Wealthy Tax Pros Client Intake Form

Wealthy Tax Pros Client Intake
Filling Status
Tax Year
Pin #
Client Information
Name

First NameLast Name
Spouse Name (If filling joint)

First NameLast Name
Social Security Number
Spouse Social Security Number
Date of Birth

MonthDayYear
Date
Spouse Date of Birth

MonthDayYear
Date
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone
Format: (000) 000-0000.
Spouse Phone
Format: (000) 000-0000.
Email
example@example.com
Spouse Email
example@example.com
Occupation
Spouse Occupation

Tax Client's Documents
ID/Driver's License

Social Security Card(s)

Pin#

W2/1099-NEC/1099-MISC/1099-INT/1099-DIV/SSA-1099/1099-G

1098 (Mortgage) Property Tax Statments 1098-/1098-E Education

Business & Income Expenses/Profit & Loss Statement/Mileage Log/Business License
File Upload

Cancelof
Dependent 1
Name

First NameLast Name

Rows	Social Security Number	Date of Birth	Relationship	Months lived in home
1

Dependent 2
Name

First NameLast Name

Rows	Social Security Number	Date of Birth	Relationship	Months lived in home
1

Dependent 3
Name

First NameLast Name

Rows	Social Security Number	Date of Birth	Relationship	Months lived in home
1

Dependent 4
Name

First NameLast Name

Rows	Social Security Number	Date of Birth	Relationship	Months lived in home
1

Rows	Business Name	Service Provided	EIN
1

Address
Address Line 1

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Business Structure
Date of Incorporation

MonthDayYear
Date
Date Business was established?

MonthDayYear
Date
Did you receive form (s) 1099?
Did you file a business return last year?
Do you have a home office?

Client Acknowledgment & Consent
Wealthy Tax Pros LLC will prepare your 2025 individual tax return based solely on the information you provide. You, the taxpayer, are ultimately responsible for the accuracy and completeness of the information used to prepare and file your tax return.

By signing below, you acknowledge that you have provided Wealthy Tax Pros LLC with all applicable tax documents and information. You certify that, to the best of your knowledge and belief, the information submitted is true, correct, and complete.
Signature

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