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
*
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 you a full-time student?
*
Yes
No
Are you totally and permanently disabled?
*
Yes
No
Are you legally blind?
*
Yes
No
Previous Tax Returns and Audits
Have you filed tax returns in the previous years
*
Yes
No
Do you have any outstanding tax liabilities or audits?
*
Yes
No
Have you received any notices or letters from the IRS or state tax authorities
*
Yes
No
Documentations and Supporting Documents
What documents do you have available to support your income and expenses (W-2s, 1099s, receipts, etc.)?
*
Yes
No
Do you have any documentation for charitable donations, medical expenses, or other deductions?
*
Yes
No
Are there any other supporting documents you think may be relevant to your tax return?
*
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
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
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
Employment Status
*
Employed
Unemployed
Self-employed
Did IRS issue to you an IP PIN?
*
Yes
No
Are you contributing to 401k or other pre-tax account?
*
Yes
No
Is this your first time opening a 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
None
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?
*
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
Did you receive a federal tax last year?
*
Yes
No
Are you a victim of identity theft?
*
Yes
No
Additional Information
Do you have any foreign bank accounts or assets?
*
Yes
No
Do you have any cryptocurrency or virtual currency transactions?
*
Yes
No
Are you a member of the military or a veteran?
*
Yes
No
Do you have any other income or expenses not mentioned above?
*
Yes
No
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
Security and Authorization
How would you like to receive your tax return and supporting documents
*
Email
Secured Portal
USPS (mail)
Are you authorizing anyone else to access your tax information or represent you in tax matters?
*
Yes
No
Do you have any questions or concerns about the tax preparation process or your tax return?
*
Yes
No
Additional comments
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
Email
example@example.com
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Print
Submit
Submit
Previous Tax Returns and Audits
Previous Tax Returns and Audits
Should be Empty: