Client_Data

Thank you for choosing ITA Tax Service to prepare your tax return. This is our 15th year and we are excited to make information gathering more convenient and accurate for our clients. Please complete the following client data form to ensure we have your current information on file.

If you are a new client, or we have not scanned your ID's into our system, please be prepared to provide a copy of social security cards of everyone listed on the tax return, as well as unexpired government photo id of you and your spouse.

If you have any questions, please contact us at 336-724-1111
Taxpayer Information
Filing Status
Taxpayer SSN#
Taxpayer Name

First NameMiddle NameLast NameSuffix
Taxpayer DOB

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Taxpayer Occupation
Can anyone claim you or your spouse as a dependent?
Taxpayer E-mail
Taxpayer Phone #

Area CodePhone Number
Self-Employed
Spouse Information
Spouse SSN#
Spouse Name

First NameMiddle NameLast NameSuffix
Spouse DOB

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Spouse Occupation
Spouse E-mail
example@example.com
Spouse Phone #

Area CodePhone Number
Spouse Self-Employed
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Dependent Information
Are you filing any dependents on your tax return?
Dependent can be child, parent, or other relative
Child/Dependent 1

First NameMiddle NameLast Name

Rows	Yes	No	Unsure
Wages or Salary? (Form W-2)?
Self-Employment income? (Form 1099-MISC, 1099-NEC, virtual currency)
Unemployment Compensation? (Form 1099G)
Interest/Dividends from: checking/savings accounts, bonds, CDs, brokerage? (Forms 1099-INT, 1099-DIV)
Income (or loss) from the sale or exchange of Stocks, Bonds, Virtual Currency or Real Estate? (Forms 1099-S, or 1099-B)
Disability income (payments from insurance or workers comp? (Forms 1099-R, W-2)
Retirement income, 401K and/or IRA? (Form 1099-R)
Social Security Benefits? (Forms SSA-1099)
Income (or loss) from Rental Property?
Other Income? (gambling, virtual currency, Sch K-1, etc.)

Rows	Yes	No	Unsure
Do You Own a Home?
Did you make energy efficient improvements to your home?
Did you purchase a new 2025 or 2026 vehicle last year?
Did you get paid for overtime work?
Did you earn money from tips?
Did you give money or items to charity?
Did you pay back any Student Loans? (Form 1098-E)
Did you pay Childcare Expenses?
Did you or anyone in your household attend College? (Form 1098-T)
Did you or anyone in your household have health coverage through the Marketplace? (Form 1095-A)
Did you contribute to a Health Savings Account (HSA)?

Taxpayer Information