Clone of Crestview Financial Solutions Intake Form

Tax Preparation Client Intake Form
Today's Date*

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NewReturning
How did you hear about us?*
Give them a shoutout.

First NameLast Name
WELCOME TO HAVEN FINANCIAL SOLUTIONS.

So happy you're trusting us to do your taxes!
- YesNo
- YesNo
- YesNo
- Will this be your first time filing taxes?*
- SingleHead of HouseholdMarried Filing SeparateMarried Filing JointQualifying Widower
- Not sure your filing status? Choose your best guess. Your preparer will confirm.
- In order to file Head of Household, the IRS requires that you have a qualifying person and that you paid more than half the cost of keeping up your home for the year.
- YesNoNot sure
- YesNoNot sure
- 3) Who is the qualifying person that allows you to file Head of Household?*
  A qualifying person is someone who allows you to file Head of Household. This is usually your child who lived with you most of the year, or a parent you supported, even if they did not live with you.
- Please explain.
- YesNoNot sure
- YesNoNot sure
- 4) Name(s) of qualified person(s).
- 5) SSN of qualified person(s).
  If this person will be listed in the Dependent section, you do not need to enter their SSN here.
- The IRS does not require HOH documents to be submitted with your tax return. However, if needed, your preparer may request documents to support Head of Household eligibility before filing.
- Primary's Name*
  
  First NameMiddle NameLast NameSuffix
- Occupation*
- Date of Birth*
  
  MonthDayYear
  Date
- SSN*
- Phone Number*
  Please enter a valid phone number.
- Preferred Email*
  example@example.com
- Address*
  
  Street Address
  
  Street Address Line 2
  
  CityState
  
  Zip Code
- In what city/county did you live on December 31st?
- YesNo
- Please list states lived, starting with your current state.
- Unexpired ID/Driver's License
  
  Please upload a clear photo of your unexpired state- or federal-issued identification card.
  Cancelof
- YesNo
- YesNo
- YesNo
- YesNo
- YesNo
- If known, please briefly explain why you've been denied the Earned Income Tax Credit.
- Spouses Name
  
  First NameMiddle NameLast NameSuffix
- Occupation
- Date of Birth
  
  MonthDayYear
  Date
- SSN
- Phone Number
  Please enter a valid phone number.
- Email*
  example@example.com
- Address (skip if same as primary's address)
  
  Street Address
  
  Street Address Line 2
  
  CityState
  
  Zip Code
- In what city/county did your spouse live on December 31st?
  This is a question sometimes asked to complete a tax return.
- YesNo
- Please list states lived, starting with your current state.
- YesNo
- YesNo
- YesNo
- YesNo
- Dependent Name
- YesNo
- W-21099-MISC/NECInterest IncomeUnemployment (1099G)1099-DIVSelf EmploymentRetirement (1099-R)Social Security (SSA-1099)Rental IncomeOther
- W-2(s)
  
  Multiple files can be uploaded here. Please upload the ENTIRE pages showing ALL information. Please take CLEAR pictures.
  Cancelof
- Upload your file
  
  Please upload your file here.
  Cancelof
- 1099s (1099-MISC, 1099G, 1099-NEC, 1099-DIV, 1099-R)
  
  Multiple files can be uploaded here. Please upload the ENTIRE pages showing ALL information. Please take CLEAR pictures.
  Cancelof
- All Others
  
  Multiple files can be uploaded here. Please upload the ENTIRE pages showing ALL information. Please take CLEAR pictures.
  Cancelof
- If applicable, upload any receipts and/or mileages from rideshare/delivery incomes.
  
  Multiple files can be uploaded here. Please upload the ENTIRE pages showing ALL information. Please take CLEAR pictures.
  Cancelof
- Business Name
- Business Type
- EIN (if applicable)
- Business Address
  
  Street Address
  
  Street Address Line 2
  CityState / ProvincePostal / Zip Code
- YesNo
- CashAccrual
- AdvertisingSuppliesVehicle / MileageHome OfficeInsuranceProfessional FeesOther
- Upload Common Expenses Documents
  
  Multiple files can be uploaded here. Please upload the ENTIRE pages showing ALL information. Please take CLEAR pictures.
  Cancelof
- As being self-employed, how much did you earn this tax year?
- I understand that income must be reported even if not received on a 1099.I certify expenses claimed are ordinary, necessary, and supported by records.
- Charitable Contributions (such as tithes and Goodwill)Home Mortgage InsuranceHome Mortgage Interest (1098)Real Estate TaxesMedical ExpensesIRA ContributionsHSA (Health Savings Account)Other
- Upload Itemization Documents
  
  Multiple files can be uploaded here. Please upload the ENTIRE pages showing ALL information. Please take CLEAR pictures.
  Cancelof
- YesNo
- Upload cancelled debt forms here
  
  Multiple files can be uploaded here. Please upload the ENTIRE pages showing ALL information. Please take CLEAR pictures.
  Cancelof
- YesNo
- Upload Daycare Statement
  
  Please upload the form(s) provided by your daycare provider.
  Cancelof
- YesNo
- Federal IP PinState IP Pin
- YesNoI don't know what that is.
- Please upload Form 1095A
  
  If you have not received your form 1095A form, please go to healthcare.gov to retrieve the form. Your taxes cannot be submitted to the IRS without this form if you had Marketplace Insurance for any duration in the tax year.
  Cancelof
- YesNo
- Please Upload
  
  Please upload the ENTIRE page(s) of your IRS letter, if you have received any.
  Cancelof
- YesNo
- Upload 1098-T(s)
  
  Multiple files can be uploaded here. Please upload the ENTIRE pages showing full form(s). Please take CLEAR pictures.
  Cancelof
- YesNo
- Additional Notes for Your Preparer:
- Direct Deposit (your own account)
- Bank Institution
- Routing Number
- Account Number
- YesNo
- Do you or your spouse owe any debts that will offset your refund (meaning the debtor will collect the debt from your refund) such as IRS, Restitution, Student Loans, or Child Support?
- Please Explain
- Important: Some refunds can be reduced due to prior debts.
- YesNo
- YesNo
- Buying cryptocurrencySelling cryptocurrencyExchanging one cryptocurrency for anotherReceiving cryptocurrency as paymentReceiving staking, mining, or reward incomeReceiving cryptocurrency from and airdrop or fork
- Please Upload
  
  Multiple files can be uploaded here. Please upload the ENTIRE pages showing full form(s). Please take CLEAR pictures.
  Cancelof
- Taxpayer Signature*
  
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- Date Signed*
  
  MonthDayYear
  Date
- Spouse Signature*
  
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- Date Signed*
  
  MonthDayYear
  Date
- Edit (If Needed)
  
  Optional. Use this section later if your preparer requests additional documents or if you need to upload something you forgot.
  Cancelof
- Terms & Conditions
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Tax Preparation Client Intake Form

WELCOME TO HAVEN FINANCIAL SOLUTIONS.