Tax Preparation Client Interview Form
Rich Empire Tax Software
Filing Status
Single
Head of Household
Married Filing Separate
Married Filing Joint
Qualifying Widower
Taxpayer Information
Name
*
First Name
Last Name
Social Security Number
*
Date of Birth
*
-
Month
-
Day
Year
Date
Phone Number
*
Please enter a valid phone number.
Email
*
example@example.com
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Occupation
Are you totally and permanently disabled?
*
Yes
No
Are you legally blind?
*
Yes
No
Are you a full-time student?
*
Yes
No
Are you a veteran?
*
Yes
No
Spouse Information
Name
First Name
Last Name
Age
Date of Birth
-
Month
-
Day
Year
Date
Phone Number
Please enter a valid phone number.
Email
example@example.com
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Occupation
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
Enter your dependents here
Name
Date of Birth
Relationship
Social Security Number
1
2
3
4
5
6
Does you, your spouse, and your dependents have health insurance within 12 months last year? If yes, who covers for it?
Yes/No
Employer
Spouse Ins
Exchange/ Marketplace
Direct with Insurer
Medicare
Medicaid
Taxpayer
Yes
No
Spouse
Yes
No
Dependent 1
Yes
No
Dependent 2
Yes
No
Dependent 3
Yes
No
Dependent 4
Yes
No
Dependent 5
Yes
No
Did your dependent(s) live with you more than 6 months out of the year?
Yes
No
Tax Related Questions
Employment Status
*
Employed
Unemployed
Self-employed
Forms to file
*
W-2(s)
1099(s)
Unemployment
Other
Last years refund amount?
Do you have IP-PIN?
*
Yes
No
IP-PIN
Are you contributing to 401k?
*
Yes
No
Did you take money from your 401k?
*
Yes
No
Did you, your spouse, or a dependent have insurance under the Affordable Care Act?
*
Yes
No
Do you have any expenses for child care?
*
Yes
No
Were any credits disallowed or reduced in a previous year?
*
Yes
No
Do you own your home?
*
Yes
No
Do you have documents that shows you paid for property taxes?
*
Yes
No
Do you have mortgage interest?
*
Yes
No
Did you sell any stock?
*
Yes
No
Expenses ( SELF-EMPLOYED/ BUSINESS OWNERS ONLY )
Please fill-up the information within the current year only.
Business Type
If you have multiple, please contact me.
General Expenses
Amount
Medical Expenses
Dental Expenses
Insurance Premiums paid
Work related Travel
Supplies
Home Mortgage
Investment Interest
Cash Contributions
Non-Cash Contributions
Unreimbursed Business Expenses
Union Dues
Phone Services
Advertising Expenses
Total Expenses
Additional comments
Refund Method
Refund method client prefer?
*
Direct deposit
Paper check
Bank name
Routing number
Account number
Document Upload
File Upload : If any listed applies to you, please upload all documents or forms. (Photo Identification front & back, Social Security Cards, Proof of Residency, W-2 or 1099 etc. forms, Childcare Information, Direct Deposit Bank Information Form, Other)
*
Browse Files
Drag and drop files here
Choose a file
Upload all documents to be included in preparations. If more information is needed you will be contacted.
Cancel
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Acknowledgment & Signature
I confirmed that all information I entered here is accurate and true.
I allow Rich Empire Tax Software to capture my sensitive data like personal id, government id, and other information.
I have read the terms and conditions and privacy policy of Rich Empire Tax Software.
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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