Tax Preparation Client Intake Form
Filing Status
Single
Head of Household
Married Filing Separate
Married Filing Joint
Qualifying Widower
Taxpayer Information
Name (a copy of social security card and driver's license will be required following initial intake)
First Name
Last Name
Date of Birth
-
Month
-
Day
Year
Date
Phone Number
Please enter a valid phone number.
Email
example@example.com
Occupation
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Are you a full-time student?
Yes
No
Are you legally blind?
Yes
No
Spouse Information
Name (a copy of social security card and driver's license will be required following initial intake)
First Name
Last Name
Date of Birth
-
Month
-
Day
Year
Date
Phone Number
Please enter a valid phone number.
Email
example@example.com
Occupation
Are they a full-time student?
Yes
No
Are they legally blind?
Yes
No
Dependents
Enter your dependents here (a copy of each social security card will be required after initial intake)
Name
Date of Birth
Relationship
1
2
3
4
5
6
Tax Related Questions
Employment Status (Taxpayer)
Employed
Unemployed
Self-employed
Employment Status (Spouse)
Employed
Unemployed
Self-employed
Did you have an employment change in the year?
Yes
No
Did your spouse have an employment change in the year?
Yes
No
Are any of your dependents required to file a tax return this year?
Yes
No
I don't know
Are you contributing to 401k or other pre-tax account?
Yes
No
Does you, your spouse, or your dependents have any college tuition expenses?
Yes
No
Do you have any expenses for child care?
Yes
No
Did you buy or sell a home last year?
Yes
No
Did you sell any stock last tax year?
Yes
No
Did you take money from your retirement account last tax year?
Yes
No
Do you have mortgage interest to report?
Yes
No
File Upload: Please upload last year's tax return, both Federal and State
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Additional comments
Acknowledgment & Signature
I confirmed that all information I entered here is accurate and true.
I allow Jennifer OBrian Bookkeeping & Tax to capture my sensitive data like personal id, government id, and other information. I understand they will not buy, sell, or otherwise disclose my information unless otherwise directed by myself.
Date Signed
-
Month
-
Day
Year
Date
Taxpayer Signature
Date Signed
-
Month
-
Day
Year
Date
Spouse Signature
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