Prime Taxes Intake Form
Please allow to 48 hours for a response via phone or email. Ensure that you submit all supporting documents for a quote/filing to prevent any future delays. Email me at audrastelly35@gmail.com or call me at (318) 597-1173
Date
*
-
Month
-
Day
Year
Date
Filing Status
*
Single
Head Of Household
Married Filing Jointly
Married Filing Separately
Widow (er)
If you are claiming HOH (head of household) what documentation of household expenses do you have proof of:
Lease
Utility Bill (in your name)
Affidavit
Please upload documentation here: (lease/utility bill/affidavit)
*
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Name
*
First Name
Middle Name
Last Name
Suffix
Social Security Number
*
Please upload a copy of your social security card here:
*
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Date Of Birth
*
-
Month
-
Day
Year
Date
Current Physical Address (No P. O. Boxes)
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
How long have you lived to this address?
*
Email
*
example@example.com
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Current Tax Year
*
2025
Are you a U. S. citizen?
*
Yes
No
Please upload a CLEAR copy of your unexpired DL/State ID
*
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What is your job title? Did/Do you currently have any student loans?
*
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Are you or one of your dependents a full-time college student?
*
Yes
No
Are you filing an eligible spouse on your return?
*
Yes
No
Can you be claimed as a dependent on another tax filer's return?
*
Yes
No
Are you claiming any dependents?
*
Yes
No
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Spouse's Information
Spouse Name
First Name
Last Name
Suffix
Spouse's Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Spouse's Email
example@example.com
Spouse's Social Security Number
Drop a copy of spouse's social security card here:
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Spouse's Date Of Birth
-
Month
-
Day
Year
Date
Spouse's Occupation
Spouse's W-2 or 1099's
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Dependent Information
List of names of all eligible dependents (other than spouse).
Number Of Dependents
Please Select
1
2
3
4
Do you provide more than half of their financial support for the whole year?
Yes
No
Dependent #1
First Name
Last Name
Date Of Birth (dependent #1)
-
Month
-
Day
Year
Date
Social Security Number
What is this dependent's relationship to you?
Please Select
Child
Niece/Nephew
Sibling
Step Sibling
Foster Child
Stepchild
Grandchild
Other
If this dependent is not your biological, adopted, or stepchild please provide a detailed explanation describing your relationship to the individual and the reason you are claiming them as a dependent on your tax return. Include information about the support of this person, their residency, and any other relevant details in order to establish your eligibility to claim them:
How many months in this current year did they live in your home?
Please Select
1-3
3-6
6-9
9+
Please upload social security card and birth certificate
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Dependent #2
First Name
Middle Name
Last Name
Suffix
Date Of Birth (dependent #2)
-
Month
-
Day
Year
Date
Social Security Number
What is this dependent's relationship to you?
Please Select
Child
Niece/Nephew
Sibling
Step Sibling
Foster Child
Stepchild
Grandchild
Other
How many months in this current year did they live in your home?
Please Select
1-3
3-6
6-9
9+
If this dependent is not your biological, adopted, or stepchild please provide a detailed explanation describing your relationship to the individual and the reason you are claiming them as a dependent on your tax return. Include information about the support of this person, their residency, and any other relevant details in order to establish your eligibility to claim them:
Please upload social security card and birth certificate
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Dependent #3
First Name
Last Name
Suffix
Date Of Birth (dependent #3)
-
Month
-
Day
Year
Date
Social Security Number
What is this dependent's relationship to you?
Please Select
Child
Niece/Nephew
Sibling
Step Sibling
Foster Child
Stepchild
Grandchild
Other
How many months in this current year did they live in your home?
Please Select
1-3
3-6
6-9
9+
If this dependent is not your biological, adopted, or stepchild please provide a detailed explanation describing your relationship to the individual and the reason you are claiming them as a dependent on your tax return. Include information about the support of this person, their residency, and any other relevant details in order to establish your eligibility to claim them:
Please upload social security card and birth certificate
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Dependent #4
First Name
Last Name
Suffix
Date Of Birth (dependent #4)
-
Month
-
Day
Year
Date
Social Security Number
What is this dependent's relationship to you?
Please Select
Child
Niece/Nephew
Sibling
Step Sibling
Foster Child
Stepchild
Grandchild
Other
How many months in this current year did they live in your home?
Please Select
1-3
3-6
6-9
9+
If this dependent is not your biological, adopted, or stepchild please provide a detailed explanation describing your relationship to the individual and the reason you are claiming them as a dependent on your tax return. Include information about the support of this person, the residency, and any other relevant details in order to establish your eligibility to claim them:
Please upload social security card and birth certificate
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Income
Please select all forms of income for the current tax year:
Wages and Salary (W2 Income)
Unemployment (1099-G)
Lottery/Gambling Income
Independent Contractor/Gig Worker (1099-NEC)
Miscellaneous Income (1099-MISC)
Interest Income (1099-INT)
Dividends/Distributions (1099-DIV)
Pensions, Annuities, Retirement, IRA's, Or Insurance Contracts (1099-R)
Please upload all supporting income documentation here:
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Credits & Deductions
Let's make sure we aren't leaving out any possible additions to your return
Did you pay for child or dependent care in 2025?
Yes
No
Did you pay college tuition or fees (for yourself/dependent's)?
Yes
No
Did you pay any medical expenses, mortgages, interest, or charitable donations?
Yes
No
Today's Date
-
Month
-
Day
Year
Date
Signature
Appointment
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