Client Intake Form for Tax Preparation

Client Intake Form for Tax Preparation

This information is required in order to file your taxes. Any incorrect or skipped information will delay things. Please be as detailed as possible to better assist. Everything is kept confidential.
Your Full Name*

PrefixFirst NameMiddle NameLast NameSuffix
Job Title
Ex. Mechanic
Are you a US Citizen?

YesNo
Social Security Number or Tax ID
111-22-3456
Your Date of Birth ( In this Format MM/DD/YEAR) ex. 11/22/1991 *

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

Street Address

Street Address Line 2
CityState / ProvincePostal / Zip Code
Previous Address (If Any)*

Street Address

Street Address Line 2
CityState / ProvincePostal / Zip Code
Check the Box if Yes or Leave Blank if No ( For you or your spouse)

Can anyone claim you or your spouse as a dependent?Have you your spouse or dependents been victims of identity theft or been issued ID protection pins
Check the box if YES leave it blank if NO (If any of these apply to YOU)

Permanently DisabledFull-Time StudentLegally BlindVictim of Identity Theft or Issued a Protection Pin
Check the box if YES leave it blank if NO (If Any of these apply to your Spouse)

Permanently DisabledFull-Time StudentLegally BlindVictim of Identity Theft or Issued a Protection Pin
What is your marital/filing status?*

Single or Never Married (This includes registered domestic partnerships civil unions or other formal relationships under state law)Married Filing JointlyMarried Filing SeparatelyLegally SeparatedHead of HouseholdQualifying Widow(er)
Date of Final Decree (If Divorced)

MonthDayYear
Date
Date of Separate Maintenance Decree (If Separated Legally)

MonthDayYear
Date
Date of Spouse's Death (If Widowed)

MonthDayYear
Date
Spouse Full Name

PrefixFirst NameMiddle NameLast NameSuffix
Spouse Date of Birth ( In this Format MM/DD/YEAR ex. 11/22/1991)

MonthDayYear
Date
Spouse Social Security Number or Tax ID
111-22-3456
Spouse Job Title
Ex. Doctor
Do you have any dependents to claim?*

YesNo
List the names, birthdays, relationship, months with you in your home, marital status, student status, and disabled status of anyone who lived with you last year (Other than your spouse) ex. Carlos Santos, 03/10/1991, Son, 12 months, Single, No, No
Lived with you* (Be sure to Upload Birth Certificate or proof at the end such as school records, medical bills, etc.)
List the names, birthdays, relationship, months with you in your home, marital status, student status, and disabled status of anyone who you supported (But did not live with you) ex. Carlos Santos, 03/10/1991, Son, 12 months, Single, No, No
Did not live with you*
Have you filed taxes in previous years?*

YesNo
If yes, what was your filing status last year?
What years have you previously filed taxes?
Who prepared your taxes last year?
Do you need previous year returns completed?

YesNoI'm not sure
Please select your sources of income for this tax year:*

Wages/Salary (W-2)Tip IncomeOvertime Pay(On your W-2 box 14 or Last Paystub)Self-Employment/Business Income (Forms 1099-MISC 1099-NEC 1099-K cash digital assets or other property or services)Interest/Dividends from: checking/savings accounts bonds CDs brokerage? (Forms 1099-INT 1099-DIV)Retirement income or payments from pensions annuities and or IRA? (Form 1099-R)Unemployment Benefits (1099-G)Social Security Benefits Railroad Retirement Benefits? (Forms SSA-1099 RRB-1099)Rental Income (or loss) from rental property?Capital Gains Income (or loss) from the sale or exchange of stocks bonds digital assets or real estate? (including your home) (Forms 1099-S 1099-B)Scholarships? (Forms 1098-T)Other income? (gambling lottery prizes awards jury duty digital assets Sch K-1 royalties foreign income etc.)Cash/check/digital assets or other property or services for any work performed not reported on Forms W-2 or 1099?Alimony income or separate maintenance payments?Refund of state/local income taxes? (Form 1099-G)NoneOther
How many Jobs did you have?
Please provide details of your income if possible (amounts, employers, etc.):
Please select your sources of Expenses for this tax year:*

Alimony or separate maintenance payments?Contributions or repayments to a retirement account?Medical & Dental (including insurance premiums)Mortgage Interest (Form 1098)Taxes (State Real Estate Personal Property Sales)Charitable ContributionsChild or dependent care expenses such as daycare?For supplies used as an eligible educator such as a teacher teacher’s aide counselor etc.?Expenses related to self-employment income or any other income you received?Student loan interest? (Form 1098-E)NoneOther
If you paid Alimony or Separate Maintenance Do you Have Recipient's SSN?

YesNo
Which deductions or credits do you plan to claim?*

Standard DeductionItemized DeductionsCharitable ContributionsMortgage InterestMedical ExpensesEducation CreditsChild Tax CreditEarned Income CreditNoneOther
Please provide details about your deductions and credits:
LIFE EVENTS - Check the Box if YES or leave it blank if NO or Unsure (In the Tax Year did YOU or your SPOUSE)

Have a Health Savings Account? (Forms 5498-SA 1099-SA W-2 with code W in box 12)Have credit card student loan or mortgage debt cancelled/forgiven by a lender or have a home foreclosure? (Forms 1099-C 1099-A)Adopt a child?Have Earned Income CreditChild Tax Credit or American Opportunity Credit disallowed in a prior year? Purchase and install energy-efficient home items? (such as windows furnace insulation etc.)Receive the First Time Homebuyers Credit in 2008?Make estimated tax payments or apply last year’s refund to this year’s tax?File a federal return last year containing a “capital loss carryover” on Form 1040 Schedule D?Have health coverage through the Marketplace (Exchange)? [Provide Form 1095-A]
If tax Credit Disallowed? What Year? Ex. 2020
If made estimated tax payments, how much?
Check the Box if YES or leave it Blank if NO (If you are due a refund would you like)

Direct DepositTo Purchase Savings BondsTo split your Refund between different accounts
Check the Box if YES or leave it Blank if NO (If have a balance due would you like)

Make a Payment directly out of your bank account
Check the Box if YES or leave it Blank if NO

Did you live in an area that was declared a Federal Disaster Area?Did you or your spouse receive a letter from the IRSWould you like information on how to vote and/or register to vote?
Necessary Documents File Upload (IDs, BIRTH CERTS, SSN Cards, ITIN Letters, Tax Documents)

Cancelof
Do you have any additional financial information or questions to share with your preparer?
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