Prosperous Empire Tax ServicesClient Intake Form

Client Intake Form

Let us know how we can help you!
Tax Year *
How did you hear about Prosperous Empire?*
If someone reffered you please list their first and last name below.
Tax Payers Filing Status*
Do you have a preferred Tax Pro?*
Income (Check all that apply)*

W2Independent ContractorsSelf Employed/Small Business1099-KPartnership or S-Corp IncomeGig Work (Uber,Lyft,Doordash,Instacart,Etc.)1099 NEC
Did you receive a refund last year?*
Do you currently have an identity theft or other PIN/Protection on your IRS profile? (if yes please provide below.)
Do you have an IPPIN? If so please list their first name(s) and IPPIN below.
blanks
Full Name*

First NameLast Name
Date of Birth*

MonthDayYear
Date
Occupation
Phone Number*
Please enter a valid phone number.
Email Address*
example@example.com
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Are you a U.S citizen?*

YesNo
Check All that apply

Can you be claimed as a dependent on someone else's returnWhere you over age 18 and a full-time student at an eligible educational institutionTax Payer is blindTaxpayer is deceasedTax Payer or spouse served in a combat zone during the current tax year.Tax Payer or spouse was affected by a natural disaster during the current tax year.Tax Payer plans to purchase a homeTax Payer prefers to receive written communications from the IRS in a language other than EnglishTax Payer
Please Upload Documents needed for the Tax Payer*

Identification card,social security card,W2,1099-K,1099NEC
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Where you self employed this year?
If yes please upload your expense sheet and form 11652 here that should have been given to you from the tax preparer
Self Employment Expense Sheet/Form 11652

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Spouse

First NameLast Name
Spouse Contact Number
Please enter a valid phone number.
Spouse Email
example@example.com
Spouse Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Check All that apply

Can you be claimed as a dependent on someone else's returnWhere you over age 18 and a full-time student at an eligible educational institutionTax Payer is blindTaxpayer is deceasedTax Payer or spouse served in a combat zone during the current tax year.Tax Payer or spouse was affected by a natural disaster during the current tax year.Tax Payer plans to purchase a homeTax Payer prefers to receive written communications from the IRS in a language other than EnglishTax Payer prefers to receive written communications from the IRS in an accessible format
Upload all Documents for the Spouse

Identification card,social security card,W2,'s,1099NEC,1099-K
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Will you have any dependents?

YesNo
Dependent 1

First NameLast Name
Dependent 1 Date of birth

MonthDayYear
Date
Dependent 1 social security number
Dependent 1 social security card

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Dependent 1 Birth Certificate

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Did the dependent live with you more than half of the year and did you provide more than half of the care?
What is your relationship to the dependent?
Dependent 2

First NameLast Name
Dependent 2 Date of birth

MonthDayYear
Date
Dependent 2 Social Security Number
Dependent 2 social security card

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Dependent 2 Birth certificate

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Did the dependent live with you more than half of the year and did you provide more than half of the care?
What is your relationship to the dependent?
Dependent 3

First NameLast Name
Dependent 3 Date of birth

MonthDayYear
Date
Dependent 3 Social Security Number
Dependent 3 Social Security Card

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Dependent 3 Birth Certificate

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Did the dependent live with you more than half of the year and did you provide more than half of the care?
What is your relationship to the dependent?
If you have any additional forms to upload please upload here

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Did you attend college?

YesNo
Please upload Form 1098T

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Did you have Marketplace Insurance?

YesNo
Please upload your Marketplace form 1095a

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Would you like to apply for a loan?

YesNo
Would you like direct deposit
Bank Name
Checking Account number
Bank Routing Number
Consent & Disclosure Agreement

By signing below, I confirm that the information provided in this intake form is true, accurate, and complete to the best of my knowledge. I understand that this information will be used by Prosperous Empire Tax Services to prepare my tax return(s).

I authorize Prosperous Empire Tax Services and its affiliated tax professionals to collect, store, and use my personal and financial information for the purpose of tax preparation and filing. I understand that any false or misleading information may result in inaccurate tax filings, which could lead to penalties, audits, or other consequences from the IRS or state agencies.

I acknowledge that Prosperous Empire Tax Services operates in accordance with IRS regulations and privacy laws. My personal information will be kept confidential and will not be shared without my written consent, except as required by law.

I understand that I am responsible for reviewing my completed tax return(s) before submission and that final approval is required by me, the taxpayer.

By signing below, I agree to the terms outlined above and give Prosperous Empire Tax Services consent to proceed with my tax preparation.
Today's Date*

MonthDayYear
Date
Signature

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