Tax Preparation Client Intake Form
As of December 31st of last year, were you:
Unmarried
Caring for Dependents in the home
Married and lived with your spouse at any time
Married and Did Not Live with your spouse at any time of the year
Divorced or Legally Separated
Taxpayer Information
Name
First and Middle Name or Initial
Last Name
Social Security Number or ITIN
Date of Birth
-
Month
-
Day
Year
Date
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Email
example@example.com
Did you move last year? If so, note approximate date and previous address
Did you live in Kansas City at any time? Provide dates if applicable
Address
Street Address
Apartment #
City
State / Province
Postal / Zip Code
Occupation
Are you a full-time student?
Yes
No
Are you totally and permanently disabled? (diagnosed by a Medical Professional)
Yes
No
Are you legally blind?
Yes
No
Spouse Information
Name
First and Middle Name or Initial
Last Name
Social Security Number or ITIN
Date of Birth
-
Month
-
Day
Year
Date
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Email
example@example.com
Did you move last year? If so, note approximate date and previous address
Did you live in Kansas City at any time? Provide dates if applicable
Address
Street Address
Apartment #
City
State / Province
Postal / Zip Code
Occupation
Are they a full-time student?
Yes
No
Are they totally and permanently disabled? (diagnosed by a medical professional)
Yes
No
Are they legally blind?
Yes
No
Dependents
Who Lived In Your Home Last Year (do not re-enter Taxpayer or Spouse) Include students away at college as part of your household
Rows
First and Last Name
Date of Birth
Social Security #
Relationship to Taxpayer/Spouse
Months Living in the Home
1
2
3
4
5
Can anyone else claim these individuals as their dependent?
Yes
No
Unmarried or Divorced parents will need to provide proof of residency for their children and a copy of the court order outlining the tax and parenting plan
Did you, your spouse, and your dependents have health insurance last year?
Rows
insurance through Employer
Insurance Paid Out of Pocket
Obamacare/ Marketplace
Medicare
Medicare Supplementals
Supplemental Insurance Costs
Taxpayer
Spouse
Dependent 1
Dependent 2
Dependent 3
Dependent 4
Dependent 5
Does anyone have a Health Savings Account either funded through work or personally? (it is listed as code W on your W2 in box 12)
Yes
No
If it was used for medical expenses, provide the 1099SA from the account
Tax Related Questions
Did anyone receive tips at work last year?
Taxpayer
Spouse
Did anyone work overtime last year?
Taxpayer
Spouse
Do you buy or sell Virtual Currency like Bitcoin or Crypto?
Taxpayer
Spouse
Provide 1099 from the institution you sold through
INCOME STREAMS
Other than W2 Jobs
Was anyone self employed last year?
Taxpayer
Spouse
Did anyone work a side gig last year? (ie, DoorDash, Uber, Ebay sales, AIRBNB)
Taxpayer
Spouse
Provide the 1099NEC from each institution and expenses you had to do the job such as supplies and mileage
Did anyone claim Unemployment last year?
Taxpayer
Spouse
Provide the 1099G from the state you drew on
Do you have investment accounts? (ie: Schwab, Fidelity, Morgan Stanley, Robinhood, E-Trade, Vanguard)
Yes
No
Provide the full 1099B from the institution. (the form may not be available until March)
Do you own rental property?
Taxpayer
Spouse
Provide the 1099MISC/Rents from each institution and expenses you had for the property
Did anyone have any gambling winnings?
Taxpayer
Spouse
Provide the 1099G from the casino
Did you take money from your 401, Roth or other retirement accounts? Rollovers also apply and will issue a 1099R
Taxpayer
Spouse
Provide the 1099R from the institution showing the amount withdrawn
Did you buy or sell a home or business?
Taxpayer
Spouse
ADDITIONAL INFORMATION
Are you a victim of identity theft?
Yes
No
Did you pay estimated taxes during the year to apply to Federal or State taxes you expected to owe?
Yes
No
Provide the amounts paid, dates paid, and to what tax agency they were submitted
Available Deductible Expenses (subject to certain circumstances)
General Expenses
Rows
Amount
Medical Expenses
Dental Expenses
Insurance Premiums paid (not through work)
Long Term Care Premiums
Prescription Drugs and Medications
Home Mortgage
Cash Contributions (with receipts)
Non-Cash Contributions (with receipts)
Real Estate Tax on Home (paid receipts)
Personal Property Tax on Vehicles (paid receipts)
Do you have any expenses for childcare?
Yes
Provide receipt with name, address, EIN and amount paid for last year
Is anyone contributing to a Roth retirement account?
Taxpayer
Spouse
Does anyone in the home have tuition expenses?
Taxpayer
Spouse
Dependent/s
Provide the 1098T from each educational institution
Is anyone paying towards student loans?
Taxpayer
Spouse
Dependent/s
Provide the 1098E from each educational institution
Do you have mortgage interest?
Yes
Provide statement from all of the mortgages
Did you pay for Real Estate taxes on your home and Personal Property taxes on your vehicles?
Yes
No
Provide the receipts for the year as paid
Did you purchase a new car for personal use since December 31, 2024 ?
Yes
If so, provide a copy of the complete VIN number
Do you have energy star rated improvements to your home?
Windows
Doors
Furnace
Other
Questions for your preparer
Banking Information for Expected Refunds
The IRS is phasing out mailed checks for both Refunds and Tax Payments
Bank Account Number for Direct Deposit of Refunds
Routing Number for Direct Deposit of Refunds
Acknowledgment & Signature
I confirm that all information I entered here is accurate and true and that my tax return will be prepared based upon the information I have provided. I will provide additional supporting documentation as requested and I understand it is my responsibility to review the return when complete.
I understand that KC Tax Prep will collect personal information and that they maintain physical, electronic and procedural safeguards that comply with federal regulations to guard the personal data.
I understand that KC Tax Prep does not work "for" the IRS or any state and has no control over the policies and practices of the taxing agencies regarding refund timing or follow up questions they may have.
Date Signed
-
Month
-
Day
Year
Date
Taxpayer Signature
Print
Submit
Submit
Should be Empty: