2022- 2025 TAX PREP INTAKE FORM

TAX PREPARATION INTAKE FORM
YEAR OF TAX PREP *
NEW OR RETURNING CLIENT*

NEWRETURNINGUNSURE
FILING STATUS
Select Filing Status *
FILING STATUS WILL BE ULTIMATELY DETERMINED BY INFORMATION GIVEN AND TAX PREPARERS DISCRETION
Number of Dependents *
TAXPAYER

ENTER IN YOUR INFORMATION
Name*

First NameLast Name
Current Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
DATE OF BIRTH*

MonthDayYear
Date
Social Security Number *
Occupation*
Phone Number*
Please enter a valid phone number.
Email*
example@example.com
Upload Driver's License or State Id*

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TAXPAYER IP PIN (issued from IRS yearly)*
SPOUSE

YOUR SPOUSES INFORMATION, IF LEGALLY MARRIED OR PRESUMED MARRIED BY COMMON LAW STATUTE IN THE STATE YOU RESIDE IN
Name

First NameLast Name
Date Of Birth

MonthDayYear
Date
Social Security Number
Occupation
Phone Number
Please enter a valid phone number.
Email
example@example.com
Spouse's Driver's License or State Id

Cancelof
SPOUSE IP PIN (issued from IRS yearly)

CHILDCARE INFORMATION
CHILDCARE PROVIDER 1 NAME
CHILDCARE PROVIDER 1 SSN OR EIN
AMOUNT PAID FOR CHILDCARE
WHICH CHILD(REN) RECIEVED CHILDCARE?
CHILDCARE PROVIDER ADDRESS

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
HIGHER EDUCATION

COLLEGE AND TUITION INFORMATION
UPLOAD SCHOOL TAX FORM(S) (1098-T)

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HAVE YOU CLAIMED THE AMERICAN OPPORTUNITY EDUCATION CREDIT IN THE PAST?

YESNOUNSURE
UPLOAD STUDENT LOAN INTEREST FORM (1098-E)

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ITEMIZED DEDUCTIONS
MEDICAL
OUT OF POCKET MEDICAL EXPENSES
TAXES PAID BY YOU
STATE AND LOCAL TAXES OR GENERAL SALES TAX PAID
STATE AND LOCAL REAL ESTATE TAX
STATE AND LOCAL PERSONAL PROPERTY TAXES
ANY OTHER STATE AND LOCAL TAXES PAID
INTEREST YOU PAID
HOME MORTGAGE INTEREST YOU PAID
UPLOAD YOU 1098-MORTGAGE STATEMENT

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GIFTS TO CHARITY
CHARITY 1 NAME AND AMOUNT DONATED
CHARITY 2 NAME AND AMOUNT DONATED
CHARITABLE CONTRIBUTION DOCUMENTS

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SOLAR POWER EXPENSES
ENERGY/ SOLAR POWER COST
UPLOAD PROOF/ DOCUMENTS FOR ENERGY/ SOLAR POWER COST

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UNEMPLOYMENT
DID YOU RECIEVE ANY UNEMPLOYMENT OR PAY ANY UNEMPLOYMENT OVERPAYMENTS BACK?

YESNOUNSURE
UPLOAD ANY UNEMPLOYMENT DOCUMENTS RECIEVED

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MISC.
Who Referred you? (Get $50 off Prep Fee)
How would you like to receive your refund?*

Paper Check Printed in OfficeDirect Deposit into my accountPRE-PAID Debit Card
Upload Social Security Cards for everyone on the return

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BANK NAME
ROUTING NUMBER
REFUND DISBURSEMENT
ACCOUNT NUMBER
Would you like to apply for the REFUND Advance? (January 2 -March 13, 2026)

YESNO
By signing below, I authorize Dynasty Consulting and/or its affiliates to prepare all federal, state, and local tax forms related to my tax return using professional tax preparation software. I authorize the use of approved IRS electronic filing methods, including the Self-Select PIN or Practitioner PIN method, to electronically sign and file my tax return on my behalf.

I understand and agree that I am solely responsible for the accuracy and completeness of all information, documents, and statements I provide for the preparation of my tax return. This includes income, deductions, credits, dependents, filing status, and any other tax-related information.

I acknowledge that Dynasty Consulting and/or its affiliates are not responsible for any misrepresentation, omission, or false claims resulting from information I provide, whether intentional or unintentional.

I further understand that tax preparation fees are earned upon completion of services and are not contingent upon the receipt of a refund. If my refund is reduced, delayed, offset, or withheld for any reason (including but not limited to IRS or state offsets, prior debts, child support, student loans, or other obligations), I remain fully responsible for payment of all agreed-upon tax preparation fees.

By signing below, I confirm that I have reviewed my information, understand this authorization, and agree to these terms.
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TAX PREPARATION INTAKE FORM

FILING STATUS

TAXPAYER

SPOUSE

DEPENDENTS

CREDITS

CHILDCARE INFORMATION

HIGHER EDUCATION

ITEMIZED DEDUCTIONS

MEDICAL

TAXES PAID BY YOU

INTEREST YOU PAID

GIFTS TO CHARITY

SOLAR POWER EXPENSES

UNEMPLOYMENT

INCOME AND WAGES

Upload Additional Documents

MISC.

REFUND DISBURSEMENT