Empire Tax Solutions

Empire Tax Solutions

Secure Intake for Tax Preparation (Tax Year 2025)
PERSONAL INFORMATION

All fields required unless otherwise noted.
First Name*
Last Name*
Date of Birth (MM/DD/YYYY)*

MonthDayYear
Date
Phone Number*
Please enter a valid phone number.
Email Address*
example@example.com
Current Address*

Street Address

Street Address Line 2
CityState / ProvincePostal / Zip Code
FILING STATUS
Filing Status*

SingleHead of HouseholdMarried Filing JointlyMarried Filing Separately
CITIZENSHIP & EMPLOYMENT
Citizenship Status*
Occupation*
SPOUSE INFORMATION

Complete if Filing Status is Married Filing Jointly or Married Filing Separately.
Spouse First Name
Spouse Last Name
Spouse Date of Birth (MM/DD/YYYY)

MonthDayYear
Date
Spouse Phone
Please enter a valid phone number.
Spouse Email
example@example.com
Spouse Address

Street Address

Street Address Line 2
CityState / ProvincePostal / Zip Code
Spouse Occupation
Spouse Citizenship Status
ADDITIONAL TAX QUESTIONS
Did you buy or refinance a home in 2025?*

Yes – BoughtYes – RefinancedNo
Did you purchase a vehicle in 2025?*

Yes – NewYes – UsedNo
Did you buy, sell, trade, or hold crypto/digital assets in 2025?*

YesNo
Did you or your spouse earn overtime pay (OT) in 2025?*

Yes – BothYes – Just meYes – Just spouseNo
Did you or your spouse receive tips in 2025?*

Yes – BothYes – Just meYes – Just spouseNo
Are you claiming dependents?*

YesNo
Did you file a federal tax return for 2024?*

YesNo
Did you receive unemployment in 2025?*

YesNo
Did you take money out of a retirement account in 2025?*

YesNo
Did you purchase health insurance through the Marketplace in 2025?*

YesNo
DOCUMENT UPLOADS (SECURE)

Upload required documents. Files are encrypted and accessible only by Empire Tax Solutions staff.
Upload picture of Drivers License, State ID, or Passport (include spouse if applicable)*

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ALL Tax Documents (PDF, JPG, PNG) *

(W-2, 1099-NEC, 1099-INT, 1099-DIV, 1099-R, 1099-G, 1099-K, SSA-1099, 1095-A, etc.) Include spouse documents if filing jointly.
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Dependents’ Social Security Cards (PDF, JPG, PNG)

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SSN Card or Work Authorization (PDF, JPG, PNG)

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PAYMENT SECURITY QUESTION (EPS)
Security Question*
Security Answer (case-sensitive)*
REFERRAL & COMMENTS
Referral Name
Additional Comments
CLIENT AGREEMENT & SIGNATURE
I certify that the information provided is true and accurate. I authorize Empire Tax Solutions to collect and use my personal and sensitive information solely for tax preparation purposes.
Client Signature*

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Date Signed*

MonthDayYear
Date
Spouse Signature

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Spouse Date Signed

MonthDayYear
Date
Should be Empty:

PERSONAL INFORMATION

FILING STATUS

CITIZENSHIP & EMPLOYMENT

SPOUSE INFORMATION

ADDITIONAL TAX QUESTIONS

DOCUMENT UPLOADS (SECURE)

PAYMENT SECURITY QUESTION (EPS)

REFERRAL & COMMENTS

CLIENT AGREEMENT & SIGNATURE