Wealthy Tax Pros Client Intake Form

Wealthy Tax Pros Client Intake
Filling Status

SingleHead of HouseholdMarried Filing SeperateMarried Filling JointWidowed
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
Spouse Phone
Email
example@example.com
Spouse Email
example@example.com
Occupation
Spouse Occupation

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

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

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

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

	Business Name	Service Provided	EIN
1

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.
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Wealthy Tax Pros Client Intake