Tax Preparation Client Intake Form
Welcome to Taxcellent Tax Service!! As a new and returning customer, we are requesting that you complete the client intake below. The information you provide will be encrypted on the software to protect your personal information.
Name of Tax Preparer
*
Tax Preparer Name
What tax year are you filing?
2024
2025
Amendent Return
2026
What is your filing status?
Single
Married Filing Separated (You are still married but have separated your finances)
Head Of Household (If your claiming dependents and not married)
Qualified Widower (Qualifing Surviving Spouse)
Married Filing Joint
Taxpayer Information
Name
First Name
Middle Name
Last Name
Suffix
Social Security Number
Date of Birth
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Email
example@example.com
Current Home Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Occupation
Did you receive a federal and state tax last year?
Yes
No
Recieved Federal
Recieved State
Didn't recieve a Federal Refund for 2024-owe a tax obligation
Didn't recieve a State Refund for 2024-owe a tax obligation
Are you a full-time student?
Yes
No
Are you totally and permanently disabled?
Yes
No
Can you be claimed as a dependent of another taxpayer?
Yes
No
Spouse Information
Name
First Name
Last Name
Suffix
Social Security
Date of Birth
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Email
example@example.com
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Occupation
Are they a full-time student?
Yes
No
Are they totally and permanently disabled?
Yes
No
Are they legally blind?
Yes
No
Is your spouse a dependent of another taypayer ?
Yes
No
Dependents
Enter your dependents here
Rows
Name
Date of Birth
Relationship to You
Social Security
How many months out the year did the dependent live with you (12)
1
2
3
4
5
6
Did you, your spouse, and your dependents have health insurance under the affordable care act in 2025 (Must Provide Form 1095A) within 12 the months last year? If you did not have an Affordable Care Acr insurance plan select NO.
Rows
Yes/No
Employer
Spouse Ins
Exchange/ Marketplace
Direct with Insurer
Medicare
Medicaid
Taxpayer
Yes
No
Spouse
Yes
No
Dependent 1
Yes
No
Dependent 2
Yes
No
Dependent 3
Yes
No
Dependent 4
Yes
No
Dependent 5
Yes
No
Tax Related Questions
What is your income status? (Check all that Apply)
Employed- W2
Unemployed
Self Employed/Contractor-1099 Misc form
Business Owner(S Corp, C Corp, Partnership)
Retired/Pension 1099R or Social Security
Gambling
Rental Income
Interest/Dividends
Does your dependents have tuition expenses?
Yes
No
Do you have any expenses for child care?
Yes
No
Do you currently own rental property?
Yes
No
What is the monthly rent collected?
Do you have your own home?
Yes
No
How long have you lived at the property?
# of months
Do you have real estate tax?
Yes
No
Do you have documents that show you paid for property taxes?
Yes
No
Did you take money from your 401K?
Yes
No
Did you sell any stock this year?
Yes
No
Do you have a mortgage interest statement?
Yes
No
Are you a victim of identity theft?
Yes
No
Do you have a IP pin number issued by IRS for 2025 filing year?
Yes
No
Are you interested in credit repair?
Yes
No
Additional comments
Acknowledgment & Signature
I confirmed that all information I entered here is accurate and true.
I allow Taxcellent Tax Service to capture my sensitive data like personal id, government id, and other information.
I have read the terms and conditions and privacy policy of Taxcellent Tax Service.
By signing below, you acknowledge that you have read and understood your responsibilities and our responsibilities in doing this tax return. You also acknowledge that you have answered all questions truthfully.
Date Signed
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Taxpayer Signature
Date Signed
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Spouse Signature
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Name
First Name
Last Name
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