Tax Intake Form

Tax Intake Form
Primary Taxpayer Information

Enter your personal details as they appear on official documents.
Full Name*

First NameLast Name
Date of Birth*

MonthDayYear
Date
Social Security Number*
Phone Number*
Please enter a valid phone number.Format: (000) 000-0000.
Email Address*
example@example.com
Address*

Street Address

Street Address Line 2
CityState / ProvincePostal / Zip Code
How many w2/1099 do you have? *
Preparer's name is fine
How many dependents are you claiming?*
Preparer's name is fine
Who referred you? *
Preparer's name is fine
Occupation*
Preparer's name is fine
SingleMarried Filing JointlyMarried Filing SeparatelyHead of HouseholdQualifying Widow(er)Other
Spouse Information (if applicable)

Complete this section if you are married and filing jointly or separately.
Spouse Full Name

First NameLast Name
Spouse Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Spouse Date of Birth

MonthDayYear
Date
Spouse Social Security Number
Spouse Email Address
example@example.com
Spouse Occupation
Household and Dependent Information

List all dependents who lived with you during the tax year.
Dependents*
If you are a single parent, Where's the other parents of your child/children?
YesNo
Income Information

Check all sources of income you (and your spouse) received during the tax year.
YesNo
W-2 (Wages)1099-INT (Interest)1099-DIV (Dividends)1099-MISC/NEC (Self-Employment)1099-G (Unemployment)1099-R (Retirement)SSA-1099 (Social Security)Other
AlimonyUnemployment CompensationGambling/Lottery WinningsOther
YesNo
YesNo
YesNo
YesNo
YesNo
Due Diligence Questions
YesNo
School recordsMedical recordsBank StatementsYearly Recipt
YesNo
YesNo
Document Uploads

Upload all relevant tax documents (W-2s, 1099s, prior year returns, etc.).
All ID, Birth certificates & Social cards*

Cancelof
Upload Tax Documents*

Ip pin, overtime, day care
Cancelof
Dependent Info*

N/A if NO dependent
Cancelof
Business Documents

Cancelof
Additional Comments or Information for GRAHAMITH TAX LAB ?
Consent and Signature

Please read and sign to authorize tax preparation.
Signature*
Direct DepositPre-Paid Debit CardI have a Tax Obligation and will not be receiving a refundPaper check printed in the office
YesNo
YesNo
Bank Name
Is this a Checking or Savings account?
Routing Number
Account Number
Confirm Account Number
Should be Empty:

Tax Intake Form

Primary Taxpayer Information

Spouse Information (if applicable)

Household and Dependent Information

Income Information

Due Diligence Questions

Document Uploads

Consent and Signature