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Mareva Accounting Firm Intake Form
!!ONLY COMPLETE THIS FORM IF YOU HAVE ALL YOUR TAX DOCUMENTS!!
Demographics
Name
*
First Name
Last Name
Phone Number
*
Email Address
*
Date of Birth
-
Month
-
Day
Year
Occupation
*
Social Security Number
*
Physical Address
*
Street address
City
State/Province
Postal/ Zip code
Filing Status
*
Single
Married/Filing single
Head of household
Married/ Filing Joint
Qualified Surviving Spouse
Business Income
Do you have a Business
*
Yes
No
What is your business structure
*
Not Registered
Sole proprietor
LLC
S corp
C corp
Did you receive payments from third-party companies? (Cash app, Zelle, PayPal etc.)
*
Yes
No
Would you require Bookkeeping Services for your business
*
Yes
No
Duration
*
One time
Monthly
Choose One
*
Yes
No
Did you purchase marketplace (Obama Care) health insurance?
Were you or your dependent enrolled in college and received a 1098-T?
Did you collect social security retirement income?
Are you ONLY self-employed?
Do you plan on purchasing a home in the next 2 years?
Do you owe any federal agencies (e.g., child support, federal/state taxes, student loans)?
*
Yes
No
Did anyone help support you through the year?
*
Yes
No
Dependents
Do you have any dependents?
*
Yes
No
Additional Questions
*
Yes
No
In the case of audit can you prove financial responsibility and residency for any of the Dependents being claimed?
Can your dependent be claimed by anyone else?
Were you ever disallowed to the EITC prior to this year?
Are any of the dependents disabled?
Yes
No
Are any of the dependents not your biological child
Yes
No
Childcare
Did you pay facility (daycare or after school program) or someone to keep your child or children?
Yes
No
Refund Questions
Are you the owner of this bank account?
*
Yes
No
Name on Account
*
Account Number
*
Verify Account Number
*
Routing Number
*
Are you the owner of this bank account?
Yes
No
Were you referred to our services?
*
Yes
No
Please select and attach all documents that concern you
Personal & Dependent Information
*
Last Year’s Federal and State Tax Returns
Driver's License(s) & Social Security card(s)
Dependent’s Social Security cards and birthcertificates/birth dates
1095-A* If purchased health insurancethrough the Health Insurance Marketplace
Income
*
Wage statements/W-2s
Self-employment business income andexpenses and vehicle mileage/1099-MISC/1099-NEC, income/expense records
Pension, retirement income/1099-R
Unemployment income/1099-G
Social Security income/SSA-1099/RRB-1099
Commissions received/paid/1099’s
Statements on the sale of stocks orbonds/1099-B or Bitcoin/Crypto Currency
Interest and dividend income/1099-INT/1099-DIV/1099-OID
Lottery or gambling winnings/losses/W2-g
State refund amount/1099-G
Alimony paid or received and ex-spouse info
Income and expenses from rental properties
Canceled Debt Amount/1099-C
Child care expenses and providerinformation (Federal ID Number)
Cash and non-cash charitable donations
Upload ALL Tax Documents
*
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