2025 Gratitude Tax Client Intake Form
How did you hear about Gratitude Tax?
*
New Client
Previous Client
Referral
Social Media
Referred By:
What tax year are you filing?
*
Please Select
2025
2024
2023
2022
2021
Section 1: Personal Information
Tell me about yourself
FULL NAME
*
First Name
Middle Initial
Last Name
ADDRESS:
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
PRIMARY PHONE NUMBER:
*
Format: (000) 000-0000.
SECONDARY PHONE NUMBER
Format: (000) 000-0000.
EMAIL:
*
example@example.com
PREFERRED CONTACT METHOD
*
Please Select
Phone
Email
Text
OCCUPATION
*
SOCIAL SECURITY NUMBER:
*
DATE OF BIRTH
*
-
Month
-
Day
Year
Date
DATE OF DEATH
-
Month
-
Day
Year
Date
DRIVERS LICENSE NUMBER
*
ISSUE DATE
*
-
Month
-
Day
Year
Date
EXPIRATION DATE
-
Month
-
Day
Year
Date
Please Upload a copy of your ID/Drivers License and Social Security Card(s)
*
Browse Files
Drag and drop files here
Choose a file
Please upload clear copies
Cancel
of
Section 2: Filing Status
Did your marital status change on or before December 31, 2025?
*
Yes
No
Spouse Information (if applicable):
SPOUSE FULL NAME
First Name
Middle Initial
Last Name
SPOUSE SOCIAL SECURITY NUMBER:
SPOUSE DATE OF BIRTH
-
Month
-
Day
Year
Date
SPOUSE DATE OF DEATH
-
Month
-
Day
Year
Date
DRIVERS LICENSE NUMBER
ISSUE DATE
-
Month
-
Day
Year
Date
EXPIRATION DATE
-
Month
-
Day
Year
Date
PRIMARY PHONE NUMBER:
Format: (000) 000-0000.
EMAIL:
example@example.com
Please Upload a copy of your ID/Drivers License and Social Security Card(s)
Browse Files
Drag and drop files here
Choose a file
Cancel
of
Dependent Information - Do not include yourself or your spouse Please list everyone who lived in your home and anyone living outside your home that you support
*
Rows
NAME: (First, Middle, Last) Print Exactly As Social Security Card Reads
Social Security No.
Date of Birth MM-DD-YY
Relationship
Full Time Student
Totally Disabled
Months lived with you
1
2
3
4
Section 3: Dependents
List all children or other dependents
Please upload a copy of the dependent(s) social security cards.
Browse Files
Drag and drop files here
Choose a file
Please take clear pictures
Cancel
of
Back
Next
Please upload all tax documents needed to prepare your tax return (for example, W-2s, 1099s, 1098-T, 1095-A, including any required photo IDs and Social Security cards).
Browse Files
Drag and drop files here
Choose a file
Cancel
of
Section 4: Tax Client Questionnaire
Do not include yourself or your spouse. Please list everyone who lived in your home living outside your home that you support.
Can another taxpayer claim you as a dependent on their tax return?
*
☐ Yes
☐ No
Do you have an IRS IP PIN?
*
☐ Yes
☐ No
Did you withdraw any money from a retirement plan or 401(k)?
*
☐ Yes
☐ No
Did you, your spouse, or any dependents attend college in 2025?
*
☐ Yes
☐ No
Did you receive health insurance through the Marketplace?
*
☐ Yes
☐ No
Do you or your spouse owe debt to any government agency (IRS, student loans, child support, etc.)?
*
☐ Yes
☐ No
Have you ever been disallowed for the Earned Income Tax Credit (EITC)?
*
☐ Yes
☐ No
Did you or your spouse work overtime?
*
☐ Yes
☐ No
Did you or your spouse receive tip pay for 2025?
*
☐ Yes
☐ No
Did you or your spouse purchase a brand-new vehicle in 2025?
*
☐ Yes
☐ No
Is your home in the United States
*
☐ Yes
☐ No
Back
Next
Sworn Statement of Residency
Please fill out this form if you have dependents
Name of Parent(s) or Guardian(s):
First Name
Last Name
Name of Parent(s) or Guardian(s):
Dates the dependent(s) lived with you in Calendar Year 2025
Address that your dependent(s) lived at with you at in 2025 for more than 6 months
If you lived at more put the 2nd full address on street Address Line 2
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
List All Dependents That Lived With You From Your Tax Return:
DEPENDENT 1 NAME
First Name
Last Name
DEPENDENT 2 NAME
First Name
Last Name
DEPENDENT 3 NAME
First Name
Last Name
DEPENDENT 4 NAME
First Name
Last Name
I am certifying that the dependents listed above that I am claiming on my tax return have lived with me at the address above for more than 6 months in [__________] in the United States.
If I was audited by the IRS for EITC, Head of Household, or Child Tax Credit; I would be able to provide the document(s) below to prove residency of my dependents: Select all that apply
☐ School Records
☐ Medical Records
☐ Daycare Records
☐ Lease Agreement
Other
Direct Deposit / Refund Options
Please select how you would like to receive your 2025 tax refund. If you choose direct deposit, provide your banking information. If you prefer a paper check or prepaid card, select that option instead.
How would you like to receive your refund?
*
Direct Deposit (bank account)
Paper Check
IRS Prepaid Debit Card
Bank Name
*
Routing Number
*
Account Number
*
Account Type
*
Please Select
Checking
Savings
Authorization Section – E-File & Direct Deposit
By signing or checking the box below, you authorize [Your Business Name] to electronically file your 2025 federal and state tax returns. If you have chosen direct deposit, you also authorize your refund to be deposited into the bank account provided. You understand that you are responsible for the accuracy of all information submitted.
Checkbox
*
I authorize Gratitude Tax to prepare and electronically file my 2025 tax return(s) and, if applicable, to deposit my refund into the account provided above. I confirm that all information I have provided is accurate and complete.
I hereby affirm under penalty of perjury that the facts set forth in this statement are true:
*
Yes
Taxpayer Print Name
First Name
Last Name
Is there anything you’d like us to know when preparing your return?
Your Signature:
*
Date Signed
*
-
Month
-
Day
Year
Date
Submit
Should be Empty: