NEW CLIENT INTAKE FORM CRUTCHFIELD TAXES AND FINANCIAL SOLUTIONS

Please provide the name of the person who referred you or provide the place where you saw our business.*
Filing Status*

Head of HouseholdSingleMarried Filing JointlyMarried Filing SeparateQualifying Widow With Dependent
Do you or your kids have an IP PIN?*

YesNo
Do you have marketplace insurance?*

YesNo
Did you get a refund last year? If so upload transcript or copy of tax return at the bottom of this form? (NEW CLIENTS ONLY)*

YesNo
Are you interested in credit repair?*

YesNo
Are you in the home buying process?*

YesNo
Your Full Name*

PrefixFirst NameLast Name
Your Phone Number*

Area CodePhone Number
Your E-mail*
example@example.com
Tax Payers Social Security Number*
Tax Payers Date of Birth*

YearMonthDay
Date
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Did you receive health insurance through the Market Place?*

YesNo
Your Occupation*
Have you ever been audited by the IRS?*
If so, Please provide the year/s of audit and what were the outcomes of the audits
Primary Taxpayer - Please Check Any That Apply

Taxpayer can be claimed as a dependent on someone else's return.Taxpayer was over age 18 and a full-time student at an eligible educational institution.Taxpayer is blind.Taxpayer is deceased.Taxpayer has received, sold, sent, exchanged, or otherwise acquired financial interest in virtual currency during the current tax year.Taxpayer prefers to receive written communications from the IRS in a language other than English.Taxpayer prefers to receive written communications from the IRS in an accessible format.Taxpayer is disabled.
Spouse Information

If no spouse, please skip.
Spouse's Name

First NameLast Name
Spouse's Date of Birth

YearMonthDay
Date
Spouse's Social Security Number
Spouse's Occupation
Spouse's Email Address
example@example.com
Spouse - Please Check Any That Apply

Spouse can be claimed as a dependent on someone else's return.Spouse was over age 18 and a full-time student at an eligible educational institution.Spouse is blind.Spouse is deceased.Spouse has received, sold, sent, exchanged, or otherwise acquired financial interest in virtual currency during the current tax year.Spouse prefers to receive written communications from the IRS in a language other than English.Spouse prefers to receive written communications from the IRS in an accessible format.Spouse is disabled.
Dependent Information

The Earned Income Credit (EIC) increases with the first 3 Children you claim. The maximum number of dependents you can claim for Earned Income Purposes is Three. You MUST also meet other requirements related to your Adjusted Gross Income (AGI) to qualify for EIC. If you are MARRIED and FILING SEPARATE you CAN'T claim the credit.
BEFORE ADDING YOUR DEPENDENTS INFO YOU ARE AGREEING THAT THEY LIVED WITH YOU FOR 6MONTHS OR LONGER AND THEY ARE ON YOUR LEASE, AND YOU ARE ON THE SCHOOL DOCUMENTS? IF AT ANY TIME IF YOU ARE TO GET AUDIT WITH THESE DEPENDENTS AND WE FIND OUT DURING THE AUDIT YOU DID NOT PROVIDE CARE OR NEVER LIVED IN THE HOME WE AT OPTIMA FINANCIAL TAX SOLUTIONS WILL NOT BE RESPONSIBLE FOR COMPLETING YOUR AUDUT SINCE TAX RETURN WAS DONE IN DISHONESTY. IF YOU AGREE TO THESE TERMS SIGN BELOW THAT YOU UNDERSTAND
PLEASE SIGN HERE

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Dependent Information

	Name	Date of Birth	Social Security Number	Full Time Student? Yes or No	Disabled? Yes or No?	How Many Months Did The Child Live In Your Home?	Relationship To The Dependent
1st Dependent
2nd Dependent
3rd Dependent
4th Dependent
5th Dependent
6th Dependent

PLEASE UPLOAD YOUR LEASE ONLY IF YOU ARE CLAIMING DEPENDENTS

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TAXPAYER IP PIN (issued from IRS yearly) EVERYONE DOESNT HAVE THIS. IF IT DOESNT APPLY SKIP
SPOUSE IP PIN (issued from IRS yearly) EVERYONE DOESNT HAVE THIS. IF IT DOESNT APPLY SKIP
Business Information

Please complete if you are self employed.
Are you self employed or a business owner?*

YesNo
If so what kind of business do you have?
Please provide your business EIN Number
How long have you been in business?
Business Adress

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Please upload your profit/expense records.

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Did you have a vehicle you used for your business?

YesNo
If so, list the year make and model of the vehicle.
Do you have a separate personal vehicle?

YesNo
College Student Information

Please complete if anyone in your household went to college.
Did Anyone Listed On This Return Attend College this Tax Season*

YesNo
If so - please upload form 1098-T and other college related documents below.

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Name(s) of the person who attended college
Did all students attend at least half time?

YesNo
Were they seeking a degree?

YesNo
How much money was spent on other books or materials in relation to college?
How many tax years have you claimed the American Opportunity Tax Credit?
Was the student ever charged with drug related felonies?

YesNo
Are You Currently Paying Student Loans?

YesNo
If so please upload your Form 1098-E - Student loan Interest

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Upload Requested Documents

PLEASE NOTE: YOU CAN UPLOAD MULTIPLE DOCUMENTS
Upload ID/DL (for anyone over 18 years old on this filing)*

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Please take a selfie*
(In order to file HOH upload lease and utility bill in your name) If filing single only a utility bill needed*

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Upload Social Security Card (for all listed on this filing)*

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Please upload all W2's HERE - You can upload multiple files

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If you received Unemployment Please Provide 1099-G form

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Withdrawal out of 401K? Please attach documentation if available.

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Please provide Mortgage / Property Tax form(s) if paid taxes / insurance

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Please Upload any Additional Tax Forms that you have Received.

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Please upload Birth Certificates for all dependents.

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Upload copy of prior year tax return or transcript (include the schedule c if was self employed)

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Banking Information
Do you owe or have you owed the IRS?*

YesNo
Will you want any of the following Bank Products? (Choose All That Apply ) ** Please note all bank products must go through an approval process and will require a written authorization Form 7216 Bank Consent to Disclosure of Tax Return Information*

Tax Refund AdvancesDeduct Tax Preparation Fee from your RefundWant refund 5 days early for a fee of $30?
If you want a tax loan advance:*

Do you want the $1000 advance (no finance charge)Up to $7000 (with finance charge)Or not interested in a tax refund advance loan
Signature Consenting to Form 7216 Bank Consent to Disclosure of Tax Return Information*

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How would you like your refund to be deposited when ready?*

Direct DepositPre-Paid Debit CardI have a Tax Obligation and will not be receiving a refundPaper check printed in the office
Bank Name*
Is this a Checking or Savings account?*
Routing Number*
Confirm Routing Number*
Account Number*
Confirm Account Number*
Due Diligence Questions
Have you ever been disallowed the Earned Income tax Credit, The additional child Tax credit, or the Child tax credit?*

YesNo
If you are a single parent, Where's the other parents of your child/children?*
What is the name of the other parent(s)*
Why is the other parent not claiming the child?*
If you are divorced or separated, when did you last live in the same home?
Do you have joint custody of your child? (If so which child/children)
How long did your child/children live in the other parent's home during the tax year? (in months)*
Do you have a signed form 8332 granting the right to claim this child/children?*

YesNoNot NeededNot Applicable
Did anyone else live in the home that provides financial support for your child/dependents?*

YesNoNot Applicable
Can or could anyone else be eligible to claim this dependent on their tax return?*
Did you pay someone to watch your child/children?*

YesNoNot Applicable
If so please upload any childcare statements.

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Did you receive any type of supplemental, non taxable income such as child support, Welfare benefits, Social security, etc?*

YesNo
In the case of a random IRS audit, can you provide for the children:*

School recordsMedical records
Signatures

Please Review & Sign Consent Forms
Signature Consenting to Client Engagement Letter*

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Signature Consenting to Consent To Use Of Tax Return Information*

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Signature Consenting to Consent To File Tax Return Electronically*

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By Typing Your Name, Signature & Date you agree that everything entered on this form is true and correct.

- I have confirmed that all the information I entered here is accurate and true.
- I allow Optima Financial & Tax Solutions LLC to capture my sensitive data like personal id, government id, social security number (SSN), and other information.
- By typing your name below and signing your signature, you acknowledge that you have read and understood your responsibilities and our responsibilities in doing this tax return.

-I understand that once tax return is sent to IRS, IRS have full control over the time frame the tax retrun is sent to the Taxpayer.

-Please be advised that if your tax refund is offset for any reason (e.g., federal or state debt), you are still fully responsible for payment of tax preparation fees. AND AUTO COLLECT WILL BE SET IN PLACE TO COLLECT FEES

If payment has not been received within 45 days of filing, Optima Financial Tax Solutions LLC reserves the right to initiate automatic collection procedures for the unpaid balance.

Thank you for your understanding and cooperation.

— Optima Financial Tax Solutions LLC
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Today's Date:*

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Date
OFTS LIKE TO BE OPEN AND TRASPARENT WHEN IT COMES TO FEES IF YOU DO NOT AGREE TO FEES PLEASE DO NOT CONTINUE WITH THIS INTAKE FORM THE FEES ARE BASED ON THE TAX PREPARATION FEES ONLY THIS IS NOT INCLUDING THE BANK FEE OF REFUND ADVANTAGE AND OR SBTPG

HIGHSCHOOL STUDENTS FREE

SINGLE FILERS 10% OF REFUND

HOH WITH DEPENDANTS $450

MARRIED JOINT $750

SELF EMPLOYED $850 UP VARIES ON LENGTH OF TIME TO PREPARE SCH C

MARRIED SINGLE 10% OF REFUND

IF YOU AGREE TO ALL TERMS AND FEES PLEASE SIGN BELOW
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Spouse Information

Dependent Information

Business Information

College Student Information

Upload Requested Documents

Banking Information

Due Diligence Questions

Signatures