ALPHA & OMEGA NEW CLIENT INFO

Taxpayer Name*

First NameLast NameSuffix
Social Security Number*
Date of Birth*

MonthDayYear
Occupation*
Email*
example@example.com
Phone Number*

Area CodePhone Number
Address*

NO P O BOX/ PHYSICAL ADDRESS ONLY

Street Address Line 2
CityState / ProvincePostal / Zip Code
Spouse Information

First NameLast NameSuffix
Social Security Number
Date of Birth

MDYEAR
Filing Status:*

SingleMarried Filing JointlyMarried Filing SeparatelyHead of HouseholdQualifying Widow
HEAD OF HOUSEHOLD FILERS MUST PRESENT ONE OF THE FOLLOWING TO FILE THIS STATUS. PICK ONE OF THE 3 OPTIONS THAT YOU WILL SUBMIT TO BE APPROVED TO FILE HEAD OF HOUSEHOLD.

LeaseUtility BillMortgage Statement
Dependent 1

First NameLast NameSuffix
Social Security Number
Date of Birth

MonthDayYear
Relationship
Dependent 2

First NameLast NameSuffix
Social Security Number
Date of Birth

MonthDayYear
Relationship
Dependent 3

First NameLast NameSuffix
Date of Birth

MonthDayYear
Social Security Number
Relationship
IF YOU ARE CLAIMING A DEPENDENT, PLEASE ANSWER THE QUESTIONS BELOW THAT PERTAINS TO YOUR DEPENDENT RELATIONSHIP. PER THE IRS REQUEST, WE MUST PROVE THAT NOBODY ELSE IS ELIGIBLE TO CLAIM YOUR DEPENDENT BUT YOURSELF.
If claiming son/daughter, where is the other parent of the dependent/dependents? Is the other parent providing any financial support?
If claiming niece, nephew, aunt, or uncle, how are you related to the dependent? Where are the parents to the dependent/dependents?
If claiming brother or sister, how are you related to the dependent? Why are the parents not claiming the dependent/dependents?
Did you pay someone to watch your child/children?

YESNO
Did you collect social security or retirement income?

YESNO
Did you purchase health insurance through healthcare.gov marketplace (Obama Care)?*

YesNo
If yes, did you receive a 1095-A Form from the marketplace?

YesNo
Were you ever disallowed the E.I.T.C prior to this year?*

YesNo
Did you make college tuition payments and received a 1098-T Form last year?*

YESNO
Do you have any other income other than your w-2(s)?*

YESNO
Do you owe any delinquent:*

Child SupportAlimonyStudent LoansBack TaxesState TaxesNone of the above
DID YOU FILE 2023 TAXES*

YesNo
DID YOU SUCCESSFULLY RECEIVE YOUR 2023 TAX REFUND?
Were you previously issued an Identity Protection PIN (IP PIN) by the IRS?

YESNo
6 Digit IP PIN
Was the taxpayer affected by a natural disaster in 2024?

YESNO
IF YES, WHAT IS THE CITY & STATE OF DISASTER? DID YOU HAVE INSURANCE TO COVER DAMAGES? DAMAGE AMOUNT?
Can another taxpayer claim you as a dependent on their tax return?

YESNO
Will you be filing a tax return with your Spouse?

YESNO
Did you, your spouse or any dependents attend college in 2024?

YESNO
Did you or your spouse pay any medical or dental expenses in 2024? (this does not include insurance premiums)

YESNO
Did you or your spouse receive unemployment benefits in 2024?

YESNO
Do you rent or own your current residence?

YESNO
Did you or your spouse make payments on your student loans in 2024

YESNO
Are you self-employed, own a full time or side business or 1099 contractor

YESNO
IF YOU ARE SELF EMPLOYED, DOES YOUR BUSINESS HAVE A EIN NUMBER?

YESNO
BUSINESS FEDERAL TAX ID
BUSINESS NAME
BUSINESS DESCRIPTION
BUSINESS ADDRESS
UPLOAD ALL BUSINESS EXPENSE DOCUMENTS

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File Upload*

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UPLOAD VALID PICTURE IDENTIFICATION Cancelof
File Upload*

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UPLOAD TAX PAYER SOCIAL SECURITY CARD Cancelof
File Upload

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UPLOAD DEPENDENT SOCIAL SECURITY CARD Cancelof
File Upload

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UPLOAD DEPENDENT SOCIAL SECURITY CARD Cancelof
File Upload

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UPLOAD DEPENDENT SOCIAL SECURITY CARD Cancelof
File Upload

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UPLOAD 2024 W2 FORM Cancelof
File Upload

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UPLOAD ADDITIONAL TAX DOCUMENTS Cancelof
File Upload

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UPLOAD ADDITIONAL TAX DOCUMENTS Cancelof
File Upload

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UPLOAD ADDITIONAL TAX DOCUMENTS Cancelof
File Upload

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UPLOAD ADDITIONAL TAX DOCUMENTS Cancelof
How would you like to receive your refund?*

Refund Transfer Direct DepositRefund Transfer Debit CardRefund Transfer Paper Check

Direct Deposit Information

	Name of Bank	Routing Number	Account Number
ENTER BANK DATA

As part of the tax form completion process, we request that you securely upload a recent selfie. This additional measure is implemented to prevent fraud and enhance the overall security of your tax filing. Your cooperation is appreciated in ensuring the accuracy and authenticity of the provided information. Please upload your selfie down below.
Selfie Upload*

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Please ensure that you provide a clear and identifiable selfie Cancelof
BY SIGNING THIS DOCUMENT, I AGREE ALL INFORMATION SUBMITTED ABOVE BELONGS TO AND WAS SUBMITTED BY THE TAXPAYER FILING THIS RETURN.*

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Date

MDYear
I, hereby, state that all the information above is true to the best of my knowledge and that I am allowing Alpha & Omega Financial to prepare my taxes based on the information I provided. I understand that I am financially responsible for any outstanding balance due to any false information given. If there is a balance due, I must pay the tax preparation fee upfront. If for any reason I owe an entity and they take the entire refund, I am STILL responsible to pay the tax preparation fee for services rendered. If for any reason an amendment has to be filed with no fault of the tax preparer, an upfront fee of $300 is required! Alpha & Omega Financial is not responsible if you provide false information or do not provide all of my 2024 income documents. Please view your tax return, which is emailed to you.(it is sent AFTER submission). Any copy after the first copy is a fee of $40.00. ALL FEES (bank and service fees) are found in the return and are non-refundable nor negotiable! NO EXCEPTIONS TO THIS!! By signing this form you give Alpha & Omega Financial permission to transmit your 2024 tax return. Please utilize www.irs.gov for all federal refund tracking. Please utilize your state Department of Revenue site for any State Refund tracking. Do NOT add the amounts together. Federal taxes are federal, and state taxes are state when tracking your status. Please allow 8 weeks to surpass from the date of submission before calling the IRS, if you have any tracking questions you can reach IRS CUSTOMER SERVICE at 800-829-1040. IF YOU AGREE TO ALL STATED ABOVE, SIGN BELOW.*
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