Tax Intake Form

Name

First NameMiddle NameLast Name

Date of Birth

Date

Social Security Number or ITIN

Occupation

Email

example@example.com

Phone Number

Please enter a valid phone number.Format: (000) 000-0000.

Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Did you move during the tax year?

States Lived In, Worked In, or Had Income From During the Tax Year

U.S. Citizen or Resident for Tax Purposes?

Marital Status

Filing Status

Spouse Name

First NameMiddle NameLast Name

Spouse Date of Birth

Date

Spouse Social Security Number or ITIN

Spouse Occupation

Spouse Email

example@example.com

Spouse Phone Number

Please enter a valid phone number.Format: (000) 000-0000.

Do you have dependents or qualifying children?

Dependent

Which income sources apply

Which deductions or credits may apply?

Were you issues an IRS Identity Protection PIN (IP PIN)?

Enter your 6-digit IP PIN

Did you work a W-2 job during the tax year?

Upload all W-2s

Did you receive 1099 income or earn income from self-employment, freelance, contract, or gig work?

Upload all applicable 1099s

Did you have health insurance through the Marketplace?

Upload Form 1095-A

Did you pay mortgage interest?

Upload Form 1098

Did you pay student loan interest?

Upload Form 1098-E

Did you pay college tuition or other qualified education expenses?

Upload Form 1098-T or other applicable education documents

Did you have foreign income, foreign accounts, or foreign assets?

Upload foreign income, account, or asset documents.

Do you have any other tax documents, income records, deductions, or supporting documents?

Upload other tax documents or supporting documents

Upload Social Security Card or ITIN Documentation

Upload Driver’s License or Government-Issued ID – Front

Upload Driver’s License or Government-Issued ID – Back

Did you add a spouse to this tax return?

Spouse Social Security Card or ITIN Documentation

Spouse Driver’s License or Government-Issued ID – Front

Spouse Driver’s License or Government-Issued ID – Back

Did you add any dependents to this tax return?

Upload Social Security Card or ITIN Document for Each Dependent

Upload Prior-Year Federal and State Returns, If Available

How did you hear about Dayrise Tax?

Who referred you? (Please enter the name of the person who referred you)

Please specify how you heard about Dayrise Tax

I certify that the information provided is accurate and complete to the best of my knowledge, and I will review the prepared return before filing.

Taxpayer Signature

Date Signed

Date

Individual Tax Return Intake Form