Tax Prep Intake Form

Tax Preparation Client Intake Form

Please upload documents with the secure link provided upon submission of this form
Filing Status*

SingleHead of HouseholdMarried Filing JointMarried Filing Separate

Enter the dependents you are claiming on your tax return here

Banking and Tax Payment Information
Is your bank account the same as last year?*

YesNo
Type of Account

CheckingSavings
If there is a balance due, do you want the payments drafted from your account with the electronic filing of your return? If no, you must submit payment electronically. Refer to our website at www.jeffpinkneycpa.com/electronicpayments*

YesNo
The IRS requires payments to be made electronically by either scheduling to be drafted along with the tax filing or paid separately via the IRS' website.

Amounts will be schedule to be drafted from your account April 15th or when the agency processes your tax return.

	Amount
Medical Expenses
Dental Expenses
Health Insurance Premiums paid
Long Term Care Premiums
Prescription Drugs and Medications
Home Mortgage
Cash Contributions
Non-Cash Contributions

Acknowledgment & Signature
- I confirm that all information I entered here is accurate and true.
- I allow Jeff Pinkney CPA, Inc. access to my sensitive personally identifiable data.
- I agree with the terms of the engagement letter of Jeff Pinkney CPA, Inc. https://www.jeffpinkneycpa.com/engagementletter
- By signing below, you acknowledge that you have read and understood your responsibilities and our responsibilities in preparing your tax return.
Taxpayer Signature*

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Spouse Signature

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Tax Preparation Client Intake Form