Intake Sheet
YOUR PERSONAL INFORMATION
Social Security Number
# of W-2s
# of 1099s
Name
First Name
Middle Initial
Last Name
Date of Birth (MM/DD/YYYY)
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Job Title
Phone Number with Area Code
Format: (000) 000-0000.
Cellphone Number
TXT OK?
Mailing Address, City, State & ZIP Code
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
EMAIL
example@example.com
This past year were you: a full-time student?
Yes
No
getting Unemployment?
Yes
No
paying dependent care expenses?
Yes
No
United States citizen?
Yes
No
Can anyone else claim you on their tax return?
Yes
No
Unsure
Additional Notes/Comments:
MARITAL STATUS/HOUSEHOLD INFORMATION as of 12/31/2025
Single
This includes registered domestic partnerships, civils unions, or other formal relationships under state law.
Divorced Date of final decree: / /
Legally Separated
Date of separate maintenance agreement:
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Widowed Year of spouse's death:
Married
Yes
Did you live with your spouse during any part of the last six months of 2025?
Yes
SPOUSE'S PERSONAL INFORMATION
# of W-2s
# of 1099s
Social Security Number
Name
First Name
Middle Initial
Last Name
Date of Birth (MM/DD/YYYY)
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Job Title
Phone Number with Area Code
Format: (000) 000-0000.
Cellphone Number
TXT OK?
Mailing Address, City, State & ZIP Code
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Email
example@example.com
This past year was spouse: a full-time student?
Yes
No
getting Unemployment?
Yes
No
paying dependent care expenses?
Yes
No
United States citizen?
Yes
No
Can anyone else claim spouse on their tax return?
Yes
No
Unsure
Additional Notes/Comments:
DEPENDENTS: Other than your spouse, list the names of everyone you provided more than ½ total support. who lived with you last year.
Rows
Name As It Appears on Social Security Card
Date of Birth mm/dd/yyyy
Relationship (son, daughter, parent, etc.)
Months lived in your home in 2025
US Citizen
Resident of US in 2025
Single or Married as of 12/31/2025
Full Time Student
Totally & Permanently Disabled ? (IRS Pub 524)
1
2
3
4
I the undersigned hereby affirm that the information provided is true and correct.
Signature
Date
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Spouse's Signature
Date
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Please return this form along with all W2's, 1099's, Social Security Cards, photo ID, and other documentation to the preparer.
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