Dale Tax Services

CLIENT FORM

Kindly Fill Out This Form So We Can Serve You Better
How did you hear about us?
Tax Preparer Name
If someone referred you, please type his or her name here.
Are you trying to buy a new home within the next 2 years?
Taxpayer Name

First NameLast Name
Taxpayer Phone Number
Example: xxx-xxx-xxxx
Taxpayer Job Title
Taxpayer Date of Birth
Example: 01/01/2001
Taxpayer SSN
Example: xxx-xx-xxxx
Taxpayer Email Address
Home Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Spouse Full Name

First NameLast Name
Spouse Date of Birth
Example: 01/01/2001
Spouse SSN
Example: xxx-xx-xxxx
Spouse Phone Number
Example: xxx-xxx-xxxx
Spouse Email Address
Example: example@example.com
Taxpayer SSN
Example: xxx-xx-xxxx
Spouse Job Title
Are you self employed?
Are you a household employee?
Did you and your spouse live apart during the year?
What is your marital status as of December
Did you pay over half the expenses of maintaining your residence for the entire year?
Did you support a child or family member for more than 6 months out of the year?
If yes, did you live together at any time after June 30, 2024?
Are you on any Government Assistance
How many dependents are you claiming?
Dependent #1

First NameLast Name
Dependent #1 Date of Birth
01/01/2001
Dependent #1 SSN
What is Dependent #1 Relationship to you (son, daughter, etc.)?
How many months did Dependent #1 live with you in 2024? (If all year, enter 12)
Dependent #2

First NameLast Name
Dependent #2 Date of Birth
Example: 01/01/2001
Dependent #2 SSN
How many months did Dependent #2 live with you in 2024? (If all year, enter 12)
What is Dependent #2 Relationship to you (son, daughter, etc.)?
Dependent #3

First NameLast Name
Dependent #3 Date of Birth
01/01/2001
How many months did Dependent #3 live with you in 2024? (If all year, enter 12)
Dependent #3 SSN
Example: xxx-xx-xxxx
Dependent #3 SSN
What is Dependent #3 Relationship to you (son, daughter, etc.)?
Dependent #4 First Name
First Name
Dependent #4 Last Name
Last Name
Dependent #4 Date of Birth
01/01/2001
Dependent #4 SSN
Example: xxx-xx-xxxx
What is Dependent #4 Relationship to you (son, daughter, etc.)?
How many months did Dependent #4 live with you in 2024? (If all year, enter 12)
Dependent #5 First Name
First Name
Dependent #5 Last Name
Last Name
Dependent #5 Date of Birth
01/01/2001
Dependent #5 SSN
Example: xxx-xx-xxxx
What is Dependent #5 Relationship to you (son, daughter, etc.)?
How many months did Dependent #5 live with you in 2024? (If all year, enter 12)
Are there any dependents in daycare? If yes, please upload the form you received from your daycare provider.
Upload a copy of your daycare form here.

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How would you like to receive your tax refund?
Name of Bank
Which type of account would you like your refund deposited into?

Other
Routing Number
Bank Account Number
Can someone else claim you as a dependent?
Did you have marketplace health insurance in 2024?
Did you have marketplace health insurance for the entire year?
Who was your insurance cover through in 2024?
Was your insurance through your employer?
Was your insurance through Medicaid?
Was your insurance through the Affordable Care Act (The Marketplace)?
Did your dependents have health insurance for the entire year?
Was YOUR DEPENDENT insurance through your employer?
Who was your Dependents insured with in 2024?
Upload Taxpayer & Dependent(s)Insurance Documents

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Was YOUR DEPENDENTS' insurance through Medicaid?
Was YOUR DEPENDENTS' insurance through the Affordable Care Act (The Marketplace)?
Have you ever been denied the Earned Tax Credit (EITC)?
Were you or any of your dependents in college in 2024?
Did you trade any Virtual Currency
Do you have a 1098-T Form for either you or your dependents?
If you have a 1098-T form, upload it here.

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Are you interested in AUDIT PROTECTION?
Primary Taxpayer's Signature
Date

MonthDayYear
Date
Taxpayer's Signature (If no spouse, leave blank)
Spouse's Signature (If no spouse, leave blank)
Date

MonthDayYear
Date
Type a question
Date

MonthDayYear
Date
Taxpayer's Driver's License

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Taxpayer's and Dependent(s ) Social Security Card(s)

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Taxpayer's W-2/ 1099'S

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Dependent(s) Birth Certificate(s)

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Dependent(s) Proof of Residency (Lease/Utility Bill)

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Should be Empty:

CLIENT FORM