, furnace, insulation, etc.)
(A) Have credit card, mortgage, or other debt cancelled/forgiven by a lender
(A) Have a loss related to a declared Federal disaster area
(B) Have a tax credit disallowed (example: earned income credit, child tax credit, or American opportunity credit)
Receive any letter or bill from the IRS
(B) Make estimated tax payments or apply last year’s refund to 2024 taxes

Credits
I attended a college/University/community college/post secondary institution/career school and paid eligible expenses that can be proven with a 1098T formI paid charity/tithes/or given donations to community organizations and/or religious institutionsI paid over $12,400 in expenses for itemizationsI paid student loan interest and received a 1098EI had eligible medical expensesI had energy and solar power expensesI sold and/or purchased a homeI adopted a child or had a babyI am in the military and had to moveI got separated/divorced paid or received alimonyDid you receive unemployment from any state or pay any unemployment back for overpaymentNONE
Please upload a document to support the credits

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YesNo
YesNo
Did someone refer you? If so can you please insert their First and Last name & Phone Number
Upload Additional Documents

Please upload one or more files into the areas below. Uploads will accept JPG, PNG and PDF files only. You can select multiple files to upload for each section by Shift or Cmd/Ctrl clicking files in the prompt.
Other Documents;1099-R(retirement), childcare/daycare letter, 1098(mortgage interest), etc.)

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BASIC EITC ELIGIBILITY RULES

All taxpayers claiming the Earned Income Tax Credit (EITC) must meet these requirements:

Adjusted Gross Income (AGI) limits

Your AGI must be below the limits listed for your filing status and number of qualifying children:

Rule 1- Adjusted gross income (AGI) limits

Your adjusted gross income (AGI) must be less than:

• $56,838 ($63,398 for married filing jointly) if you have three or more qualifying children,

• $49,399 ($55,529 for married filing jointly) if you have two qualifying children,

• $43,492 ($49,622 for married filing jointly) if you have one qualifying child, or

• $16,480 ($22,610 for married filing jointly) if you do not have a qualifying child.

Rule 2- you must have a valid social security number (SSN)

Rule 3- your filing status cannot be married filing separately

Rule 4- you must be a United States citizen or resident alien all year

Rule 5- you cannot file form 2555 or form 2555-ez

Rule 6- your investment income must be $10,300 or less

Rule 7- you must have earned income of at least $1

Rule 8- your child must meet the relationship, age, residency, and joint return tests

Rule 9- your qualifying child cannot be used by more than one person to claim the EIC

Rule 10- you cannot be a qualifying child of another taxpayer

Rule 11- you must be at least 25, but under age 65 (if no qualifying child)

Rule12- you cannot be the dependent of another person

Rule 13-you must have lived in the United States more than half of the year

The maximum amount of credit for Tax Year 2025 is:

• $7,830 with three or more qualifying children
• $6,960 with two qualifying children
• $4,213 with one qualifying child
• $632 with no qualifying children

When Can I Expect My Refund?

If you claim the earned income tax credit (EITC) or the additional child tax credit (ACTC) on your tax return, by law the IRS can't issue your refund before mid-February — even the portion not associated with EITC or ACTC
Date Signed*

MonthDayYear
Date
Tax Payer Signature
Note Section: For Preparers Only
Should be Empty:

Intake Form

DIRECT DEPOSIT INFORMATION

Income:

Expenses and Tax Related Events:

Credits

Upload Additional Documents