Tax Client Intake Form

Do you have dependents? *

Yes No

Dependent 1 Full Name

First Name Last Name

Dependent 1 DOB

Month Day Year

Dependent 1 Social Security Number

Dependent 1 Gender

Male Female

Dependent 1 Relationship to You

Dependent 1 Live with You for 12 Months?

Yes No

Dependent 2 Full Name

First Name Last Name

Dependent 2 DOB

Month Day Year

Dependent 2 Social Security Number

Dependent 2 Gender

Male Female Option 3

Dependent 2 Relationship to You

Dependent 2 Live with You for 12 Months?

Yes No

Dependent 3 Full Name

First Name Last Name

Dependent 3 DOB

Month Day Year

Dependent 3 Social Security Number

Dependent 3 Gender

Male Female Option 3

Dependent 3 Relationship to You

Dependent 3 Live with You for 12 Months?

Yes No

Dependent 4 Full Name

First Name Last Name

Dependent 4 DOB

Month Day Year

Dependent 4 Social Security Number

Dependent 4 Gender

Male Female Option 3

Dependent 4 Relationship to You

Dependent 4 Live with You for 12 Months?

Yes No

Dependent 5 Full Name

First Name Last Name

Dependent 5 DOB

Month Day Year

Dependent 5 Social Security Number

Dependent 5 Gender

Male Female Option 3

Dependent 5 Relationship to You

Dependent 5 Live with You for 12 Months?

Yes No

Dependent 6 Full Name

First Name Last Name

Dependent 6 DOB

Month Day Year

Dependent 6 Social Security Number

Dependent 6 Gender

Male Female Option 3

Dependent 6 Relationship to You

Dependent 6 Live with You for 12 Months?

Yes No

If the IRS ever audits you, what documents can you provide them to prove dependents resided with you? (Click All That Apply) *

School Records Medical Records Landlord or property statement Child care provider records Placement agency statement Social service records/statement Other I don't have any records

Does this apply to you?: (select one option below)

If someone has custody of their child, but wants to release the right to claim the child's exemption to the non-custodial parent, this is perfectly legal. This is typcially done if you don't file a return OR if you reach an agreement with your child's noncustodial parent. Does this apply to you?

Does this apply to you? *

#1: No, I have no dependents. #2: No, all my dependents lived with me for 12 months. #3: Even though 1 or more of my dependents did not live with me for the full 12 months, I DO NOT have a "Custodial Parent Release Claim" (Form 8336 or similar document). I need one. I would like advisement on this. #4: This DOES apply to me and I DO have a "Custodial Parent Release Claim" (Form 8336 or similar document) because 1 or more of my dependents did not live with me for the full 12 months.

Did you pay for child care? *

Yes No Not Applicable Not Sure

Total expenses paid for Child Care:

Child Care Provider Name

Child Care Provider SSN or EIN (you can skip & simply provide a print out)

Child Care Provider Phone Number

Area Code Phone Number

Child Care Provider Address

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code Country

COVID-Legislation May Increase Your Refund