Tax Preparation Intake Form

TAX CLIENT INTAKE

Thank you for taking time to complete. This information is critical to ensure that we accurately file your tax return.
Filing Status*

SingleHead of HouseholdMarried Filing SeparateMarried Filing JointQualifying Widower
Did you pay more than half your household bills this year?*

YesNo
Do you want to opt into a refund advance up tp $7,000?*

YesNo
Were you referred? If so, who referred you?

Enter your dependents here

Did your dependent(s) live with you more than 6 months out of the year?

YesNo
Are any dependent(s) currently, or intended to be, a qualifying child on any other individual's tax return?

YesNo

SELF-EMPLOYED or BUSINESS OWNER (only use if applies to you)
Please fill-up the information within the current year only. If you have multiple businesses, please contact me.
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

Document Upload (applies to all)
File Upload : Photo Identification*

Upload all documents to be included in preparations. If more information is needed you will be contacted.
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File Upload : Social Security Card(s) taxpayer &/or dependent(s)*

Upload all documents to be included in preparations. If more information is needed you will be contacted.
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File Upload: Dependent(s) Birth Certificate(s)

Upload all documents to be included in preparations. If more information is needed you will be contacted.
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File Upload: Head of Household (Lease, Utility Bill, or Mortgage Statement)

Upload all documents to be included in preparations. If more information is needed you will be contacted.
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File Upload: ANY IRS FORMS ( W-2(s), 1099(s), 1098(s), etc. )

Upload all documents to be included in preparations. If more information is needed you will be contacted.
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File Upload: Self-employed business income records, expense receipts, mileage logs, etc.

Upload all documents to be included in preparations. If more information is needed you will be contacted.
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Acknowledgment & Signature (applies to all)
- 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*

MonthDayYear
Date
Taxpayer Signature*

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TAX CLIENT INTAKE