JACQUELINE BLAKE TAX PROFESSIONAL

Tax Preparation Client Intake Form

Please fill out the form carefully. Any Questions or concerns Email info@anjtotalservicesltd.com TEXT/CALL (888) 835-4571
Filing Status*

SingleHead of HouseholdMarried Filing SeparateMarried Filing JointQualifying Widower

Enter your dependents here

Does you, your spouse, and your dependents have health insurance within 12 months last year? If yes, who covers for it?

General Expenses

	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

Acknowledgment & Signature
I confirmed that all information I entered here is accurate and true. I allow JACQUELINE BLAKE TAX PROFESSIONAL to capture my sensitive data like personal id, government id, social security number (SSN), and other information. I have read the terms and conditions and privacy policy of JACQUELINE BLAKE TAX PROFESSIONAL . By signing below, you acknowledge that you have read and understood your responsibilities and our responsibilities in doing this tax return.
Date Signed

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Date
Taxpayer Signature

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Date Signed

MonthDayYear
Date
Spouse Signature

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Tax Preparation Client Intake Form