Client Intake Form 2023

Taxpayer Name*

First NameLast NameSuffix
Social Security Number*
Date of Birth*

MonthDayYear
Occupation*
Email*
example@example.com
Phone Number*
Please enter a valid phone number.Format: (000) 000-0000.
Spouse Information

First NameLast NameSuffix
Social Security Number
Date of Birth

MDYEAR
Occupation
Email
example@example.com
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Address*

NO P O BOX/ PHYSICAL ADDRESS ONLY

Street Address Line 2

CityState / Province

Postal / Zip Code
SingleMarried Filing JointlyMarried Filing SeparatelyHead of HouseholdQualifying Widow
LeaseUtility BillMortgage Statement
Dependent 1

First NameLast NameSuffix
Social Security Number
Date of Birth

MonthDayYear
Relationship
Dependent 2

First NameLast NameSuffix
Social Security Number
Date of Birth

MonthDayYear
Relationship
Dependent 3

First NameLast NameSuffix
Date of Birth

MonthDayYear
Social Security Number
Relationship
IF YOU ARE CLAIMING A DEPENDENT, PLEASE ANSWER THE QUESTIONS BELOW THAT PERTAINS TO YOUR DEPENDENT RELATIONSHIP. PER THE IRS REQUEST, WE MUST PROVE THAT NOBODY ELSE IS ELIGIBLE TO CLAIM YOUR DEPENDENT BUT YOURSELF.
If claiming son/daughter, where is the other parent of the dependent/dependents? Is the other parent providing any financial support?
If claiming niece, nephew, aunt, or uncle, how are you related to the dependent? Where are the parents to the dependent/dependents?
If claiming brother or sister, how are you related to the dependent? Why are the parents not claiming the dependent/dependents?
YESNO
YESNO
YesNo
YesNo
YesNo
YESNO
YESNO
Child SupportAlimonyStudent LoansBack TaxesState TaxesNone of the above
YesNo
DID YOU SUCCESSFULLY RECEIVE YOUR 2024 TAX REFUND?
Refund Transfer Direct DepositRefund Transfer Debit CardRefund Transfer Paper Check
YESNO
File Upload*

UPLOAD VALID PICTURE IDENTIFICATION
Cancelof
File Upload*

UPLOAD TAX PAYER SOCIAL SECURITY CARD
Cancelof
File Upload

UPLOAD DEPENDENT SOCIAL SECURITY CARD
Cancelof
File Upload

UPLOAD DEPENDENT SOCIAL SECURITY CARD
Cancelof
File Upload

UPLOAD DEPENDENT SOCIAL SECURITY CARD
Cancelof
File Upload

UPLOAD W2 FORM
Cancelof
File Upload

UPLOAD ADDITIONAL TAX DOCUMENTS
Cancelof
File Upload

UPLOAD ADDITIONAL TAX DOCUMENTS
Cancelof

Bank Information

Rows	Name of Bank	Routing Number	Account Number
ENTER BANK DATA

Signature*

Powered by Jotform SignClear
Date

MDYear
I, hereby, state that all the information above is true to the best of my knowledge and that I am allowing KGS to prepare my taxes based on the information I provided. I understand that I am financially responsible for any outstanding balance due to any false information given. If there is a balance due, I must pay the tax preparation fee upfront. If for any reason I owe an entity and they take the entire refund, I am STILL responsible to pay the tax preparation fee for services rendered. If for any reason an amendment has to be filed with no fault of the tax preparer, an upfront fee of $300 is required! KGS is not responsible if you provide false information or do not provide all of my 2025 income documents. Please view your tax return, which is emailed to you.(it is sent AFTER submission). Any copy after the first copy is a fee of $40.00. ALL FEES (bank and service fees) are found in the return and are non-refundable nor negotiable! NO EXCEPTIONS TO THIS!! By signing this form you give KGS permission to transmit your 2025 tax return. Please utilize www.irs.gov for all federal refund tracking. Please utilize your state Department of Revenue site for any State Refund tracking. Do NOT add the amounts together. Federal taxes are federal, and state taxes are state when tracking your status. Please allow 8 weeks to surpass from the date of submission before calling the IRS, if you have any tracking questions. For any direct assistance please email KAYGOTSOLUTIONS@GMAIL.COM or the IRS for all updates at 800-829-1040. IF YOU AGREE TO ALL STATED ABOVE, SIGN BELOW. *
PRINT NAME
Email
example@example.com
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
511 RONALD REAGAN PKWY.

UNIT 268

LOUGHMAN, FL. 33858

KayGotSolutions@gmail.com

(407) 460-6463
List all IP Pins for you and all dependents on the return.
Referral Source: How or where did you learn about us?
Should be Empty: