Client Tax Preparation Intake Form
Erfoudy Tax Services LLC (616)414-2078
Filing Status
*
Single
Head of Household
Married Filing Separate
Married Filing Joint
Qualifying Widower
Taxpayer Information
Name
*
First Name
Middle Name
Last Name
Suffix
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
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
Due Diligence Questions (Form 8867 Compliance)
*
Taxpayer
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
Did you live in the U.S. for more than half of the tax year?
Yes
No
Did you live in the U.S. for more than half of the tax year?
Yes
No
Did all dependents live with you for more than half of the year?
Yes
No
Are you claiming Head of Household filing status?
Yes
No
Are you claiming the Earned Income Credit (EIC)?
Yes
No
Are you claiming the Child Tax Credit or Additional Child Tax Credit?
Yes
No
Are you claiming the American Opportunity Credit?
Yes
No
Do you have documentation supporting your dependents and credits claimed?
Yes
No
Did you have income from self-employment or independent contracting?
Yes
No
Did you receive Social Security benefits this year?
Yes
No
Did you receive unemployment benefits this year?
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
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
Expenses
Please fill-up the information within the current year only.
Truck Drivers
Rows
BUSINESS INFORMATION
BUSINESS NAME
EIN
BUSINESS ADDRESS :
CITY / STATE / ZIP CODE
Truck Drivers
Rows
Days
OVERNIGHT TRIPS ONLY
Business Expenses
Rows
Amount
Advertising
Office expenses
Supplies
Materials
Uniforms / Work Shoes
Utilities
Repair & Maintenance
Gas
Mileage
Tools & Equipment
Association dues
Mileage use for business
Parking & Tolls Fees
Wash (business Vehicles)
Cell Phone & Internet ...
GPS/ ELD Sub /Dispatches Fees
Truck washing
Cleaning / Laundry
Meal Expenses
Trailer repairs/equipment costs
Hotels/lodging only for business
Depreciation (truck, trailer, equipment)
Tires
Truck payments or lease payments
Total Expenses
Additional comments
Signature Type Your Full Name
*
Tax Preparation Engagement Agreement – Client Responsibility Clause Scope of Services Erfoudy Tax Services LLC will prepare your tax return based solely on the information and supporting documentation you provide. Our services do not include auditing, examining, or independently verifying the accuracy or completeness of your representations unless required by law. Taxpayer Responsibility You acknowledge and agree that you are solely responsible for: The accuracy and completeness of all information provided All reported income, deductions, credits, and business expenses Eligibility for filing status and any dependents claimed Maintaining records and documentation to substantiate items reported on your return Reviewing your completed return before signing and filing Fraud, Misrepresentation, and False Information You represent that all information provided to Erfoudy Tax Services LLC is truthful, accurate, and complete. You understand that providing false, inflated, unsupported, or fraudulent information—including improper dependent claims or fictitious business expenses—may subject you to penalties, interest, audits, repayment obligations, or civil/criminal consequences by the Internal Revenue Service or state tax agencies. Limitation of Liability Erfoudy Tax Services LLC shall not be responsible or liable for any tax, penalty, interest, audit adjustment, disallowed credit or deduction, or other consequences resulting from inaccurate, incomplete, omitted, or fraudulent information provided by the taxpayer. Indemnification Client agrees to indemnify and hold harmless Erfoudy Tax Services LLC from claims, losses, penalties, costs, or liabilities arising from false, misleading, or incomplete information supplied by the client. Right to Refuse or Withdraw Erfoudy Tax Services LLC reserves the right to decline preparation services or withdraw from an engagement if information appears inaccurate, unsupported, inconsistent, or potentially fraudulent. Client Certification By signing below, I certify under penalty of perjury that the information I provided is true, complete, and accurate, and I accept full responsibility for the contents of my tax return.
Acknowledgment & Signature
ERFOUDY TAX SERVICES LLC
Engagement Letter & Taxpayer Responsibility Agreement
By signing below, I acknowledge and agree:
Client Certifications
All information and documents I provide are true, complete, and accurate.
I have disclosed all income.
All deductions, expenses, credits, and dependents claimed are legitimate and supported.
I am responsible for maintaining supporting records.
Taxpayer Responsibility
☐ I am solely responsible for the accuracy of information provided.
☐ I will review and approve my completed return before filing.
☐ I accept responsibility for taxes, penalties, or assessments resulting from incorrect information I provide.
Fraud / Misrepresentation
☐ I understand false or misleading information may result in penalties, audits, or legal consequences with the or state tax agencies.
☐ Erfoudy Tax Services LLC is not liable for consequences caused by inaccurate or fraudulent taxpayer information.
Hold Harmless & Indemnification
☐ I agree to hold harmless and indemnify Erfoudy Tax Services LLC from claims, penalties, damages, or costs resulting from false or incomplete information I provide.
Virtual Services Consent
☐ I authorize remote tax preparation and electronic communication.
☐ I consent to electronic filing and document exchange.
☐ I agree my electronic signature is legally binding.
Right to Refuse Service
☐ I understand Erfoudy Tax Services LLC may refuse or withdraw services if information appears false or fraudulent.
I confirmed that all information I entered here is accurate and true.
I allow Erfoudy Tax Services LLC to capture my sensitive data like personal id, government id, and other information.
I have read the terms and conditions and privacy policy of Erfoudy Tax Services LLC
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
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