Fiscora Tax Services LLC
Prior-Year & Late Return Intake Form
Client Information
Full Legal Name
*
First Name
Middle Name
Last Name
Email Address
*
example@example.com
Phone Number
*
Please enter a valid phone number.
Date of Birth
*
/
Month
/
Day
Year
Date
SSN or ITIN
*
Used solely for identity verification and tax filing purposes. This form is encrypted and confidential in accordance with IRS and NYS security standards. This form is SSL-secured. All data is stored confidentially and used soley for tax preparation in compliance with IRS and NYS privacy standards.
Spouse Information
(if applicable)
Spouse Full Name
Spouse SSN
Used solely for identity verification and tax filing purposes. This form is encrypted and confidential in accordance with IRS and NYS security standards. This form is SSL-secured. All data is stored confidentially and used soley for tax preparation in compliance with IRS and NYS privacy standards.
Spouse Date of Birth
-
Month
-
Day
Year
Spouse Email
(if different)
Relationship to filer (You)
Number of Months Lived with You
Please Select
1
2
3
4
5
6
7
8
9
10
11
12
Dependent Information
If you're claiming one or more dependents on your tax return, please enter their information below. Click "Add row" to enter another dependent.
Add Dependents
Employment & Income
Filing Status
*
Please Select
Single
Married Filing Jointly
Married Filed Separately
Head of Household
Qualifying Widow(er)
Tax Year
*
Which tax year are you filing for?
Do you have any W-2 income?
*
Yes
No
Upload your W-2(s)
Browse Files
Drag and drop files here
Choose a file
Accepting: .pdf,.docx,.jpg,.png,.doc.
Cancel
of
Do you have any 1099 income?
*
Yes
No
Upload your 1099(s)
Browse Files
Drag and drop files here
Choose a file
Upload 1099-MISC/ 1099-NEC, 1099-G, 1099-INT/1099-DIV, SSA-1099, K-1s, Rental Income Documentation, Crypto Income or Stock Sales (e.g 1099-B) Accepting .pdf,.docx,.jpg,.png,.doc.
Cancel
of
Any other alternative income or notes to include?
Include any freelance work, cash income, unemployment benefits, or unique tax circumstances you'd like us to consider.
Prior-Year Documents
Upload W-2s,1099s, and other tax documents for the selected year.
Browse Files
Drag and drop files here
Choose a file
PDF,JPG,PNG,DOCX
Cancel
of
Deductions & Credits
Are you claiming dependents?
*
Please Select
Yes
No
Did you pay for college, medical expenses, or childcare?
*
Yes
No
Check all that apply anf allow file upload if needed
Student Loan Interest (1098-E)
Tuition/Education Expenses (1098-T)
Retirement Contributions (IRA/HSA)
Medical Expenses (over 7.5% of AGI)
Mortgage Interest (1098)
Property Taxes
Charitable Donations (with receipts)
Childcare Expenses (include provider name, EIN, and amount)
Alimony Paid (and SSN of recipient)
Upload related documents here:
Browse Files
Drag and drop files here
Choose a file
If yes, upload related documents such as: 1098-T (tuition), Form 2441 (childcare), or medical expense receipts that exceed 7.5% of your income. Do not include food, transportation, or general living expenses. Student Loan Interest (1098-E), Retirement Contributions (IRA/HSA), Medical Expenses (over 7.5% of AGI), Mortgage Interest (1098), Property Taxes, Charitable Donations (with receipts), Childcare Expenses (include provider name, EIN, and amount), Alimony Paid (and SSN of recipient)
Cancel
of
Any specific tax credits or deductions you'd like us to review?
Use this space to tell us about any major expenses or life events (e.g., energy-efficient home upgrades, adoption costs, education-related purchases). Upload IRS-eligible documentation only--please exclude receipts for groceries, rent, or travel.
Tax Credits
Child Tax Credit?
Earned Income Credit (EIC)?
American Opportunity or Lifetime Learning Credit?
Estimated Tax Payments
Did you make any estimated tax payments in the year in which your filing?
*
Yes
No
How many payments did you make?
Dates for each payment made
Amounts for each payment
Health Coverage Information
The Affordable Care Act mandates reporting of health coverage. Please answer the questions below based on your coverage for the tax year you're filing.
Did you have health insurance for the entire tax year?
*
Yes- Through employer, government, or marketplace
No- I did not have coverage for the full year
Part of the year
What months did you have coverage?
What type of health insurance did you have?
Employer-Provided (W-2 job)
Private Insurance (not from an employer)
Healthcare.gov or State Marketplace (Obamacare)
Medicare
Medicaid
VA or Tricare
No coverage
Upload any relevant health coverage forms
Browse Files
Drag and drop files here
Choose a file
Form 1095-A (Marketplace), Form 1095-B (insurer or Medicaid/Medicare), Form 1095-C (Employer)
Cancel
of
Foreign Financial Accounts
Do you have any foreign bank accounts or financial assets
*
Yes
No
Please Provide Details
New York Residency & State Income
Required as Fiscora Tax Services exclusivly does tax work within NY and for NY residents at the moment.
Do you live within NYC?
*
Yes
No
Did you live in New York State for the entire tax year?
*
Yes
No
What date did you move into or out of New York State?
-
Month
-
Day
Year
Date
Which other state(s) did you live or work in during the tax year?
Upload any tax forms or documents related to those states:
Browse Files
Drag and drop files here
Choose a file
Allowed File Types: PDF,JPG,PNG,DOCX, DOC.
Cancel
of
Direct Deposit Info
Bank Name
Routing Number
Accounting Number
Account Type
Please Select
Checking
Saving
Upload Photo ID
*
Browse Files
Drag and drop files here
Choose a file
Required
Cancel
of
Upload Last Year's Return or the Latest Year in which you filed.
Browse Files
Drag and drop files here
Choose a file
(if available)
Cancel
of
Upload Any Additional Documents
Browse Files
Drag and drop files here
Choose a file
Cancel
of
IRS Refund Window Notice: IRS refunds can only be claimed within 3 years of the return's original due date. After that, any refund is forfeited.
*
I understand
Are you aware that filing late may result in IRS penalties and interest if a balance is owed?
*
I understand
Why are you filing this return late? (optional)
Helps us assess context and ensure accuracy.
*
Sign Here
*
Tell us how we did!
1
2
3
4
5
How did you hear about us?
Continue
Continue
Should be Empty: