TAX PREPARER INTAKE FORM
This Tax Preparer Intake Form ("Form") is designed to gather necessary information to ensure the accurate and timely preparation of your tax return. Please complete the form in full. If you have any questions, feel free to reach out to your tax preparer for assistance.
Personal Information
1. Full Name:
2. Social Security Number:
3. Date of Birth:
-
Month
-
Day
Year
Date
4. Phone Number:
Format: (000) 000-0000.
5. Email Address:
example@example.com
6. Home Address:
Marital Status
7. Marital Status (Check one):
Single
Married
Divorced
Widowed
8. Spouse's Name (if applicable):
9. Spouse's Social Security Number (if applicable):
10. Do you and your spouse want to file jointly?
Yes
No
Dependents
11. Do you have any dependents?
Yes
No
If yes, please list the following information for each dependent:
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Dependent 1:
Name:
Relationship to You:
Date of Birth:
-
Month
-
Day
Year
Date
Social Security Number:
Dependent 2:
Name:
Relationship to You:
Date of Birth:
-
Month
-
Day
Year
Date
Social Security Number:
(Attach additional sheets if you have more dependents)
Income Information
Please provide the following details regarding your income for the tax year:
12. Employment Income (W-2):
Yes
No
If yes, please provide your W-2 forms for all jobs.
13. Self-Employment Income (1099):
Yes
No
If yes, please provide 1099 forms or a summary of self-employment income.
14. Rental Income:
Yes
No
If yes, please provide details of rental property income and expenses.
15. Investment Income (Dividends, Interest, Capital Gains):
Yes
No
If yes, please provide 1099 forms and details of any investments.
16. Other Sources of Income:
Yes
No
If yes, please describe the source and amount (e.g., alimony, child support, gambling winnings, etc.).
Deductions and Credits
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17. Do you itemize deductions?
Yes
No
If yes, please provide the following:
Mortgage interest (Form 1098):
Yes
No
Charitable contributions:
Yes
No
Medical expenses:
Yes
No
State and local taxes:
Yes
No
18. Do you have any child tax credits or other credits?
Yes
No
If yes, please provide documentation.
19. Retirement Contributions (IRA, 401k, etc.):
Yes
No
If yes, please provide details of contributions.
Other Tax Considerations
20. Did you sell any property during the tax year?
Yes
No
If yes, please provide details, including sale price, cost basis, and related expenses.
21. Did you receive any unemployment compensation?
Yes
No
If yes, please provide the unemployment compensation statement (Form 1099-G).
22. Did you receive any form of government assistance?
Yes
No
If yes, please provide the details (e.g., stimulus payments, EITC, etc.).
23. Did you incur any moving expenses for a job relocation?
Yes
No
If yes, please provide details and receipts.
Tax Payments and Withholdings
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24. Have you made estimated tax payments?
Yes
No
If yes, please provide records of estimated payments made during the year.
25. Have you had taxes withheld from your income?
Yes
No
If yes, please provide your W-2, 1099 forms, or any other documents indicating withheld taxes.
Other Information
26. Are you planning to file jointly with your spouse, or separately?
Jointly
Separately
27. Do you have any pending audits, adjustments, or other unresolved tax matters?
Yes
No
If yes, please provide additional details.
28. Any additional information you would like to provide?
Acknowledgement and Signature
By signing below, I acknowledge that the information provided above is accurate to the best of my knowledge and that I have disclosed all relevant income, deductions, and credits necessary for the preparation of my tax return.
I understand that the tax preparer will rely on this information for the completion of my tax filings, and I am responsible for providing accurate, complete, and truthful information.
Client Signature:
Date:
-
Month
-
Day
Year
Date
Tax Preparer Signature:
Date:
-
Month
-
Day
Year
Date
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