Southern Tax Solutions Client Intake Form

Southern Tax Solutions Client Intake Form

Please fill out this form thoroughly to ensure compliance with IRS regulations and to assist us in providing accurate tax services.
Choose your tax preparer.
Full Name*

First NameMiddle NameLast Name
Email Address*
example@example.com
Phone Number*
Please enter a valid phone number.Format: (000) 000-0000.
Residential Address*

Street Address

Street Address Line 2
CityState / ProvincePostal / Zip Code
Date of Birth*

MonthDayYear
Date
SSN
Spouse/Partner Full Name

First NameMiddle NameLast Name
I confirm that I have reviewed and understand the IRS regulations applicable to my tax situation.
YesNo
SingleMarried Filing JointlyMarried Filing SeparatelyHead of HouseholdQualifying Widow(er)
Dependents' Full Names (if any)

First NameMiddle NameLast Name
Birthday

MonthDayYear
Date
SSN
Number of Dependents
Wages, Salaries, TipsSelf-Employment IncomeRental IncomeInterest and DividendsCapital GainsRetirement DistributionsSocial Security BenefitsUnemployment CompensationOther (please specify)
Gifts over $15,000Large Cash Transactions over $10,000Sale of Property or BusinessOther (please specify)
Please specify any other income not listed above.
Please specify details of large transactions.
Mortgage InterestCharitable ContributionsMedical ExpensesState and Local TaxesRetirement ContributionsEducation ExpensesBusiness ExpensesOther (please specify)
Please specify other deductions you are claiming.
YesNo
If yes, please provide details.
YesNo
Would you like to Apply for an Advancement ? (Depends on your bank)
Please provide details if involved in IRS audits or investigations.
Signature Acknowledgment*

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