Noline's Tax Prep Intake Form

Noline's Tax Prep and Bookkeeping Client Intake Form
Today's Date*

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Client Status*

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First NameLast Name
WELCOME TO NOLINE'S TAX PREP and BOOKKEEPING

So happy you're trusting us to do your taxes!
Tax Year*

202520242023Other
Filing Status

SingleHead of HouseholdMarried Filing SeparateMarried Filing JointQualifying Surviving Spouse
- 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.
- 1) Were you unmarried or considered unmarried on December 31 of the tax year?*
  
  YesNoNot sure
- 2) Did you pay more than half the cost of keeping up your home for the year?*
  
  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.
- Did you pay more than half the cost of maintaining your parent’s home for the year? This applies whether your parent lived with you or lived elsewhere.
  
  YesNoNot sure
- Did the qualifying person(s) live with you for more than half the year?
  
  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.
- Primary's Name*
  
  First NameMiddle NameLast NameSuffix
- Occupation*
- Date of Birth*
  
  MonthDayYear
  Date
- SSN*
- Social Security Card
  
  Please upload a clear photo of your Social Security Card.
  Cancelof
- Phone Number*
  Please enter a valid phone number.
- Preferred Email
  example@example.com
- Address*
  
  Street Address
  
  Street Address Line 2
  
  CityState
  
  Zip Code
- Did you live in more than one state during the tax year?*
  
  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
- Are you totally and permanently disabled?*
  
  YesNo
- Are you legally blind?*
  
  YesNo
- Are you the dependent of other taxpayer?*
  
  YesNo
- Have you ever been denied the Earned Income Tax Credit (EITC)?*
  
  YesNo
- If known, please briefly explain why you've been denied the Earned Income Tax Credit.
- Do you have dependents to claim?*
  
  YesNo
- Name
  
  First NameMiddle NameLast NameSuffix
- Occupation
- Date of Birth
  
  MonthDayYear
  Date
- SSN
- Social Security Card
  
  Please upload a clear photo of your Social Security Card.
  Cancelof
- 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
- Did you live in more than one state during the tax year?
  
  YesNo
- Please list states lived, starting with your current state.
- Is your spouse totally and permanently disabled?
  
  YesNo
- Is your spouse legally blind?
  
  YesNo
- Is your spouse a dependent of other taxpayer?
  
  YesNo
- Has your spouse ever been denied the Earned Tax Credit (EITC)?
  
  YesNo
- Dependents' Social Security Card
  
  Multiple files can be uploaded here. Please upload the ENTIRE Social Security Card(s). Please take CLEAR pictures.
  Cancelof
- Did you receive any government assistance paying your rent or utilities for the tax year?*
  
  YesNo
- Have you waited on all income sources such as W2s, 1099s, Cash App Statements, Marketplace Forms, etc.?*
  
  YesNo
- Please select all forms of Income.*
  
  W-21099-MISC/NECInterest IncomeUnemployment (1099G)1099-DIVSelf EmploymentRetirement (1099-R)Other
- W-2(s)
  
  Multiple files can be uploaded here. Please upload the ENTIRE pages showing ALL information. Please take CLEAR pictures.
  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
- As a self-employed person, how much did you earn this tax year?
- Schedule C Due Diligence*
  
  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.
- Itemizing (Please Submit Any Documents)
  
  Charitable Contributions (such as tithes and Goodwill)Home Mortgage InsuranceHome Mortgage InterestReal Estate TaxesMedical ExpensesOther
- Upload Itemization Documents
  
  Multiple files can be uploaded here. Please upload the ENTIRE pages showing ALL information. Please take CLEAR pictures.
  Cancelof
- Were any cancelled debt forms received (such as 1099C, 1099A)?*
  
  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
- Do you have any expenses for child care?
  
  YesNo
- Upload Daycare Statement
  
  Please upload the form(s) provided by your daycare provider.
  Cancelof
- Were you issued an Identity Pin (IP Pin)?*
  
  YesNo
- Federal IP PinState IP Pin
- Did you or your dependent have health insurance through the Marketplace (ObamaCare)?*
  
  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
- Have you received any letters from the IRS last year?*
  
  YesNo
- Please Upload
  
  Please upload the ENTIRE page(s) of your IRS letter, if you have received any.
  Cancelof
- Are you, your spouse or dependent enrolled in school and have received Form 1098T? Or are you currently paying on a student loan and received a 1098 E?
  
  YesNo
- Upload 1098-T(s) and/ or 1098-E(s)
  
  Multiple files can be uploaded here. Please upload the ENTIRE pages showing full form(s). Please take CLEAR pictures.
  Cancelof
- Are you a victim of identity theft?*
  
  YesNo
- Additional Notes for Your Preparer:
- How would you like your refund disbursed?
  
  Direct Deposit (your own account)Not Expecting a Refund
- Bank Institution
- Routing Number
- Account Number
- In the event you or your spouse refund is offset for a debt you owed, held up for any reason, or not disbursed at the fault of your negligence, you are still responsible for your agreed prep fee which will be shared with you prior to eFiling your return. Payment options are available upon request. Do you understand and agree?*
  
  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
- ☐ I confirm that the information and documents I have provided in this intake form are accurate and complete to the best of my knowledge. I understand that Noline’s Tax Prep and Bookkeeping may request additional information if needed before preparing my tax return.
  Full Name
- Should be Empty:

Noline's Tax Prep and Bookkeeping Client Intake Form

WELCOME TO NOLINE'S TAX PREP and BOOKKEEPING