Client Intake Data Sheet Tax Year 2025
To ensure IRS compliance and accurate tax preparation, please answer all questions completely.
Filer's Name
*
First Name
Middle Name
Last Name
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Email
*
example@example.com
Date of Birth
*
-
Month
-
Day
Year
Date
Residential Address
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Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Spouse/Partner Name
First Name
Last Name
Tax Filing Status
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Single
Head of Household
Married Filing Jointly
Married Filing Separately
Qualifying Widower
Are filing for Dependents?
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Yes (Please list number of dependents below)
No
Number of Dependents
Name of Dependent 1
First Name
Middle Name
Last Name
Name of Dependent 2
First Name
Middle Name
Last Name
Name of Dependent 3
First Name
Middle Name
Last Name
Name of Dependent 4
First Name
Middle Name
Last Name
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Please choose the following income options that you received during 2025?
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Wages, salaries, tips
Self-employment Income
Rental Income
Interest and Dividends
Capital Gains
Retirement Distributions
Social Security Benefits
Unemployment Compensation
Other (Please specify below)
If you chose "OTHER" in the previous question, please specify the income below for 2025
Please choose any of the following if you have made any large financial transactions in 2025
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Gifts over $15,000
Large Cash Transactions over $10,000
Sale of Property or Business
Other (Please Specify Below)
None
If you have selected "OTHER" for previous question, please specify any large financial transactions below for 2025
Please select from the following if you will be claiming any of the deductions below
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Mortgage Interest
Charitable Contributions
Medical Expenses
State and Local Taxes
Retirement Contributions
Education Expenses
Business Expenses
Other (Please Specify Below)
None
If you have selected "OTHER" in the previous question, please specify the deductions you are claiming for 2025
Do you have any foreign financial accounts or assets?
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Yes (Please Specify Below)
No
If answered "YES" in the previous question, please specify the foreign accounts or assets below for 2025
Are you currently involved in any IRS audits or investigations?
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Yes (Please Specify Below)
No
If you have answered "YES" in the previous question, please provide the details of your IRS audit or investigation below
Have you previously filed taxes with us?
*
Yes
No
Would you be interested in applying for an Advancement?
*
Yes
No
CONSENT TO USE OF TAX RETURN INFORMATION For the purposes of this consent form, “we,” “us,” and “our” mean A Tax Koore Professional (Printed name of Tax Preparer) Federal law requires this consent form be provided to you (“you” refers to each taxpayer, if more than one). Unless authorized by law, we cannot use your tax return information for purposes other than the preparation and filing of your tax return without your consent. You are not required to complete this form to engage in our tax return preparation services. If we obtain your signature on this form by conditioning our tax preparation services on your consent, your consent will not be valid. Your consent is valid for the amount of time that you specify. If you do not specify the duration of your consent, your consent is valid for one year from the date of signature. If you do not consent, you may still have your tax return prepared and electronically filed by us for a fee. For your convenience, we have entered into an arrangement with third parties to provide qualifying taxpayers with the opportunity to apply for a Refund Advance Loan product from First Century Bank, N.A. To determine whether this Refund Advance Loan product may be available to you, we will need to use your tax return information in order to calculate the amount of your anticipated refund. If you would like us to use your tax return information to determine whether this Refund Advance Loan product may be available to you while we are preparing your return, please sign and date this consent to the use of your tax return information. By signing below, you authorize us to use the information you provide to us during the preparation of your 2025 tax return to determine whether to present you with the opportunity to apply for this Refund Advance Loan product.
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I consent
CONSENT TO DISCLOSE OF TAX RETURN INFORMATION For the purposes of this consent form, “we,” “us,” and “our” mean A Tax Koore Professional (Printed name of Tax Preparer) Federal law requires this consent form be provided to you (“you” refers to each taxpayer, if more than one). Unless authorized by law, we cannot disclose your tax return information to third parties for purposes other than the preparation and filing of your tax return without your consent. If you consent to the disclosure of your tax return information, Federal law may not protect your tax return information from further use or distribution. You are not required to complete this form to engage in our tax preparation services. If we obtain your signature on this form by conditioning our services on your consent, your consent will not be valid. If you agree to the disclosure of your tax return information, your consent is valid for the amount of time that you specify. If you do not specify the duration of your consent, your consent is valid for one year from the date of signature. You have indicated that you are interested in receiving a Refund Advance Loan product from First Century Bank, N.A. (“Bank”). In order to provide you with the opportunity to apply for this Refund Advance Loan product, we must disclose all of your 2025 tax return information necessary for evaluating the request to Bank or its service provider, Green Dot Corporation. If you request a more limited disclosure of tax return information, you will not be eligible to submit an application request for this Refund Advance Loan product. If you would like us to disclose your 2025 tax return information to Bank for this purpose, please sign and date your consent to the disclosure of your tax return information to Bank. By signing below, you authorize us to disclose to Bank all of your 2025 tax return information necessary for the evaluation and processing of your request for a Refund Advance Loan product. You understand that if you are unwilling to authorize the disclosure and sharing of your tax return information with Bank, you will not be able to obtain a Refund Advance Loan product from Bank, but you may still choose to have your tax return prepared and filed by us for a fee.
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I consent
INTAKE ACKNOWLEDGEMENT I or we acknowledge that the information submitted to A Tax Office INC. to prepare my or our tax return can be substantiated by receipts, canceled checks and other documentations. This information provided to A Tax Office Inc. is true, accurate and complete to the best of my or our knowledge. I or we also, understand that in the event of an audit, that I or we are responsible for gathering all necessary information for the audit. I or we also, understand that I or we may request the assistance of A Tax Office INC in helping to put such information together for the IRS or NC Department of Revenue. I or we also, understand, that as a taxpayer, I or we are responsible for my or our own tax return and that I or we can’t hold A Tax Office Inc. harmless for any misrepresentation of information. I or we may have provided to the preparer. I/we have received and read this statement of the company’s private policy and understand that I/we tax return information is kept confidential between A Tax Office Inc. and my or we and that I must submit written authorization to A Tax Office Inc. before any copy or fax of my return(s) information will be released to any outside party. (Example: mortgage company, financial institutions, educational institutions, etc.) *PRIVACY ACT: We reserve the right to use your contact information to email, text, call or mail you with advertising or promotional materials.
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I acknowledge
SIGNATURE ACKNOWLEDGEMENT
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By checking this box and typing my full legal name below, I acknowledge and agree that this action constitutes my electronic signature and that I intend to be legally bound by this agreement.
PRINT FULL NAME
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TODAY'S DATE
*
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Month
-
Day
Year
Date
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