2025 New Tax Client Intake Form

2025 New Tax Client Intake Form
Did anyone refer you? If so who?*
Filing Status*

SingleHead of HouseholdMarried Filing SeparateMarried Filing JointQualifying Widower

Spouse Information
Name

First NameLast Name
Age
Date of Birth

MonthDayYear
Date
Phone Number
Please enter a valid phone number.
Email
example@example.com
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Occupation
SSN
Are they a full-time student?

YesNo
Are they totally and permanently disabled?

YesNo
Are they legally blind?

YesNo
Are they your dependent(s)?

YesNoOther

Dependents

Enter your dependents here

	Name	SSN	Date of Birth	Relationship
1
2
3
4
5
6

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
Spouse
Dependent 1
Dependent 2
Dependent 3
Dependent 4
Dependent 5

Expenses
Please fill-up the information within the current 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
Tax Preparation Fees
Investment Expenses

Total Expenses

Bank Information
Bank Name*
Account Number*
Routing Number*

Documents
Upload Documents for You and Dependents (ID, SS CARD, W-2, 1099, RECEIPTS OF EXPENSES, ETC.)*

Cancelof
Additional comments

Acknowledgment & Signature
Client Confirmation and Agreement
- Accuracy of Information:I confirm that all information I have provided is accurate and true to the best of my knowledge.
- Authorization to Capture Sensitive including but not limited to personal identification, government-issued identification, Social Security Number (SSN), and other pertinent information required for tax preparation and related services.
- Acknowledgment of Terms and Privacy Policy:
  I have read, understood, and agreed to the terms and conditions, as well as the privacy policy of LIMITLESS CONSULTING SERVICE.
- By signing below, I acknowledge that I have read and understood my responsibilities and the responsibilities of LIMITLESS CONSULTING SERVICE in preparing and submitting my tax return.
Date Signed*

MonthDayYear
Date
Taxpayer Signature*

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Date Signed

MonthDayYear
Date
Spouse Signature

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