Tax Quesionnaire/Intake

Tax Preparation

Address: P O BOX 470~ DACULA~GA~30019 Phone: (833) 382-9829 Email: admin@blackdogfinancial.org
Client Information
Taxpayer Full Name*

First NameLast Nameundefined
Taxpayer Social Sec Number*
Spouse Full Name

First NameLast NameSuffix
Spouse Social Sec Number
Email Address*
example@example.com
Phone Number*
Please enter a valid phone number.
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Tax Year 2025 Information (January 2026 - Dec 2026)
Do you want to apply for a loan advance this year? We cannot request amounts or determine amounts before application and approval. If so, the refund fund disbursement method WILL BE THE SAME as the refund loan method.*

Yes, I DO want to apply for a loan up to $9,500No, I do NOT want to apply for a loan at this time.
Filing Status*

SingleMarried Filing JointlyMarried Filing SeparatelyHead of HouseholdQualifying Widow(er)
Dependents
Income

Please provide the following income information for the tax year.
W2
Household Employee Cash Income (not included on W2~ See commonly asked question below)
Common Question: "How much Household Employee Income Should I Claim?

Although we cannot provide amounts to report for your Household Employee Wages, we can let you know what most taxpayers in your exact position report and the refunds they normally expect. (These do not include W2 or 1099M wages). Taxpayers who report $8,900 - $12,000 and are claiming 1 child, expect to receive a tax refund of up to $4861 before fees. Most taxpayers who report anywhere from $16,000 - $19,000 and are claiming 2 children expect receive a tax refund of up to $8,516 before fees. Finally, most taxpayers who report $21,000 - $23,000 and are claiming three or more children expect to receive a refund of up to $10,031 before fees.
Interest Income/Dividend
Business Income
Other Income (Including Unemployment/Lottery/1099M)
Credits and Expenses

Please provide the following credit information for the tax year.
Child Care Expenses (Attach Day Care Receipt with Daycare EIN & Contact Info)
Education Expenses (Attach 1098T)
Other Credits/Expenses (Real Estate Taxes/Mortgage/Charity Contributions)
Additional Information
Date

MonthDayYear
Date

I choose to receive my tax refund in the form of a:*

CheckDirect Deposit
If Direct Deposit is chosen provide routing number:
If Direct Deposit is chosen provide account number:
If Direct Deposit is chosen, provide Bank Name:
If Direct Deposit is chosen, select Savings OR Checking Account
Acknowledgements Supporting Docuements

Attach the following documents as proof of requested credits: W2 if you receive a paycheck.1099 if you are an independent contractor. Birth Certificates of dependents. School records or lease for dependents. All social security cards.1098 if you are requesting educational credit.
Acknowledgements Outstanding Documents

I, have been notified of outstanding documents requested in order to successfully send my return to the IRS, and ultimately receive my refund. I have been notified my documents must be IN THE OFFICE and the record of income (if I am filing household employee income) has been COMPLETELY and CORRECTLY filled out. I have been notified that INCOMPLETE; INCORRECT income records will not be accepted.
Acknowledgements State Tax Returns

I understand that Black Dog Financial Inc. or Girl Boss Financial LLC does not provide ANY SUPPORT for state income tax returns or related state audits. I understand that reporting “self-reported” income such as self-employment or household employee income may result in the denial of the entire refund amount from my state return, and in some cases may result in a tax obligation/ liability. I understand that I am responsible for any amounts owed to my state resulting from the reporting of my income on the Federal Income Tax. I understand that I am solely responsible for providing adequate proof of income to support all self-reported income on my tax returns. I release Black Dog Financial Inc. and/or Girl Boss Financial LLC from all legal ramifications of state tax warrants and related issues.
Guide to Claiming Household Employee Wages
Upload your supporting documents here:

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Tax Preparation

Client Information

Tax Year 2025 Information (January 2026 - Dec 2026)

Income

Common Question: "How much Household Employee Income Should I Claim?

Credits and Expenses

Acknowledgements Supporting Docuements

Acknowledgements Outstanding Documents

Acknowledgements State Tax Returns