Clone of Taxes Served Client Sheet

Client Information
Client Type:
How did you hear about us (Referral)?:
Prefix
Prefix
First Name
First Name
Last Name
Last Name
Suffix
Suffix
Email Address:
Email

Resident Address
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number
Format: (000) 000-0000.
DOB

MonthDayYear
Date
What is your current occupation?
Are You A Non-Resident?

Martial Status
Marital Status:
First Name (Spouse)
Last Name (Spouse)
Email (Spouse)
DOB (Spouse)

MonthDayYear
Date
Spouse occupation:
Is Your Spouse A Non-Resident?

Dependent Care Expenses
Do you have dependent care expenses?
Name of daycare/care provider:
Address of Daycare/ Care provider

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Identification Number of Daycare/ Care provider (EIN):
Total Amount Paid in Daycare Expenses:

Rental Property
Do you own a rental property?
Rental Addresses:
Number of Days Rented:
# Total Miles Driven for Rental Work:
Type of Rental
Total Rental Income $:
Total Rental Expenses $:
Please upload your Rental Income and Expenses Excel Sheet (if applicable)

Cancelof

Deduction and Credits
Medical Insurance Premiums (paid by you) $:
$ ####
Prescriptions $:
$ ####
Doctors / Dentists / Hospitals $:
$ ####
Medical Miles (# of miles) $:
$ ####
Total Property Tax Paid $:
$ ####
Total Gambling Losses (to extent of winning) $:
$ ####

Signature and Terms
Signature
Should be Empty: