Clone of 2025 BTA TN Services Client Intake Form V1

Client Intake Form
Important Information

Thank you for taking the time to complete your Client Intake Form.
The information you provide is essential to ensure your tax return is prepared accurately and on time.

Please read all instructions carefully and review your answers before submitting. Incomplete or inaccurate information may delay the processing of your return.

Estimated Time to Complete: 20–30 minutes

Before You Begin:
- Please complete this form in full and upload all required documents at the end.
- Wait until you have all necessary documents before submitting.
If claiming dependents, please upload the following:
- Social Security cards and birth certificates for each dependent
- Proof that the dependent lives with you (e.g., school or medical records, Medicaid statements, or social service records showing both your name and address)
Important Reminders:

Do not submit this form until all supporting documents are uploaded.

Ensure all documents are valid, clear, and current.

For lease agreements or similar documents, make sure your dependent’s name appears on them (if applicable).

Incomplete submissions will not be processed and may result in delays.

Thank you for your cooperation and attention to detail — this helps us serve you efficiently and accurately.

REFERRAL & FILING INFORMATION
How did you hear about us? *
If referred, please type his or her name here.
Reminder: If you are filing multiple years you must complete a separate form for each year.
Which Tax Year Are You Filing For?
Are you interested in applying for an advance loan?*
Date of Interview*

MonthDayYear
Date
Interview Setting*

In PersonVirtualTranslator Used

GENERAL INFORMATION
Taxpayer's Name*

First NameLast Name
Taxpayer's Social Security Number*
Example: xxx-xx-xxxx
Taxpayer's Date of Birth*
Example: 01/01/2001
Taxpayer's Job Title*
Taxpayer's Phone Number*
Example: (xxx)-xxx-xxxx
Home Address*
Street Address
City
State/Province
Postal/Zip Code
Taxpayer's Email Address*
example@example.com
What is your status as of December 31st?*

Single or Unmarried (Potentially could change base on the information provided)Married Filing JointlyMarried Filing SeparatelySurviving Spouse
Taxpayer's Driver's License/ State ID (Stand directly over the item on a flat surface and zoom in for a clear shot)*

Cancelof
Please upload a Selfie to Validate your Government Issued ID.*

Cancelof
Taxpayer's Social Security Card (Stand directly over the item on a flat surface and zoom in for a clear shot)*

Cancelof
Were you previously issues an Identity Protection Pin (IPPIN) by the IRS? *
IPPIN IDENTITY THEFT IF (APPLICABLE) (Stand directly over the item on a flat surface and zoom in for a clear shot.)

Cancelof
Can someone else claim you as a dependent?*
If yes, please write down their name:
Do you owe the IRS, Child Support or in default with student loans?*
If yes, which agency?
How much did you owe?
Have you ever been disallowed for EITC/AOTC/CTC/ACTC? *
Did you make any charitable contributions during the year?*
If Yes, please upload supporting documents.

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Do you have any General Medical Expenses (e.g. Co-pay, Medical or Dental)?*

Please upload supporting documents here:

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	Answer
Medical and dental expenses
State income or sales taxes paid
Real estate taxes paid
Personal property taxes (vehicle, etc.)
Did you pay mortgage interest?
Points paid on new mortgage (if any)
Mortgage insurance premiums
Did you suffer a casualty or theft loss during the year?
Describe the event and estimated loss
Unreimbursed job expenses (if applicable)
Investment interest expenses
Other qualifying deductions

SPOUSE'S INFORMATION
Spouse's Full Name
First Name
Spouse's Social Security
Example: xxx-xx-xxxx
Spouse's Date of Birth
Example: 01/01/2001
Spouse's Phone Number
Example: xxx-xxx-xxxx
Spouse's Email Address
Example: example@example.com
Spouse's Driver's License/State ID (Stand directly over the item on a flat surface and zoom in for a clear shot)

Cancelof
Please upload a Selfie of your spouse to validate their Government Issued ID.

Cancelof
Spouse's Social Security Card (Stand directly over the item on a flat surface and zoom in for a clear shot)

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Did you and your spouse live apart for more than 6 months in 2022?
What months?
Upload Separate Lease agreement (For Married Filing Separately)

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DEPENDENT'S INFORMATION
Are you claiming any dependents on your tax return?*
What Type of Dependent(s) are you claiming?

ChildAdult Relative
Is your dependent fully disabled? (e.g. Impaired or Handicap)
If yes, please clarify the disability.
Upload supporting documents:

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Did your dependent/s have health insurance for the entire year?
How many dependents are you claiming?*
Dependent #1 Name

First NameLast Name
Dependent #1 Date of Birth
01/01/2001
Dependent #1 Social Security Number
###-##-####
Dependent #1 Social Security Card (Stand directly over the item on a flat surface and zoom in for a clear shot)

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Dependent #1 Birth Certificate (Stand directly over the item on a flat surface and zoom in for a clear shot)

Cancelof
What is Dependent #1's Relationship to you (son, daughter, etc.)?
Are you the custodian parent (Mother / Guardian)?

Form 8332
Release/Revocation of Release of Claim
to Exemption for Child by Custodial Parent

Note: This form also applies to some tax benefits, including the child tax credit, additional child tax credit, and credit for other dependents. It doesn’t apply to other tax benefits, such as the earned income credit, dependent care credit, or head of household filing status. See the instructions and Pub. 501.
Part I. Release of Claim to Exemption for Current Year
I agree not to claim an exemption for Type a label for the tax year 20 Type a label .
Signature of custodial parent releasing claim to exemption

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Custodial parent’s SSN
Date Signed

MonthDayYear
Date
Part II. Release of Claim to Exemption for Future Years (If completed, see Noncustodial Parent on page 2.)
I agree not to claim an exemption for Type a label for the tax year 20 Type a label .
Signature of custodial parent releasing claim to exemption

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Custodial parent’s SSN
Date Signed

MonthDayYear
Date
Part III. Revocation of Release of Claim to Exemption for Future Year(s)
I revoke the release of claim to an exemption for Type a label for the tax year 20 Type a label .
Signature of custodial parent releasing claim to exemption

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Custodial parent’s SSN
Date Signed

MonthDayYear
Date
Upload Form 8332 here.

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How many months did dependent #1 live with you?
If the child under 12 years of age who caring for the child while you at work
If the child is cared by a daycare, please upload form 2441

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Is the dependent below 18 years old?
Did your dependent provide more than half of their financial support for the year?
If yes, how much support did the dependent(s) provide?
Did you provide more than half of the financial support to maintain your household for you and your dependent(s) for more than 6 months?

YesNo
Does anyone else provide support to the dependent?
If yes, specify the name.
Where is the other biological parent?

DeceasedIncarceratedNot ActiveActiveWhereabouts UnknownN/A
Why is the other parent not claiming the child?
What is the name of the other Parent(s)?
Dependent #2's Name

First NameLast Name
Dependent #2's Date of Birth
Example: 01/01/2001
Dependent #2's Social Security Number
###-##-####
Dependent #2 Social Security Card (Stand directly over the item on a flat surface and zoom in for a clear shot)

Cancelof
Dependent #2 Birth Certificate (Stand directly over the item on a flat surface and zoom in for a clear shot)

Cancelof
What is Dependent #2's Relationship to you (son, daughter, etc.)?
Are you the custodian parent (Mother / Guardian)?

Form 8332
Release/Revocation of Release of Claim
to Exemption for Child by Custodial Parent

Note: This form also applies to some tax benefits, including the child tax credit, additional child tax credit, and credit for other dependents. It doesn’t apply to other tax benefits, such as the earned income credit, dependent care credit, or head of household filing status. See the instructions and Pub. 501.
Part I. Release of Claim to Exemption for Current Year
I agree not to claim an exemption for Type a label for the tax year 20 Type a label .
Signature of custodial parent releasing claim to exemption

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Part II. Release of Claim to Exemption for Future Years (If completed, see Noncustodial Parent on page 2.)
I agree not to claim an exemption for Type a label for the tax year 20 Type a label .
Signature of custodial parent releasing claim to exemption

Powered by Jotform SignClear
Part III. Revocation of Release of Claim to Exemption for Future Year(s)
I revoke the release of claim to an exemption for Type a label for the tax year 20 Type a label .
Signature of custodial parent releasing claim to exemption

Powered by Jotform SignClear
Upload Form 8332 here.

Cancelof
How many months did dependent #2 live with you?
If the child under 12 years of age who caring for the child while you at work
If the child is cared by a daycare, please upload form 2441

Cancelof
Is the dependent below 18 years old?
Did your dependent provide more than half of their financial support for the year?
If yes, how much support did the dependent(s) provide?
Did you provide more than half of the financial support to maintain your household for you and your dependent(s) for more than 6 months?

YesNo
Does anyone else provide support to the dependent?
If yes, specify the name.
Where is the other biological parent?

DeceasedIncarceratedNot ActiveActiveWhereabouts UnknownN/A
Why is the other parent not claiming the child?
What is the name of the other Parent(s)?
Dependent #3's Name

First NameLast Name
Dependent #3's Date of Birth
01/01/2001
Dependent #3's Social Security
Example: xxx-xx-xxxx
Dependent #3 Social Security Card (Stand directly over the item on a flat surface and zoom in for a clear shot)

Cancelof
Dependent #3 Birth Certificate (Stand directly over the item on a flat surface and zoom in for a clear shot)

Cancelof
What is Dependent #3's Relationship to you (son, daughter, etc.)?
Are you the custodian parent (Mother / Guardian)?

Form 8332
Release/Revocation of Release of Claim
to Exemption for Child by Custodial Parent

Note: This form also applies to some tax benefits, including the child tax credit, additional child tax credit, and credit for other dependents. It doesn’t apply to other tax benefits, such as the earned income credit, dependent care credit, or head of household filing status. See the instructions and Pub. 501.
Part I. Release of Claim to Exemption for Current Year
I agree not to claim an exemption for Type a label for the tax year 20 Type a label .
Signature of custodial parent releasing claim to exemption

Powered by Jotform SignClear
Part II. Release of Claim to Exemption for Future Years (If completed, see Noncustodial Parent on page 2.)
I agree not to claim an exemption for Type a label for the tax year 20 Type a label .
Signature of custodial parent releasing claim to exemption

Powered by Jotform SignClear
Part III. Revocation of Release of Claim to Exemption for Future Year(s)
I revoke the release of claim to an exemption for Type a label for the tax year 20 Type a label .
Signature of custodial parent releasing claim to exemption

Powered by Jotform SignClear
Upload Form 8332 here.

Cancelof
How many months did dependent #3 live with you?
If the child under 12 years of age who caring for the child while you at work
If the child is cared by a daycare, please upload form 2441

Cancelof
Is the dependent below 18 years old?
Did your dependent provide more than half of their financial support for the year?
If yes, how much support did the dependent(s) provide?
Did you provide more than half of the financial support to maintain your household for you and your dependent(s) for more than 6 months?

YesNo
Does anyone else provide support to the dependent?
If yes, specify the name.
Where is the other biological parent?

DeceasedIncarceratedNot ActiveActiveWhereabouts UnknownN/A
Why is the other parent not claiming the child?
What is the name of the other Parent(s)?
Dependent #4's Name

First NameLast Name
Dependent #4's Date of Birth
01/01/2001
Dependent #4's Social Security
Example: xxx-xx-xxxx
Dependent #4 Social Security Card (Stand directly over the item on a flat surface and zoom in for a clear shot)

Cancelof
Dependent #4 Birth Certificate (Stand directly over the item on a flat surface and zoom in for a clear shot)

Cancelof
What is Dependent #4's Relationship to you (son, daughter, etc.)?
Are you the custodian parent (Mother / Guardian)?

Form 8332
Release/Revocation of Release of Claim
to Exemption for Child by Custodial Parent

Note: This form also applies to some tax benefits, including the child tax credit, additional child tax credit, and credit for other dependents. It doesn’t apply to other tax benefits, such as the earned income credit, dependent care credit, or head of household filing status. See the instructions and Pub. 501.
Part I. Release of Claim to Exemption for Current Year
I agree not to claim an exemption for Type a label for the tax year 20 Type a label .
Signature of custodial parent releasing claim to exemption

Powered by Jotform SignClear
Part II. Release of Claim to Exemption for Future Years (If completed, see Noncustodial Parent on page 2.)
I agree not to claim an exemption for Type a label for the tax year 20 Type a label .
Signature of custodial parent releasing claim to exemption

Powered by Jotform SignClear
Part III. Revocation of Release of Claim to Exemption for Future Year(s)
I revoke the release of claim to an exemption for Type a label for the tax year 20 Type a label .
Signature of custodial parent releasing claim to exemption

Powered by Jotform SignClear
Upload Form 8332 here.

Cancelof
How many months did dependent #4 live with you?
If the child under 12 years of age who caring for the child while you at work
If the child is cared by a daycare, please upload form 2441

Cancelof
Is the dependent below 18 years old?
Did your dependent provide more than half of their financial support for the year?
If yes, how much support did the dependent(s) provide?
Did you provide more than half of the financial support to maintain your household for you and your dependent(s) for more than 6 months?

YesNo
Does anyone else provide support to the dependent?
If yes, specify the name.
Where is the other biological parent?

DeceasedIncarceratedNot ActiveActiveWhereabouts UnknownN/A
Why is the other parent not claiming the child?
What is the name of the other Parent(s)?
Dependent #5's Name

First NameLast Name
Dependent #5's Date of Birth
01/01/2001
Dependent #5's Social Security
Example: xxx-xx-xxxx
Dependent #5 Social Security Card (Stand directly over the item on a flat surface and zoom in for a clear shot)

Cancelof
Dependent #5 Birth Certificate (Stand directly over the item on a flat surface and zoom in for a clear shot)

Cancelof
What is Dependent #5's Relationship to you (son, daughter, etc.)?
Are you the custodian parent (Mother / Guardian)?

Form 8332
Release/Revocation of Release of Claim
to Exemption for Child by Custodial Parent

Note: This form also applies to some tax benefits, including the child tax credit, additional child tax credit, and credit for other dependents. It doesn’t apply to other tax benefits, such as the earned income credit, dependent care credit, or head of household filing status. See the instructions and Pub. 501.
Part I. Release of Claim to Exemption for Current Year
I agree not to claim an exemption for Type a label for the tax year 20 Type a label .
Signature of custodial parent releasing claim to exemption

Powered by Jotform SignClear
Part II. Release of Claim to Exemption for Future Years (If completed, see Noncustodial Parent on page 2.)
I agree not to claim an exemption for Type a label for the tax year 20 Type a label .
Signature of custodial parent releasing claim to exemption

Powered by Jotform SignClear
Part III. Revocation of Release of Claim to Exemption for Future Year(s)
I revoke the release of claim to an exemption for Type a label for the tax year 20 Type a label .
Signature of custodial parent releasing claim to exemption

Powered by Jotform SignClear
Upload Form 8332 here.

Cancelof
How many months did dependent #5 live with you?
If the child under 12 years of age who caring for the child while you at work
If the child is cared by a daycare, please upload form 2441

Cancelof
Is the dependent below 18 years old?
Did your dependent provide more than half of their financial support for the year?
If yes, how much support did the dependent(s) provide?
Did you provide more than half of the financial support to maintain your household for you and your dependent(s) for more than 6 months?

YesNo
Does anyone else provide support to the dependent?
If yes, specify the name.
Where is the other biological parent?

DeceasedIncarceratedNot ActiveActiveWhereabouts UnknownN/A
Why is the other parent not claiming the child?
What is the name of the other Parent(s)?

CURRENT LIVING SITUATION
Do you receive Subsidized Housing or Section 8?
If yes, “Do you pay more than half of your rent?

YesNo
If yes, “How much?
Do you have a 1098 Mortgage Interest Statement?
If yes, please upload 1098 Mortgage Interest Statement below:

Cancelof
Was your insurance through the Affordable Care Act (The Marketplace)?
Please upload your 1095-A - If Applicable (Stand directly over the item on a flat surface and zoom in for a clear shot.)

Cancelof
Did anyone in your household attend college for the selected tax year? *
What was the Name of the person who attended college?
Form 1098-T (School Credit) *Stand directly over the item on a flat surface and zoom in for a clear shot.

Cancelof
Provide the following documents; Lease with children's name on it. Letter from Clergy, Rental Receipts, Housing Assistance document. (Stand directly over the item on a flat surface and zoom in for a clear shot.)

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INCOME
What's your source of income?

W2UnemploymentRetirement / Social Security BenefitsInvestmentGambling WinningsIndependent Contractor (Miscellaneous Income)Business Owner
Upload W2 statements (Stand directly over the item on a flat surface and zoom in for a clear shot.)

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1099 - G Unemployment Taxpayer/Spouse (Stand directly over the item on a flat surface and zoom in for a clear shot.)*

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Upload 1099 - R, Form SSA - 1099 and Form RRB - 1099 (Stand directly over the item on a flat surface and zoom in for a clear shot.)

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Income Documents such as 1099 INT, 1099 DIV, 1099 - SA and 1099 - B. (Stand directly over the item on a flat surface and zoom in for a clear shot.)

Cancelof
Upload W2-G Section*

Cancelof
1099 NEC (Stand directly over the item on a flat surface and zoom in for a clear shot.)

Cancelof
1099 - MISC (Stand directly over the item on a flat surface and zoom in for a clear shot.)

Cancelof

Business Owner (Complete only if you have your OWN business ,or in a partnership, or Contractor)
What is your business entity?

Sole PropriotorLLC- Single MemberLLC- SCorpLLC- Multi-MemberC-CorpS-CorpNonprofit
Please complete the Profit or Loss From Business Form
How long have you owned your business?
What services do you perform?
How many clients do you have?
Do you have a website or is your business on social media?
If other, please list here.
Do you travel for business?
How do you track of mileage?
When and where do you have to travel for business?
Please provide documentation of Business License and Registration if Applicable

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Did you receive payments from a 3rd Party Network such as Cash App, PayPal, or Venmo ?

YesNo
How much did you receive in payments from a 3rd Party Network? (If over $5,000 please upload your 1099 K form.
Upload your 1099 K document below. (Stand directly over item on a flat surface and zoom in for a clear shot.)

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Do you maintain separate banking accounts for personal and business transactions?
Who maintains the business records?
What form of records were provided?
Please upload supporting business documents. (ex P&L, 1099 NEC, Summary of Income, Spread sheet with expenses). (Stand directly over item on a flat surface and zoom in for a clear shot.)

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ACKNOWLEDGMENT & SIGNATURE
Are you interested in Audit Protection? (Mandatory For ALL Schedule C'S)*
Are you interested in Credit Repair?*
STOP!

Did you finish uploading your documents?

IF YOU DID NOT UPLOAD ALL NECESSARY DOCUMENTS YOUR INTAKE FORM WILL BE VOIDED.
CLIENT NON-PAYMENT/OFFSET CLAUSE

At BTA TN Services LLC, we strive to assist all of our clients in their tax needs, however, 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 within 30 days legal actions will be sought to resolve payment.
How would you like you refund disbursed if receiving on?*

Direct DepositCheckBy MailN/A
Name of Bank
Routing Number
Bank Account Number
Primary Taxpayer's Signature*

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Primary Taxpayer's Spouse Signature*

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I am giving BTA TN Services LLC permission to prepare all forms related to my tax return. To apply for and secure RAC's and RAL's on my behalf, sign all necessary forms and file my taxes electronically. I take full responsibility for the accuracy of this form and understand that BTA TN Services LLC and/or associated affiliates hold no responsibility for any misrepresentation or false claims.
Taxpayer's Signature

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Date*

MonthDayYear
Date
Spouse's Signature (If no spouse, leave blank)

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Date

MonthDayYear
Date
Form Status
Should be Empty: