KEY'S TAX & NOTARY, LLC
Client Intake Form
Filing Status
*
Single
Head of Household
Married Filing Separate
Married Filing Joint
Qualifying Surviving Spouse
Taxpayer Information
Name
*
First Name
Last Name
Social Security Number
*
Email
*
example@example.com
Date of Birth
*
-
Month
-
Day
Year
Date
Phone Number
*
Please enter a valid phone number.
Address
*
Street Address
Apt/Street Address Line 2
City
State / Province
Postal / Zip Code
Occupation
*
Are you a full-time student?
*
Yes
No
Did you work a job and make more than ?
*
Yes
No
Are you totally and permanently disabled?
*
Yes
No
Spouse Information
Name
First Name
Last Name
Date of Birth
-
Month
-
Day
Year
Date
Phone Number
Please enter a valid phone number.
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Occupation
Are they a full-time student?
Yes
No
Are they totally and permanently disabled?
Yes
No
Are they your dependent?
Yes
No
Dependents
Enter your dependents here
Name
Date of Birth
Social Security Number
Relationship
1
2
3
4
5
Check box if you have NO dependents
No dependents
Does you, your spouse, and your dependents have health insurance within 12 months last year? If yes, who covers for it?
Yes/No
Employer
Spouse Ins
Exchange/ Marketplace
Direct with Insurer
Medicare
Medicaid
Taxpayer
Yes
No
Spouse
Yes
No
Dependent 1
Yes
No
Dependent 2
Yes
No
Dependent 3
Yes
No
Dependent 4
Yes
No
Dependent 5
Yes
No
Tax Related Questions
Employment Status
*
W2 Employed
Self-employed
Unemployed
Tax year need filing
*
Current (2024)
Last Year (2023)
2022
2021
Does your dependents have tuition expenses?
*
Yes
No
Do you have any expenses for child care?
*
Yes
No
Are you currently renting?
*
Yes
No
Do you own a home?
*
Yes
No
Do you have documents that shows you paid for property taxes?
*
Yes
No
Did you sell any stock?
*
Yes
No
Did you take money from your 401?
*
Yes
No
Do you have mortgage interest?
*
Yes
No
Did you receive a federal tax refund last year?
*
Yes
No
Do you have copies of your last year tax documents? (NEW CLIENTS ONLY)
Yes
No
Do you require an Identity Protection PIN from the IRS?
*
Yes
No
If yes, enter IP PIN here and Upload a photo of the document
Must have PIN to file today
Take Photo of IP PIN
Expenses
Please fill-up the information within the expenses for 2024 year only.
General Expenses
Amount
Medical Expenses
Dental Expenses
Insurance Premiums paid
Long Term Care Premiums
Prescription Drugs and Medications
Home Mortgage
Investment Interest
Cash Contributions
Non-Cash Contributions
Unreimbursed Business Expenses
Union Dues
Investment Expenses
Bank & Documents Upload
How would you like to receive your refund?
*
Direct Deposit
Prepaid Card
Check
Bank Name
*
Account Type
*
Checking
Savings
Routing Number
*
Routing Number
*
Account Number
*
Account Number
*
Upload a photo of your valid ID
*
Browse Files
Drag and drop files here
Choose a file
Cancel
of
Upload a photo of ALL SOCIALS
*
Browse Files
Drag and drop files here
Choose a file
Cancel
of
Upload W2's
Browse Files
Drag and drop files here
Choose a file
Cancel
of
Upload additional tax documents
Browse Files
Drag and drop files here
Choose a file
Cancel
of
Take Photo of Valid ID or Driver License
*
Take Photo of ALL Social Security Cards In ONE Snapshot
*
Acknowledgment & Signature
I confirmed that all information I entered here is accurate and true and i have included all income.
I allow Key's Tax & Notary LLC to capture my sensitive data like, government id, income, bank information and other personal information.
I have read the terms and conditions and privacy policy of Key's Tax & Notary LLC.
By signing below, i acknowledge that i agree to file MY tax return with Key's Tax & Notary LLC.
I would like to apply for refund advance loan ($80 fee)
*
No
Yes up to $7,000 (36% Interest rate)
Yes up to $1,000 (No interest)
Referred by :
Date Signed
*
-
Month
-
Day
Year
Date
Taxpayer Signature
*
Date Signed
-
Month
-
Day
Year
Date
Spouse Signature
Print
Submit
Submit
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