Tax Preparation Client Intake Form

Tax Preparation Client Intake Form

Tax Preparation Client Intake Form

You will need: Tax information such as Forms W-2, 1099, 1O98, 1095. Social security cards or ITIN letters for all all persons on your tax return. Picture ID (valid Drivers License) for you and your spouse if applicable.
YEAR OF TAX PREP*
NEW OR RETURNING CLIENT

NEWRETURNING
Filing Status

SingleHead of HouseholdMarried Filing SeparateMarried Filing JointQualifying Widower

Name

First NameLast Name
Age
Date of Birth

MonthDayYear
Date
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Email
example@example.com
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Occupation
Were you or someone in your household a full-time student?

YesNo
Who was the student?
Are you totally and permanently disabled?

YesNo
Are you legally blind?

YesNo

Name

First NameLast Name
Age
Date of Birth

MonthDayYear
Date
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Email
example@example.com
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Occupation
Are they a full-time student?

YesNo
Are they totally and permanently disabled?

YesNo
Are they legally blind?

YesNo
Are they your dependent?

YesNo

Enter your dependents here

Rows	Name	Date of Birth	Relationship
1
2
3
4
5
6

Did 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
Spouse
Dependent 1
Dependent 2
Dependent 3
Dependent 4
Dependent 5

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
Additional comments

- By proceeding with Shon’s Premier Tax Services, I acknowledge and agree to the following:
- I confirm that all information provided by me is accurate, complete, and true to the best of my knowledge. I understand that I am responsible for the accuracy of all documents, income, deductions, credits, and personal details submitted for tax preparation.
- I authorize Shon’s Premier Tax Services to collect, store, and process my sensitive personal information, including but not limited to personal identification, government-issued identification, financial records, and tax documents, solely for the purpose of preparing and filing my tax return.
- I acknowledge that I have read, understood, and agreed to the Terms & Conditions and Privacy Policy of Shon’s Premier Tax Services.
- I understand that both my responsibilities and the responsibilities of Shon’s Premier Tax Services have been explained to me, and I acknowledge my role in providing truthful and timely information necessary to complete my tax return.
- I acknowledge that consultation fees are separate from tax preparation fees, are not included in tax prep pricing, and are non-refundable, regardless of whether I proceed with tax preparation services.
Date Signed

MonthDayYear
Date
Taxpayer Signature
Date Signed

MonthDayYear
Date
Spouse Signature
Should be Empty: