Amended Tax Return Intake Form

Amended Tax Return Intake Form

214-609-2082
Personal Information
Name

First NameLast Name
Date

MonthDayYear
Date
Phone Number
Email Address
SSN/ITIN
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Original Tax Return Information
Tax Year(s) to Amend
Filing Status on Original Return
Did you file your original return?

YesNo
If Yes (Attach a copy of the original tax return)

Cancelof
State(s) where tax return was filed
Reason for Amendment
Select all that apply

Incorrect income reportedAdditional income needs to be reportedIncorrect deductions/creditsMissed deductions/creditsFiling status changeDependents claimed incorrectlyIRS or state notice received (Attach a copy)Other
Attach a copy OF IRS or state notice received if available

Cancelof
Income Adjustments (If Applicable)
Additional W-2s, 1099s, or other income documents to report?

YesNo
If Yes (Attach a copy)

Cancelof
Were there any self-employment earnings not previously reported?

YesNo
If Yes (Attach income/expense details)

Cancelof
Deductions & Credits Adjustments
Were any deductions, credits, or expenses incorrectly reported or missed?

YesNo
(Specify and attach supporting documents)

Cancelof
New or revised deductions/credits to claim

Education CreditsChild Tax CreditEarned Income CreditBusiness ExpensesOther
Refund or Balance Due Adjustments
Did the original return result in a refund or balance due?
Refund of $
Balance due of $
Have you received an IRS/state notice regarding this return?

YesNo
If Yes (Attach a copy)

Cancelof
Supporting Documentation
Please attach all necessary documents
Copy of original tax return

Cancelof
IRS/state notice (if received)

Cancelof
W-2s, 1099s, and any additional income documents

Cancelof
Any other relevant documents related to the amendment

Cancelof
Self-employment income and expense records (if applicable)

Cancelof
Proof of additional deductions or credits

Cancelof
Additional Documentation (For Incorrect Income Reporting)

If you are amending your return due to incorrect income being reported to the IRS and you received a notice, please upload the following documents:
Lease agreement

Cancelof
Birth certificate

Cancelof
Social Security card

Cancelof
Signed letter explaining the income discrepancy

Cancelof
Report card or immunization records (for dependents)

Cancelof
W-2 (if applicable, optional)

Cancelof
Payment Method
How would you like to pay?

Pay with Square (Credit Card/Apple Pay)Pay with Zelle
Acknowledgment & Signature
I authorize Second Chance Taxes to prepare my amended tax return based on the information provided. I understand that any additional information requested must be submitted promptly to avoid processing delays. I confirm that the information provided is accurate to the best of my knowledge.
Signature

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Date

MonthDayYear
Date
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Amended Tax Return Intake Form

Personal Information

Original Tax Return Information

Reason for Amendment

Income Adjustments (If Applicable)

Deductions & Credits Adjustments

Refund or Balance Due Adjustments

Supporting Documentation

Please attach all necessary documents

Additional Documentation (For Incorrect Income Reporting)

Payment Method

Acknowledgment & Signature