Which tax pro are you filing with?
Please Select
Shaterrica Butler
Broderick Jackson
Shari Dupree
Angel Hymes
Lakeya Bowie
Samantha Wilson
Tax Preparation Client Intake Form
I am here to:
File my taxes with Empire Financial Solutions
Filing Status:
*
Single
Head of Household
Married Filing Separately
Married Filing Jointly
Widower
TAXPAYER INFORMATION
Full name listed on social:
*
Date of birth:
*
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Month
-
Day
Year
Date
Social Numb.
*
Phone Number
*
Email
*
example@example.com
Home address (Full address + city, state, zip):
*
Occupation:
Are you a full-time student? (if yes, upload 1098-T)
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DEPENDENTS
Please list all dependents - NAME, SSN, BIRTHDAY, RELATIONSHIP (if none, type n/a)
*
TAX RELATED QUESTIONS
Do you owe any previous debts? (IRS debt, child support, alimony, etc.)
*
Yes (if yes, select other and explain)
No
Other
Are you a full-time student? (if yes, upload 1098-T)
yes
no
Did you receive a tax refund last year?
*
Yes
No
Were you audited?
Yes
No
Are you self employed? If yes, please list what type of self employment do you do?
Explain Self-employment:
Did you receive Marketplace Insurance?
*
Yes
No
I'm not sure
Do you have any expenses for child care? Please upload docs to 3188017701.
yes
no
Please list you IP PIN # (IF you have had to use it in previous years, you will need it! Each year you are issued a NEW IP PIN! You will need to obtain it before submitting your return. No loans will be processed without IP PINS)
*
Yes, I have an IP PIN
Yes, I have an IP PIN, but I need help locating it
No IP PIN
Other documents (anything extra) if documents do not load, send them to empirefinancialsolns@gmail.com or 3188017701:
ACKNOWLEDGMENT & SIGNATURE
Bank name (for payment):
Routing Number:
Account Number:
Re-enter Account Number:
I agree to send all documents to 3188017701 or email them to empirefinancialsolns@gmail.com
I agree, I am sending documents immediately following this application.
Terms & Conditions:I confirm that all information I entered here is accurate and true.I allow Shae at Empire Financial Solutions LLC. to capture my sensitive data like personal id, government id, social security number (SSN), and other information. EFS has permission to file my tax return. I have read the terms and conditions and privacy of Empire Financial Solutions.By signing below, you acknowledge that you have read and understood your responsibilities and our responsibilities in completing this tax return.
*
I accept the Terms & Conditions.
Today's Date:
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Month
-
Day
Year
Date
Signature
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