Tax Preparation Intake Form

Tax Preparation Intake Form

Please provide your personal and financial information to assist with your tax return.
Date

MonthDayYear
Date
UCT MinutesAM/PM Option
Basic Information
Full Name

First NameMiddle InitialLast NameSuffix
DOB

MonthDayYear
Date of Birth
SSN
Please enter your full Social Security Number.
Employment Status
Occupation
Are you a Veteran?
Did you file a Tax Return previous year?
Current Mailing Address

Street Address

Street Address Line 2
CityStateZip Code
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Email Address
example@example.com
Domestic Information
Marital Status

Other
Filing Status
Can you be claimed as a Dependent by anyone?
Do you have any dependents?
How many dependents do you have? (Select only one option)
Dependent 1 Full Name

First NameMiddle NameLast NameSr, Jr, etc.
DOB #1

MonthDayYear
Please enter your full Date of Birth.
SSN #1
Please enter your full Social Security Number.
Relation #1
Dependent 2 Full Name

First NameMiddle NameLast NameSr, Jr, etc.
DOB #2

MonthDayYear
Please enter your full Date of Birth.
SSN #2
Please enter your full Social Security Number.
Relation #2
Dependent 3 Full Name

First NameMiddle NameLast NameSr, Jr, etc.
DOB #3

MonthDayYear
Please enter your full Date of Birth.
SSN #3
Please enter your full Social Security Number.
Relation #3
Dependent 4 Full Name

First NameMiddle NameLast NameSr, Jr, etc.
DOB #4

MonthDayYear
Please enter your full Date of Birth.
SSN #4
Please enter your full Social Security Number.
Relation #4
Dependent 5 Full Name

First NameMiddle NameLast NameSr, Jr, etc.
DOB #5

MonthDayYear
Please enter your full Date of Birth.
SSN #5
Please enter your full Social Security Number.
Relation #5
Account Information

This information is required to understand how your finances will be handled.
If a Refund is due, how would you like to receive your Refund?
If a Balance is due/owed to the IRS, how would you like to pay?

Income
Did you receive money from any of the following? (select all that apply)

Other
Were you a student previous year?
Were you legally blind at the end of last year?
Were you permanently disabled at the end of last year?
Have you ever been issued an IP PIN (Identity Protection PIN) by the IRS?
Expenses
Life Events
Did you pay any of the following expenses?
Did any of the following occur in the previous year?
Please list any questions or concerns you have regarding your tax return.
Signature
Should be Empty:

Rows	Bank Information
Bank Name
Account Number
Routing Number

Tax Preparation Intake Form

Basic Information

Domestic Information

Account Information

Income

Expenses

Life Events