2025 Tax Preparation Client Intake Form

2025 Tax Preparation Client Intake Form

2025 Tax Preparation Client Intake Form
Filing Status
Do you want to apply 2025 Tax Loans up to $7,000, starting Jan 2nd?
Who is your Tax Preparer
Who were you Referred by?

Name

First NameLast Name
Date of Birth

MonthDayYear
Date
Social Security Number
Occupation
Did you receive an Identity Theft PIN
Identity Protection PIN Number
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Email
example@example.com
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Bank Information for Direct Deposit

Routing NumberAccount Number
Select the Type of ID Card from dropdown
Select your State
Enter your identification Number
Issue Date

MonthDayYear
Date
Expiration Date

MonthDayYear
Date
Are you a full-time student?
Are you totally and permanently disabled?
Do you or your spouse have health insurance through the Healthcare Marketplace?
If you have health insurance through the Healthcare Marketplace you will have a 1095A, upload it at the end of this form.
Are you legally blind?

Name

First NameLast Name
Social Security Number
Date of Birth

MonthDayYear
Date
Occupation
Did you receive an Identity Theft PIN
Identity Protection PIN
Email
example@example.com
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Select the Type of ID Card from dropdown
Select your State
Enter your identification Number
Issue Date

MonthDayYear
Date
Expiration Date

MonthDayYear
Date
Are they a full-time student?
Are they totally and permanently disabled?
Are they legally blind?
Are they your dependent?

Enter your dependents here

Rows	Name	Date of Birth	Social Security Number	Relationship	Childcare
1
2
3
4
5
6

Do you, your spouse, and your dependents have health insurance within 12 months last year? If yes, who covers for it?

Rows	Yes/No	Employer	Spouse Ins	Exchange/ Marketplace	Direct with Insurer	Medicare	Medicaid
Taxpayer
Spouse
Dependent 1
Dependent 2
Dependent 3
Dependent 4
Dependent 5

Employment Status
How many W-2's do you have?
upload all W-2's to your intake form*****
How many W-2's do your Spouse have?
upload all W-2's to your intake form*****
What is your Self Employment
What is your Spouse Self Employment
OTHER:
Are you contributing to 401k or other pre-tax account?

School Name (University, Community College, or Trade School)

Rows	Name	EIN	Address	Phone Number	Amount Paid for the Year 2024	Out of Pocket Expenses for 2024
1

Do your dependents have tuition expenses?
Do you have any expenses for childcare?

Childcare Provider Information

Rows	Name	EIN/SSN	Address	Phone Number	Amount Paid for the Year 2025
1
2

Do you have energy star rated improvements to your home?

Other
How long have you lived at the property?
# of months
Do you have your own home?
Do you have documents that shows you paid for property taxes? (1098E, receipts)
Did you sell any stock?
Did you take money from your 401k?
Do you have your 1099-R?
Did you pay your vehicle tax?
Do you have mortgage interest?
Do you have real estate tax? (1098E)
Did you receive a federal tax last year?

Please fill-out the information within the current year only.

General Expenses

Rows	Amount
Medical Expenses
Dental Expenses
Insurance Premiums paid
Long Term Care Premiums
Prescription Drugs and Medications
Home Mortgage
Investment Interest
Cash Contributions
Non-Cash Contributions
Unreimbursed Business Expenses
Union Dues
Tax Preparation Fees
Investment Expenses

Total Expenses
Additional comments

- I certify that I have made full disclosure of all income, expenses, and related supporting information to TNTS and the preparer of this return.
- Therefore, if an assessment of additional taxes, fines, penalties, or interest is levied due to my failure to produce or provide such supporting information to TNTS or one of the examining agents, I shall hold TNTS and their preparers, agents, or employees harmless for such failure.
- Subsequently, the undersigned agrees that they shall be solely responsible for the payment of all taxes, penalties, fines, and/or interest, which may be assessed against TNTS or the preparer of this return.
- I allow Top Notch Tax Service to capture my sensitive data like Personal ID, Government ID, and other information.
- I have read the terms and conditions and privacy policy of Top Notch Tax Service.
- 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
Date Signed

MonthDayYear
Date
Spouse Signature
File Upload

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