IRS DUE DILIGENCE INTAKE FORM

IRS Due Diligence Intake Form
Marital Status
Taxpayer Name

First NameLast Name
Taxpayer Date of Birth

MonthDayYear
Date
Taxpayer Occupation
Check all that apply:
Spouse Name

First NameLast Name
Spouse Date of Birth

MonthDayYear
Date
Spouse Occupation
Taxpayer Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Taxpayer Phone Number
Format: (000) 000-0000.
Spouse Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Spouse Phone Number
Format: (000) 000-0000.
Taxpayer Email Address
example@example.com
Spouse Email Address
example@example.com

DEPENDENTS INFORMATION

Rows	FULL DEPENDENT NAME	DATE OF BIRTH	# OF MONTHS DEPENDENT RESIDE WITH TAXPAYER
DEPENDENT 1
DEPENDENT 2
DEPENDENT 3
DEPENDENT 4
DEPENDENT 5

Do you have a "Special Needs" child?
ADVANCE CHILD TAX CREDIT PAYMENT:
Enter the aggregate amount of advance child tax credit payments you (and your spouse if filing jointly) received.
CHILD TAX CREDIT PAYMENT AMOUNT
Enter the amount from IRS Notice 1444-C, Your Economic Impact Payment.
ECONOMIC IMPACT PAYMENT (THIRD STIMULUS AMOUNT)
HEALTH INSURANCE COVERAGE:
DID YOU RECEIVED HEALTH COVERAGE (INSURANCE) THROUGH YOUR STATE MARKETPLACE OR HEALTHCARE.GOV? IF SO, PLEASE UPLOAD YOUR FORM 1095A
Please upload 1095A

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Wages and Salaries (Attach W-2's)

Interest Income (Attach 1099's) (List and identify as non-taxable Interest Income)

Unemployment Compensation Received (FORM 1099G) PLEASE UPLOAD FORM BELOW:
File Upload

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Were you, your spouse, or any dependent registered in college? Do you have a form 1098T?
File Upload

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If you would like your tax refund (if any) deposited directly into your bank
Bank Name
Your Account Number
Bank Routing Number
Rental & Royalty Income and Expense (Rental Property)
Type a question
If so how much?
File Upload

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Property Type
Number of days rented
Number of days used personally
Property is owned by
Percentage ownership of not 100%: Please indicate if income and expenses below are listed at 100% or your percentage
Percentage ownership of not 100%
Did you live in part of the rental property?
If yes, what percentage did you occupy as a tenant?
If yes, what percentage did you occupy as a tenant?
Business Income & Expenses (Sole Proprietorship, LLC)
Tax Payer Agrees that for any reason they are due a refund and it is taken PER IRS for past due obligations TAX PAYER AGREES TO PAY TAX PREPERAR FEES OF $250 FOR THE PREPARATION OF THE RETURN. OR IF TAX PAYER HAS A SCHEDULE C BUSINESS RETURN TAX PAYER AGREES TO PAY $1150 FOR BUSINESS RETURN OUT OF POCKET UPON INVOICE. IF YOU SELECT NO WE CANT MOVE FORWARD WITH YOUR RETURN.
DO YOU OWE THE IRS? PLEASE BE TRUTHFUL I MAY CAN HELP YOU.
Signature
Owner Name

First NameLast Name
Business name
Business Type
Employer ID number (EIN)
LLC documents

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Please upload a copy of your EIN Document

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Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
File Upload

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Do you use any part of your home regularly and exclusively for business?
Estimated percentage of time spent in home office compared to total time spent in this business
Estimated of time in home office compared to total time in this business
Description of work done in home office
Description of work done outside of work office
Total area of home
Total area of home used regularly for business
Please upload any additional tax documents below:

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Does anyone listed on the Tax Return have an Identity Pin? If so, please list the name and Identity Pin below:
Do you plan on buying a home in the next 2 years?

Are you Interested in credit repair? If so would you like the option to have the cost deducted from your Tax refund or would you like to pay upon invoice? Start up cost $300 If interested you will receive a different form to fill out after submission and schedule a consultation with Brittany Mays Roberts to go over your credit report. Please take advantage of this discounted offer and focus on your financial freedom

📜 Taxpayer Accuracy and Compliance Certification AgreementThis Agreement outlines the respective responsibilities of [Your Name/Business Name] (hereinafter "Preparer") and the Taxpayer (hereinafter "Client") concerning the preparation of the Client's [State specific tax year, e.g., 2024] tax returns.1. Preparer's ResponsibilityThe Preparer agrees to perform the tax preparation services based solely upon the information and documents provided by the Client. The Preparer will use professional judgment to interpret tax laws and apply them to the facts provided, ensuring the return is prepared in accordance with the Internal Revenue Code and applicable state tax laws.The Preparer will not audit or independently verify the accuracy or completeness of the information provided by the Client.2. Client's Responsibility and Certification of AccuracyThe Client understands and agrees that they have the final responsibility for the accuracy, completeness, and sufficiency of the information used in the preparation of the tax return. The Client certifies and warrants the following:Completeness: The Client has provided the Preparer with all necessary information and documents, including but not limited to, all income forms (W-2s, 1099s, K-1s), all expense records, and information regarding all assets, liabilities, and transactions relevant to the tax year.Accuracy: All facts, figures, representations, and documents provided to the Preparer are true, correct, and complete to the best of the Client's knowledge and belief.Substantiation: The Client has records to substantiate every item of income, deduction, and credit reported in the tax return, as required by the Internal Revenue Service (IRS) and relevant State tax authorities.Final Review: The Client agrees to carefully review the final draft of the tax return before signing or authorizing e-filing. By signing the return, the Client affirms that the return, as prepared, is true, correct, and complete.3. Penalties and LiabilityThe Client acknowledges that by signing the tax return, they are subject to the penalties of perjury and are legally responsible for its accuracy.The Client agrees to hold the Preparer harmless from any and all liability, including but not limited to, additional tax, penalties, interest, and professional fees, that may result from:The Client's failure to provide complete, accurate, or sufficient information.The disallowance of any deduction or credit due to inadequate documentation.Any audit or examination by the IRS or State tax authorities, where the discrepancy is based on incorrect information supplied by the Client.The Client remains personally responsible for the payment of all federal and state taxes, interest, and penalties imposed by the tax authorities.4. Governing Law and SeverabilityThis Agreement shall be governed by and construed in accordance with the laws of the State of Texas and federal tax laws.CertificationBy selecting "I Agree" and providing my electronic signature below, I certify that I have read and understood the terms of this Agreement and attest that all information I have provided to the Preparer for the preparation of my tax returns is accurate, complete, and properly supported by adequate documentation.
I have read and agree to the above Taxpayer Accuracy and Compliance Certification Agreement
Signature
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IRS Due Diligence Intake Form

ADVANCE CHILD TAX CREDIT PAYMENT:

HEALTH INSURANCE COVERAGE: