RAB DYNAMICS ENTERPRISE Tax Preparation Client Intake Form

TAX CLIENT INFORMATION
Filing Status*

SingleHead of HouseholdMarried Filing SeparateMarried Filing JointQualifying Widower

Taxpayer Details
Name*

First NameMiddle NameLast NameSuffix
Date of Birth*

MonthDayYear
Date
Social Security #*
Email*
example@example.com
Phone Number*
Please enter a valid phone number.
Age
Can you be claimed on someone else's Tax Return?

YesNoI don't know

Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Occupation*
If no Occupation, print NONE
Are you a full-time student?*

YesNo
Are you totally and permanently disabled?*

YesNo
Are you legally blind?*

YesNo

Spouse Information
IF NO SPOUSE, LEAVE THIS PART OF THE FORM BLANK AND SKIP TO THE NEXT QUESTION.
Name

First NameLast Name
Age
Date of Birth

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

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Occupation
Are they a full-time student?

YesNo
Are they totally and permanently disabled?

YesNo
Are they legally blind?

YesNo
Are they your dependent?

YesNo

Expenses
Please fill-up the information within the current year only.

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

Total Expenses
Additional comments

Acknowledgment & Signature
Date Signed*

MonthDayYear
Date
Taxpayer Signature*

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Date Signed

MonthDayYear
Date
Spouse Signature

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Should be Empty: