2025-2026 Tax Intake Due Diligence Form

2025-2026 Tax Intake & Due Diligence Form

Thank you so much for choosing Prosperity 93 Consultants! Please complete the below questions as accurately as possible. If you have any questions or concerns, please text us 346-744-7729
Tax preparer name*
FacebookInstagramPrevious clientReferral
If referred, please enter your referrals name here (put N/A if none)*
YesNo
YesNo
- Taxpayer first and last name*
  
  First NameLast Name
- Date of birth*
  
  MonthDayYear
  Date
- Taxpayer SSN*
- Taxpayer phone number*
  Please enter a valid phone number.Format: (000) 000-0000.
- Taxpayer job title*
- Taxpayer email*
  example@example.com
- Taxpayer address*
  
  Street Address
  
  Street Address Line 2
  
  CityState / Province
  
  Postal / Zip Code
- Taxpayer spouses full name
  
  First NameLast Name
- Spouse DOB
  
  MonthDayYear
  Date
- Spouse SSN
- Spouse Phone Number
  Please enter a valid phone number.Format: (000) 000-0000.
- Spouse job title
- Spouse email
  example@example.com
- Spouse address (if different from taxpayer address)
  
  Street Address
  
  Street Address Line 2
  
  CityState / Province
  
  Postal / Zip Code
- Taxpayers drivers license *
  
  Cancelof
- Primary taxpayers SSC*
  
  Cancelof
- Taxpayers W-2/1099*
  
  Cancelof
- YesNo
- YesNo
- YesNo
- YesNo
- YesNo
- If Yes, Please briefly explain the type of work performed, who paid you and how were you paid. Answer Here If No Put N/A*
- YesNo
- YesNo
- YesNo
- YesNo
- YesNo
- YesNo
- If yes, please upload 1098-T here
  
  Cancelof
- YesNo
- YesNo
- YesNo
- YesNoN/A
- YesNoN/A
- YesNo
- YesNo
- YesNo
- MarketplaceEmployerMedicaidOther
- YesNo
- MarketplaceEmployerMedicaidOther
- Upload tax payer insurance documents here*
  
  Cancelof
- YesNo
- YesNo
- YesNo
- 012345
- Dependent #1 first and last name
  
  First NameLast Name
- Dependent #1 DOB
  
  MonthDayYear
  Date
- Dependent #1 SSN
- Your relation to dependent #1
- How many months did Dependent #1 live with you in 2019?
  If all year, enter 12 months
- Dependent #1 social security card
  
  Cancelof
- Dependent #1 birth certificate
  
  Cancelof
- Dependent #2 first and last name
  
  First NameLast Name
- Dependent #2 DOB
  
  MonthDayYear
  Date
- Dependent #1 SSN
- Your relation to dependent #2
- How many months did Dependent #2 live with you in 2019?
  If all year, enter 12 months
- Dependent #2 social security card
  
  Cancelof
- Dependent #2 birth certificate
  
  Cancelof
- Dependent #3 first and last name
  
  First NameLast Name
- Dependent #3 DOB
  
  MonthDayYear
  Date
- Dependent #3 SSN
- Your relation to dependent #3
- How many months did Dependent #3 live with you in 2019?
  If all year, enter 12 months
- Dependent #3 social security card
  
  Cancelof
- Dependent #3 birth certificate
  
  Cancelof
- Dependent #4 first and last name
  
  First NameLast Name
- Dependent #4 DOB
  
  MonthDayYear
  Date
- Dependent #4 SSN
- Relation to dependent #4
- How many months did Dependent #4 live with you in 2019?
  If all year, enter 12 months
- Dependent #4 social security card
  
  Cancelof
- Dependent #4 birth certificate
  
  Cancelof
- Dependent #5
  
  First NameLast Name
- Dependent #5 DOB
  
  MonthDayYear
  Date
- Dependent #5 SSN
- Relation to dependent #5
- How many months did Dependent #5 live with you in 2019?
  If all year, enter 12 months
- Dependent #5 social security card
  
  Cancelof
- Dependent #5 birth certificate
  
  Cancelof
- Are there any dependents in daycare? If yes, please upload the form you received from your daycare provider.
  
  Cancelof
- Upload dependent #1 insurance documents
  
  Cancelof
- Upload dependent #2 insurance documents
  
  Cancelof
- Upload dependent #3 insurance documents
  
  Cancelof
- Upload dependent #4 insurance documents
  
  Cancelof
- Upload dependent #5 insurance documents
  
  Cancelof
- Dependents proof of residency (Lease/Utility bill)
  
  Cancelof
- You are not required to know filing status rules. Please answer the questions below honestly. Your tax preparer will determine whether Head of Household filing status applies based on IRS rules and documentation
- YesNo
- Single (Not married)Married living with spouseMarried not living with spouse
- YesNo
- YesNo
- YesNo
- YesNo
- YesNo
- Check (Only available for in-office visits)Direct deposit
- Name of bank*
- CheckingSavings
- Routing number*
- Confirm routing number*
- Account bank number*
- Confirm bank account number*
- CLIENT NON PAYMENT/OFFSET CLAUSE
  
  At Prosperity 93 Consultants LLC, we strive to assist all of our clients in their tax needs, howwever we understand that situations arise. If your refund is offset by the IRS, student loans, child support or your check is mailed, you are still obligated to pay our company the fees associated with filing your tax return.
  
  By signing this agreement you acknowledge that if payment is not made in full with in 30 days legal actions will be sought to resolve payment.
  
  -
  
  I am giving Prosperity 93 Consultants LLC permission to prepare all forms related to my tax return; to apply for and secure RAC's and RAL's on my behalf; and sign all necessary forms and file my taxes electronically. I take full responsibility for the accuracy of this form and understand that Prosperity 93 Consultants LLC and/or associated affiliates hold no responsibility for any misrepresentation or false claims.
- Full name of taxpayer*
  
  First NameLast Name
- Taxpayer signature*
- Date*
  
  MonthDayYear
  Date
- Full name of taxpayer spouse
  
  First NameLast Name
- Spouse signature
- Date
  
  MonthDayYear
  Date
- I certify under penalty of perjury that the information I have provided in this questionaire is true and correct, and complete to the best of my knowledge. I understand that my tax preparer is relying on the information I provided to prepare and file my tax return. I acknowledge that providing false information or imcomplete information may result in penalitiles, denials of tax credtis , or additional IRS action.
- YesNo
- Who provided the answers in this questionnaire? First Name* Last Name*
- YesNo
Should be Empty:

2025-2026 Tax Intake & Due Diligence Form