2025-2026 Bouji Tax Services Client Intake Form

Personal Information*

Email*
example@example.com
Marital Status:*

SingleMarriedSeparatedWidowed
Are you or can you be claimed as a dependent on someone else's tax return?*

YesNo
Residence Information
Address*

Street Address

Street Address Line 2

City, State, ZipState / Province

Postal / Zip Code
Driver’s License/ ID

Cancelof
Dependent/s Information

Dependent/s Information

Adjustments to Income/Credits
ADJUSTMENTS
HSA Contributions (external from employer plan):
Self-employed SEP, SIMPLE and qualified retirement plans:
Are you a teacher?

YesNo
CHILD CARE EXPENSE CREDITS
Name Provider #1:
SS#/EIN:
Address:
Yearly Amount Paid:
Name Provider #2:
SS#/EIN:
Address:
Yearly Amount Paid:
HIGHER EDUCATION CREDITS
Please submit Form 1098-T if you or anyone in your household was enrolled in an institute of higher learning during the tax year.
AFFORDABLE CARE ACT PREMIUM TAX CREDIT
All required information will be listed on Form 1095-A provided by the Health Insurance Marketplace.
ADOPTION CRE DIT: (Please Provide Name, SS#, DOB in Dependents Section)
Amount of expense incurred for adoption of child:
Please write any notes below that will assist with your return.

Rental Income/Expense Sheet

	PROPERTY	DESCRIPTION (Single-family, Mixed-use, Condo, Townhouse, Etc.	ADDRESS
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Number of qualified children used to calculate Advanced CTC payments:
Select a Bouji Preparer:*
Appointment
Signature*

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	DATE FROM	DATE TO	CITY	STATE	LIVE/WORK
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CLIENT INTAKE FORM (CIF)