Tax year 2023 Intake Form

Name*

First NameLast Name

Email*

example@example.com

Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Phone Number*

Please enter a valid phone number.

Alternative Phone Number

Please enter a valid phone number.

Did someone refer you? Type their name or type "no"*

Tax Payers Date of Birth*

Tax Payers Social Security Number*

How many W2's Does The Tax Payer Have?

Bank Information

Name of Bank*

Routing Number*

Bank Account Number*

Spouse's Full Name

Spouse's Phone Number

Spouse's Date of Birth

Spouse's Social Security Number

How many W2's Does Your Spouse have? (Please attach copies)

Spouse's Email Address

Preferred Method of Contact

Do you own a business and/or were you self employed? *Please note all self-employed, cash business, gig workers will receive an additional form to complete*

YesNo

Do you need to schedule a phone/video consultation or have questions you would like to discuss verbally?

YesNo

What Type of Self Employed Work? (Please attach proof of self employment: 1099, EIN letter, etc)

How much profit was made in 2023 for your business?

Do you certify the profit made in 2023 is true, accurate and is given to use as a source of income for your 2023 Federal and State return?

YesNoN/A

Did you incur material expenses to operate your business in 2023?

YesNoN/A

How many dependents are you claiming? (Please attach social security cards/birth certificate for each dependent)

Dependent #1 Full Name

Dependent # 1 Date of Birth

Dependent # 1 Social Security Number

What is the relationship to dependent # 1?

How many months did dependent #1 live with you in 2023?

Dependent # 2 Full Name

Dependent # 2 Date of Birth

Dependent # 2 Social Security Number

What is the relationship to dependent # 2?

How many months did dependent # 2 live with you in 2023?

Dependent # 3 Full Name

Dependent # 3 Date of Birth

Dependent # 3 Social Security number

What is the relationship to dependent # 3?

How many months did dependent # 3 live with you in 2023?

Are there any dependents in daycare? If so, please upload the form you receive from the daycare provider.

If you had insurance through the marketplace, did you receive a 1095A Health Insurance Marketplace statement? (Not providing form IRS could delay your refund)

Have you ever been denied the Earned Income Tax Credit (EITC)?

YesNo

Did you or spouse attend college in 2023? (Please attach 1098-T from institution)

YesNo

Did any of your dependents attend college in 2023? (Please attach 1098-T from institution)

YesNoN/a

Please attach all applicable documents including IRS forms, identification for filer and dependents and any supporting documentation.

Please confirm that all phone numbers, social security numbers, bank account information and name spellings are correct before submitting. Files that cannot be attached at this time can be emailed to contact@majesticlegacyllc.com

I confirm and agree that all information is correct.

I agree

I hereby authorize Tonisha Peterson to prepare all forms related to my tax return and I have signed all necessary forms to file my income tax return electronically. I take full responsibility for the accuracy of this client intake form and understand that the tax preparer holds no responsibility for any misrepresentation or false claims.

I agree

Signature