New Client Intake Form
Name of Referral
Filing Status
Single
Head of Household
Married Filing Separate
Married Filing Joint
Qualifying Widower
Unknown
Taxpayer Information
Name
*
First Name
Last Name
Age
*
Date of Birth
*
-
Month
-
Day
Year
Date
Phone Number
*
Please enter a valid phone number.
Email
*
example@example.com
Preferred Method of Contact?
Phone
Email
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Are you a full-time student?
Yes
No
Are you totally and permanently disabled?
Yes
No
Are you legally blind?
Yes
No
Income
Estimated Annual Income
Employment Status
Employed
Unemployed
Self-employed
Deduction Related Questions
Number of Dependants
Are they a full-time student?
Yes
No
Are they totally and permanently disabled?
Yes
No
Are they legally blind?
Yes
No
Can they be claimed by anyone else?
Yes
No
Acknowledgment & Signature
I confirmed that I have downloaded and will complete the Letter of Engagement Provided.
I allow Ashlyn Gerber to capture my sensitive data like personal id, government id, and other information.
I have read the Letter of Engagement of Legacy Taxes and Consulting.
By signing below, you acknowledge that you have read and understood your responsibilities and our responsibilities in doing this tax return.
Date Signed
*
-
Month
-
Day
Year
Date
Taxpayer Signature
*
Date Signed
-
Month
-
Day
Year
Date
Spouse Signature
Print
Submit
Submit
Should be Empty: