REBORN TAX 2025!

Client Intake form

Upload your info below you will be contacted in the order you receive it!
Tax Payers Name

First Last Name
Email
example@example.com
Job Title
Social Security Number
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Date of Birth

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
EIN Number
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
What tax years are you requesting to file?
What is your filing status?
If you are Head of Household, how can you prove your Head of Household Status?
How did you hear about us

Other
Are you self employed?
Name of the person who referred you! Enter their name and phone number if applicable
Who is your tax preparer?
Are you planning to buy a new home in the next 2 years?
Year of vehicle
Make of vehicle
Model of vehicle
Cost of vehicle
Was there business mileage during 2025? If so enter in box.
Do you own or lease a vehicle? If client does not own or lease a vehicle type N/A in boxes above.
Complete this section for spouse if you are married

If not you are unmarried you can skip this section
Spouse's Name

First NameLast Name
Spouse's Email
example@example.com
Spouse's Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Spouse's Social Security Number
Spouse's DOB

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Spouse's job title
Spouse's EIN
Did you and your spouse live apart during the year?
What is your marital status as of December
Complete this section

Mandatory
Did you pay over half the expenses of maintaining your residence for the entire year?
Did you support a child or family member for more than 6 months out of the year?
Are you on any Government Assistance
Are you disabled?
Is your dependent(s) disabled?
Are you applying for the Cash Advance?
How many dependents are you claiming?
Dependent 1 Name

First NameLast Name
Dependent 1 Social Security Number
Dependent 1 DOB

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Relationship
Number of months lived with the tax payer?
Dependent 2 Name

First NameLast Name
Dependent 2 Social Security Number
Dependent 2 DOB

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Relationship
Number of months lived with the tax payer?
Dependent 3 Name

First NameLast Name
Where is the other parent?
Dependent 3 Social Security Number
Dependent 3 DOB

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Relationship
Number of months lived with the tax payer?
PLEASE LIST THE NAME DOB AND SSN OF ANY OTHER DEPENDENTS
If you are not the biological parents, where are the biological parents, and do they have income?
If you are not the biological parent, do you have custody or mandate custody?
PLEASE UPLOAD dependent(s) birth certificate and Social security card(s).

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Are there any dependents in daycare? If yes, please upload the form you received from your daycare provider.
Upload a copy of the daycare form

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Can someone else claim you as a dependent?
Can someone else claim your dependents on their tax return?
PLEASE LIST YOUR IP PIN AND IP PIN OF YOUR DEPENDENTS (if applicable)
Taxpayer's Social Security Card

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Taxpayer's Driver's License

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Taxpayer's W-2/ 1099'S IF YOU haven't RECEIVED ALL YOUR W-2 PLEASE WAIT UNTIL YOU HAVE RECEIVED ALL YOUR W-2s. I do not file with your last check stub.

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Taxpayer's self employed income profit loss statement. if you do not have one will help you add your income and expenses and sign your P&L statement and add it to your file

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Proof of Residency (Lease/Utility Bill)

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Last Year Tax Return if applicable

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Did you have health insurance in 2025
Upload a your 1095-A form

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Was your insurance through your employer?
Have you ever been denied the Earned Tax Credit (EITC)?
Were you or any of your dependents in college in 2025?
Did you trade any Virtual Currency?
Were you enrolled in a Trade School or 4 year University?
Do you have a 1098-T Form for either you or your dependents?
Were you enrolled full time or part-time?
Complete this section if you are self employed

Please upload all invoices & receipts
File Upload

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Please Click the link to fill out the form for your business Income & Expenses

https://1drv.ms/w/c/39ab1c5586ecb014/IQDjZpTLAlSPRoLOAdqVOu5JAeTCco8hCnL4dm9b1jBBHVs?e=KqPaZR
How Did you receive ALL of your income this year?
Do you have documentation for the expense you want to claim?
How would you like to receive your refund?
Bank Name
Routing number
Account number
Account type
Would you like an advance Loan
Upload a your 1098-T form

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Are you interested in AUDIT PROTECTION?
Did You Receive The ERC
CLIENT NON PAYMENT/OFFSET CLAUSE

REBORN Financial & Business Services, strives to assist all of our clients in their tax needs, however I understand that situations arise. If your refund is offset by the IRS, student loans, child support or your check is mailed, you are still obligated to pay our company the fees associated with filing your tax return. By signing this agreement you acknowledge that if payment is not made in full with in 30 days legal actions will be sought to resolve payment.
Signature
ADDITIONAL SERVICES

While I specialize in tax preparation, our offerings go far beyond that! Below, you’ll find a list of additional services we provide.If any of these services catch your interest, let us know, and we’ll be happy to schedule a time to discuss them further..
ADDITIONAL SERVICES
Any additional Questions you would like to ask?
Electronic Filing Permission Disclosure

I am giving REBORN Financial & Business Services permission to prepare all forms related to my tax return; to apply for and secure RAC's and RAL's on my behalf; and sign all necessary forms and file my taxes electronically. I take full responsibility for the accuracy of this form and understand that REBORN Financial & Business Services and/or associated affiliates hold no responsibility for any misrepresentation or false claims.
Signature
Name

First NameLast Name
Signing Date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Spouse's Signature
Spouse's Name

First NameLast Name
Signing Date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Should be Empty:

Client Intake form

Complete this section for spouse if you are married

Complete this section

Complete this section if you are self employed

CLIENT NON PAYMENT/OFFSET CLAUSE

ADDITIONAL SERVICES

Electronic Filing Permission Disclosure