Batten Financial Intake Form
!!ONLY COMPLETE THIS FORM IF YOU HAVE ALL YOUR TAX DOCUMENTS!!
Which Tax Expert Are You Looking For?
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Alicia Batten
Are you interested in a cash advance up to $7,000
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Yes
No
Name
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First Name
Last Name
Phone Number
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Who is your cell phone carrier? (see examples below)
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**AT&T, Verizon, T-Mobile, Etc**
Email
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Address
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Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Social Security Number?
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Date Of Birth
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Month
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Day
Year
What is your occupation?
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What is your filing status?
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Please Select
Single
Head of household
Married/Filing joint
Married/Filing single
Widow
Filing status is a category that defines the type of tax return form a taxpayer must use when filing their taxes. If you are Head of Household you must provide a lease or utility bill.
Please enter your spouses information below:
Only for Married/ Filing Joint or Married / Filing Single
Spouse Name
First Name
Last Name
What is your spouses date of birth?
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Month
-
Day
Year
What is your spouses Social Security Number?
Phone Number
Cell phone carrier?
AT&T, Verizon, T-Mobile, Etc
Email
What is your spouses occupation?
Do you or any dependents have an identity pin?
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Yes
No
If yes then what is it? and who do it belong to?
Select the type of income you received in 2024
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W2 / Wages Income
1099NEC / Contractor Income
1099k Self-Employment Income
1098T Filer (College Credit)
Cryptocurrency
1099G- Unemployment Income
Household Income (ex: Nanny/Home Health)
Interest Income (1099INT, 1099DIV)
Self-Employment Income
No Income
What was your income this year?
Did you receive any payments from a 3rd party companies?
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Please Select
YES
NO
Cash app, Zelle, PayPal etc.
Was your income less than $20,000?
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YES
NO
If yes, how were you able to financially manage?
Did you receive assistance from the state, received assistance from children's other parent, friends and family assisted, etc.
Were you or your dependent enrolled in college and received a 1098-T?
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Yes
No
Did you purchase marketplace (Obama Care) health insurance?
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Please Select
YES
NO
If so please have documentation ready
Did you collect social security retirement income?
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Please Select
YES
NO
If so please have documentation ready
Schedule C – Business Income & Expenses
Complete this section only if you are self-employed. Enter annual totals.
Did you have self-employment or 1099 income in 2025?
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Yes
No
Business Name (or your name if none)
Describe your business activity
Example: Uber driver, hairstylist, online sales
Business Start Date
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Month
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Day
Year
Date
Business Structure
Sole Proprietor
Single-Member LLC
Independent Contractor
Other
Total 1099 Income
Cash or Other Income (not reported on 1099s)
Upload 1099 Forms (if applicable)
Browse Files
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Choose a file
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Enter your total business expenses for the year
Amount ($)
Advertising
Car & Truck Expenses
Insurance
Office Expenses
Supplies
Repairs & Maintenance
Meals (Business Only)
Travel
Utilities
Phone & Internet
Software / Subscriptions
Rent / Lease
Legal & Professional Fees
Contract Labor
Other Expenses
Did you use a vehicle for business?
Yes
No
Business Miles:
Total Miles:
Personal Miles:
Vehicle Expenses Table
Amount $
Gas
Repairs
Insurance
Lease
I certify the income and expenses entered are accurate.
Yes
Signature
Date
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Month
-
Day
Year
Date
Do you plan on purchasing a home in the next 2 years?
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YES
NO
Do you owe any federal agency's?
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Please Select
YES
NO
To find out call 1-800-304-3107 ( child support, federal or state taxes, student loans, etc.)
How many people live with you?
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Did anyone help support you through the year? If so, please list how much.
In the case of audit can you prove financial responsibility and residency for any of the Dependents being claimed?
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YES
NO
Great! Now, do you have any dependents?
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Please Select
YES
NO
PSST! A dependent is someone who relies on another person for financial support, such as for housing, food, clothing, necessities, and more. Typically, this includes your children or other relatives, but it can also include people who aren’t directly related to you, such as a domestic partner.
Dependents Information (Enter All Dependents You Are Claiming)
Dependent Full Name
Social Security Number
Date of Birth
Relationship
Dependent 1
Dependent 2
Dependent 3
Dependent 4
Dependent 5
Can any of your dependents be claimed by anyone else?
YES
NO
Were you ever disallowed to the EITC prior to this year?
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YES
NO
Are any of the dependents being claimed disabled? Please list the nature of the disability. Does the dependent receive Social Security benefits? If so, what type?
Are any of the dependents listed on this return not your biological son or daughter? If yes, why are the parents not claiming the child?
(Please explain and list the child’s name(s) if more than one is listed on the return).
Did you pay facility (daycare or after school program) or someone to keep your child or children?
Please Select
YES
NO
13 & Under
If you paid an individual, let us know a little more information
Provider Name
Phone Number
Social Security Number
Amount Paid
How would you like to receive your refund?
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Please Select
Check
Debit Card
Direct Deposit
The IRS issues more than 9 out of 10 refunds in less than 21 days. However, it’s possible your tax return may require additional review and take longer. Mailed-in refunds usually take up to 6 weeks.
Type your bank details
Please re-type your bank details
Are you the owner of this bank account?
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Yes
No
Are you applying for the advance?
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YES
NO
Were You Referred? If So By Who?
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Upload ALL Tax Documents
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Browse Files
Drag and drop files here
Choose a file
Taxpayer (and spouse if applicable) : Unexpired Drivers License, State ID, Passport + Social or Birth Certificate. Filing Status Head of Household: Lease or Utility bill. Dependents: Birth Certificate + social security card. Income: W2, 1099, Quickbooks, 1098T, etc. Childcare: End of Year statement. Market Place insurance: 1095A. ETC
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Signature
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Submit
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