2025 Tax Intake Form

TAX INTAKE FORM

In order for us to file your federal and state return, we need the following information. The information you provide to us will remain confidential. We value you as our client and promise not to share your information with any third-party vendors.
Filing Status*

SingleMarried Filing SeparatelyWidowMarried Filing JointlyHead of Household
Upload a document that reflects your ability to claim head of household. An example would be a utility bill (water and PG&E), mortgage statement, rental payments, etc.*

Cancelof
To be eligible for the Head of Household (HOH) credit, please provide either a lease agreement or a recent utility bill (water bill or PG&E bill). We require the Social Security card for each dependent and taxpayer, and/or birth certificate.

For all taxpayers: Before signing, please ensure that you submit a copy of your Social Security card and birth certificate.

If you encounter any issues with your documents, please contact me at the following phone number: 916-460-1393.
Would you like to request a Refund Advance Loan? (additional fees apply)*

YesNo
Tax Payer's Name*

First NameLast Name
Tax Payer's Email Address*
example@example.com
Tax Payer's Phone Number*
Please enter a valid phone number.
Taxpayer's Date of Birth *
Example: 01/01/2001
Taxpayer's SSN *
Example: xxx-xx-xxxx
Home Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Spouse's Full Name
Full Name
Spouse's SSN
Example: xxx-xx-xxxx
Spouse's Date of Birth
Example: 01/01/2001
Spouse's Phone Number
Example: xxx-xxx-xxxx
Spouse's Email Address
Example: example@example.com
Spouse's Job Title

Other dependents or people who lived with you

Rows	Name	Social Security	IP Pin	Date of Birth	Relationship	Income
1
2
3
4
5
6
7
8

Earned Income Credit

Additional Due Diligence
Areas of Emphasis

Around 60% of all mistakes in EITC are results of 3 main areas:

1. The child might not meet the age, residency, or relationship requirement.

2. The case might be that someone is filing as single or HOH when he/she is actually married.

3. A mistake might arise when reporting income or expenses. Special attention has to be paid when the client is answering these questions.

The people who are eligible for EITC:

1. Have earned income
2. Have a valid Social Security Number
3. Are filing separately and not as married
4. Are not a nonresident alien
5. Are not a qualifying child of another person
6. Are not filing Form 2555 or Form 2555-EZ
7. Have limited investment income
How many dependents are you claiming? *
Are you claiming a niece, nephew, grandchild, or other relative instead of your own children, and you are providing 50% or more of their expenses?*

YesNo
Please clarify why the parents are unable to claim them. What is the status of the parents?*
If requested by the IRS, do you have documentation (i.e. receipts, records) to substantiate your eligibility for the Child Tax Credit, Earned Income Tax Credit and/or Head of Household Filing Status?*

YesNo
Please upload a rental agreement with your dependents listed on it, or school records with your address listed.*

Cancelof

Market Place Insurance

This Question needs to be answered carefully as it can cause the IRS to deny your return.
If you're not sure, PLEASE CALL MARKET PLACE INSURANCE AND FIND OUT. IF YOU DO HAVE IT, PLEASE ASK THEM FOR YOUR 1095-A FORM FOR THE CURRENT YEAR…

(WE WILL NEED IT TO FILE)…. #

MARKET PLACE INSURANCE

1-800-318-2596
Did you or your dependents have insurance under the affordable care act (Marketplace Insurance?*

Document Upload
Taxpayer's ID and/or Driver's License/ Birth Certificate

Cancelof
Taxpayer's and Dependent(s) Social Security Card(s)

Cancelof
Taxpayer's W-2/ 1099'S/

Cancelof
Dependent(s) Proof of Residency (Lease Agreement or/Utility Bill) if you would like to receive the HOH Credit (Head of Household)

Cancelof
Dependent(s) Birth Certificate(s)

Cancelof
If you have a 1098-T form, upload it here.

Cancelof

BUSINESS INFORMATION

Please provide EIN, a business card, LLC Form, or Cash App statements.

Skip This Section if It does not apply to you
Schedule C - Self Employment / Side Business

1099 independent Contractor Uber, Lyft, etc
Name of Business
EIN Number
Business Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Schedule C - Business Expenses
Gross Income
USD ($)

List Business Expenses

Rows	Amount (USD)
Advertising
Travel
Rent/Lease
Meals
Supplies
Taxes
Wages
License
Office Supplies
Labor
Equipment
Utilities
Commission
Insurance
Legal Fees
Repairs
Vehicle Mileage
Misc

Did you use a vehicle for your BUSINESS ? If so , Name of Vehicle?
milage used on that vehicle for business?
Please provide documentation for the past 12 months of income and expenses. This should include receipts, invoices, bank statements, business logs, booking logs, mileage logs, business cards, Cash App statements, sales receipts, electronic records, and any other relevant documents that support claimed deductions or income, such as contracts, agreements, or correspondence related to business activities.*

Cancelof
Self-Employment Expense Log, Summary of Income, Business License, Bank Statements, receipts, etc

Cancelof
Additional Documents

Cancelof
Terms and Conditions*

Tax Preparation Checklist
Please provide the following documentation:
- Form 1095-A (for health insurance purchased through a public exchange), Form 1095-B (for health insurance purchased outside of a public exchange), or Form 1095-C (for employer-provided health insurance coverage).
- If you are a new client, provide copies of last year’s tax returns.
- Mileage figures for any automobile expenses claimed, including total mileage, commuting mileage, and business mileage.
- Details of estimated tax payments made, if any.
- Copy of all acknowledgment letters received from charitable organizations for contributions made in 2023.
Tax Return Preparation

We will prepare your tax return based on the information you provide. If your return is audited, you will be responsible for verifying the reported items. Please review the return carefully before signing to ensure the information is correct. Unless otherwise stated, the services for preparing your return do not include auditing, review, or any other form of verification or assurance.

Taxpayer Responsibilities

You agree to provide us with all income and deductible expense information. If you receive additional information after we commence work on your return, you will contact us immediately to ensure that your completed tax returns contain all relevant information. You affirm that all expenses or other deduction amounts are accurate and that you have all required supporting written records. In some cases, we may ask to review your documentation. You must be able to provide written records of all items included on your return if audited by either the IRS or state tax authority. We can provide guidance on what evidence is acceptable.

Before signing, carefully review the return to ensure the information is correct. Fees must be paid before your tax return is delivered to you or filed on your behalf. If you terminate this engagement before completion, you agree to pay a fee for work completed. A retainer is required for the preparation of late returns.

It is advisable to keep a copy of your tax return and any related tax documents. A fee may be assessed if you request a copy in the future.

By signing below, you acknowledge reading, understanding, and accepting your obligations and responsibilities.

For a joint return, both taxpayers must sign.

TAX INTAKE FORM

DEDUCTIONS

WORK RELATED EXPENSES

Earned Income Credit

Market Place Insurance

Document Upload

Schedule C - Self Employment / Side Business

Schedule C - Business Expenses

Tax Preparation Checklist

Payment of Tax Refund Disbursement