Tax Preparation Client Intake Form
Current Tax Year
*
Did you file with ZipN2Taxes last year?
*
Please Select
Yes
No
Are you filing an eligible spouse on you return
*
Please Select
Yes
No
Your Preferred Tax Professional
Please Select
Camille Asztalos
Tierra Burns
Katurah Davis
Kayla Dixon
Marc-Donald Laguerre
Antoinette Ellis
Dale Fox
Melaine Gallagher
Lakeisha Johnson
Jasmine Redding
Lakisha Smith
Zaibreona Whatley
Aqusha Williams
Alisha Mitto
Zilphia Rice
Natalie
Marc-Donald Lagurre
Filing Status
*
Single
Head of Household
Married Filing Separate
Married Filing Joint
Qualifying Widower
Taxpayer Information
Date of Birth
*
-
Month
-
Day
Year
Date
Occupation
*
Name
*
First Name
Last Name
Social Security Number
*
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Email
*
example@example.com
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Are you a full-time student?
*
Yes
No
Are you totally and permanently disabled?
*
Yes
No
Are you legally blind?
*
Yes
No
File Upload (State ID)
*
Browse Files
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Choose a file
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of
File Upload (Social Security Card)
*
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of
Spouse Information
Date of Birth
-
Month
-
Day
Year
Date
Occupation
Name
First Name
Last Name
Social Security Number
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Email
example@example.com
File Upload (State ID)
Browse Files
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Choose a file
Cancel
of
File Upload (Social Security Card)
Browse Files
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Choose a file
Social Security Card
Cancel
of
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Are they a full-time student?
Yes
No
Are they totally and permanently disabled?
Yes
No
Are they legally blind?
Yes
No
Are they your dependent?
Yes
No
Dependents
Dependent 1
First Name
Last Name
Date of Birth
-
Month
-
Day
Year
Date
Social Security Number
Dependent 2
First Name
Last Name
Date of Birth
-
Month
-
Day
Year
Date
Social Security Number
Dependent 3
First Name
Last Name
Date of Birth
-
Month
-
Day
Year
Date
Social Security Number
File Upload (Dependent/s Social Security Card)
Browse Files
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Choose a file
Cancel
of
File Upload (Dependent/s Birth Certificate)
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Cancel
of
Do you and or your dependent have Marketplace Insurance? If so, please attached 1095A form below.
Please Select
Yes
NO
File Upload (1095A)
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of
Tax Related Questions
Employment Status
*
Employed
Unemployed
Self-employed
Are you contributing to 401k or other pre-tax account?
Yes
No
Is this your first time opening a pre-tax account?
Yes
No
Please select what state return are you requesting?
State return
School
Local
RITA
Country returns
Does your dependents have tuition expenses?
Yes
No
Do you have any expenses for child care?
Yes
No
Are you currently renting?
Yes
No
What is the monthly rental amount?
How long have you lived at the property?
# of months
Do you have your own home?
Yes
No
Do you have documents that shows you paid for property taxes?
Yes
No
Did you sell any stock?
Yes
No
Did you take money from your 401K?
Yes
No
Did you pay your vehicle tax?
Yes
No
Do you have mortgage interest?
Yes
No
Do you have real estate tax?
Yes
No
Did you receive a federal tax last year?
Yes
No
Are you a victim of identity theft?
Yes
No
Expenses
Please complete the information for the current year only.
General Expenses
Rows
Amount
Medical Expenses
Dental Expenses
Insurance Premiums paid
Long Term Care Premiums
Prescription Drugs and Medications
Home Mortgage
Investment Interest
Cash Contributions
Non-Cash Contributions
Unreimbursed Business Expenses
Union Dues
Tax Preparation Fees
Investment Expenses
Total Expenses
File Upload (W2, 1099, Expense Sheet)
*
Browse Files
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of
Do you currently owe the IRS?
*
Please Select
Yes
No
Do you have an IP Pin
*
Please Select
Yes
No
Provide IP Pin, if you answered yes to previous question.
If you are eligible for a refund, how would like disbursement?
*
Direct Deposit
Check
Prepaid Card
Bank Name
Bank Account Number
Bank Routing Number
File Upload (Direct Deposit Form)
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of
Are you interested in a refund advance?
*
Please Select
Yes
No
Do you understand that approval is based on your refund amount and bank product eligibility?
Please Select
Yes
NO
Provide Your IDME log
User Name
Additional comments
Acknowledgment & Signature
I confirmed that all information I entered here is accurate and true.
I allow ABC Financial to capture my sensitive data like personal id, government id, and other information.
I have read the terms and conditions and privacy policy of ABC Financial.
By signing below, you acknowledge that you have read and understood your responsibilities and our responsibilities in doing this tax return.
Date Signed
*
-
Month
-
Day
Year
Date
Taxpayer Signature
*
Date Signed
-
Month
-
Day
Year
Date
Spouse Signature
Print
Submit
Submit
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