Lychelle Royal Services LLC Client Intake Form 2025

Taxpayer Name*

First NameLast NameSuffix

Social Security Number*

Date of Birth*

MonthDayYear

Taxpayers Occupation*

Email*

example@example.com

Phone Number*

Please enter a valid phone number.Format: (000) 000-0000.

Address*

NO P O BOX/ PHYSICAL ADDRESS ONLY

Street Address Line 2

CityState / Province

Postal / Zip Code

Taxpayers Required Documents (ID, DL, SS Card, Passport)*

SHOULD NOT BE EXPIRED

Spouse Basic Information

First NameLast NameSuffix

Social Security Number

Date of Birth

MonthDayYear

Occupation

Email

example@example.com

Phone Number

Please enter a valid phone number.Format: (000) 000-0000.

Spouse Address if different from Taxpayer's address

Street Address Line 1 - NO P.O. BOX/PHYSICAL ADDRESS ONLY

Street Address Line 2

CityState / Province

Postal / Zip Code

Spouse Required Documents (ID, DL, SS Card, Passport)

SHOULD NOT BE EXPIRED

IF YOU ARE CLAIMING A DEPENDENT, PLEASE ANSWER THE QUESTIONS BELOW THAT PERTAINS TO YOUR DEPENDENT RELATIONSHIP. PER THE IRS REQUEST, WE MUST PROVE THAT NOBODY ELSE IS ELIGIBLE TO CLAIM YOUR DEPENDENT BUT YOURSELF.

Dependent 1

First NameLast NameSuffix

Social Security Number

Date of Birth

MonthDayYear

Relationship

Did dependent (1) live with you more than half the year?

YesNo

Did anyone else provide more than half of te dependent's (1) support?

YesNo

Is anyone else planning to claim this dependent (1)?

YesNoOther

Identification: Dependent (1) required documents (Birth Certificate, Social Security Card etc.)

Dependent 2

First NameLast NameSuffix

Social Security Number

Date of Birth

MonthDayYear

Relationship

Did dependent (2) live with you more than half the year?

YesNo

Did anyone else provide more than half of te dependent's (2) support?

YesNo

Is anyone else planning to claim this dependent (2)?

YesNoOther

Identification: Dependent (2) required documents (Birth Certificate, Social Security Card etc.)

Dependent 3

First NameLast NameSuffix

Date of Birth

MonthDayYear

Social Security Number

Relationship

Did dependent (3) live with you more than half the year?

YesNo

Did anyone else provide more than half of te dependent's (3) support?

YesNo

Is anyone else planning to claim this dependent (3)?

YesNoOther

Identification: Dependent (3) required documents (Birth Certificate, Social Security Card etc.)

Did you pay someone to watch your dependent(s)?

YESNO

If yes, please provide the following care provider:

Provider Name / Facility Name

Provider Social Security or EIN

Social Security or EIN

Provider Street Address

Street Address - Provider

Street Address Line 2 - Provider

City - ProviderState / Province - Provider

Postal / Zip Code - Provider

Upload Proof of Childcare (Receipts, Invoices, Pay Statements, etc)

Did IRS issue you an Identity Protection Pin?*

YESNO

If yes, provide the IP Pin number below:

IP PIN

Upload Required IRS identity Protection Pin Document

Taxpayer Filing Status:*

HEAD OF HOUSEHOLD FILERS MUST PRESENT ONE OF THE FOLLOWING DOCUMENTS IN YOUR NAME TO VERIFY ELIGIBILITY. PICK SELECT THE DOCUMENT YOU ARE SUBMITTING FOR REVIEW:*

Utility Bill (gas, electric water, or internet)Lease or Rental AgreementMortgage StatementNot filing Head of Household

Upload Proof of Head of Household Status

Did the taxpayer (you) file a Federal Tax Return last year?*

YESNO

Did the Taxpayer (you) receive and Economic Impact Payments (stimulus payments) last year?*

YESNO

If yes, input total amount received:

Economic Impact Payment

Did you earn W-2 wages last year?*

YESNO

If yes, upload W-2 statement(s) here:

W-2 only

Did you earn income as a self employed, freelance, or independent contractor?*

YESNO

Self Employment

1099's only

Did you earn income in cash via Zelle, CashApp, Venmo, PayPay or similar?*

YESNO

If yes, input total amount received:

Cash. Payment

Cash Payment Documentation (receipts, statements summary from any of the above merchants)

If applicable

Did you make college tuition payments and received a 1098-T Form last year?*

YESNO

If yes, upload 1098-T statement(s) here:

College Forms: 1098-T, book receipts, tuition payments etc.

Did you contribute to a retirement account (IRA, Roth, 401) last year?

YesNo

If yes, upload documents here:

IRA, Roth, Retirement Account (401k, 403b etc)

Did you purchase health insurance through Marketplace (healthcare.gov) ?*

YesNo

If yes upload your Healthcare Form(s) here:

1095-A

Did you receive unemployment compensation (1099-G) last year?*

YESNO

If yes, did you receive regular unemployment?

RegularPUA (Pandemic Unemployment Compensation) *Applicable only during pandemic years.

Upload 1099-G statement(s) here:

1099-G only

Did you receive any government income last year?

YesNo

Total Amount Received?

Were you ever disallowed the Earned Income Tax Credit (E.I.T.C.) prior to this year?*

YesNo

Do you owe any delinquent:*

Are you applying for the refund advance loan?*

Interest Free Up To $1000With Interest Up To $7,500NO!

How would you like to receive your refund?*

Refund Transfer Direct DepositRefund Transfer Debit CardRefund Transfer Paper Check

Bank Information

Rows	Name of Bank	Routing Number	Account Number
ENTER BANK DATA

Direct Deposit

I, hereby, state that all the information above is true to the best of my knowledge and that I am allowing Lychelle Royal Services LLC to prepare my taxes based on that fact. I understand that I am financially responsible for any outstanding balance due to any false information given.

If there is a balance due, you must pay the tax preparation fee upfront. If for any reason you owe an entity and they take the entire refund, you are STILL responsible to pay the tax preparation fee for services rendered.

*For any reason an amendment has to be filed with no fault of the tax preparer, an upfront fee of $150.00 is required! Please view your tax return, which is emailed to you (it is sent prior to submission). Any copy after the first copy is a fee of $10.00.

ALL FEES (bank and service fees) are found in the return and are non-refundable nor negotiable! NO EXCEPTIONS TO THIS!!

Please utilize www.irs.gov for all federal refund tracking. Please utilze your state Department of Revenue site for any State Refund tracking. Do NOT add the amounts together. Federal taxes are federal, and state taxes are state when tracking your status. Please allow 8 weeks to surpass from the date of submission before calling the IRS, if you have any tracking questions.

For any direct assistance please email ceo@lychelleroyalservices.com

IRS Contact 800-829-1040

Please click this link to check your federal refund status. You will need your filing status, social security number, and the total amount of the refund before fees

https://sa.www4.irs.gov/irfof/lang/en/irfofgetstatus.jsp

Previous Year Tax Return (The year immediately prior to the year you are filling)

Misc. Forms

Are there any additional comments that you would like to share:

Are you interested receiving information on any of our other services?

BookkeepingBusiness FormationCredit RepairLife Insurance

Were you referred?*

Yes!No

If yes, who gets the credit for sending you my way?

Signature*

Date

MonthDayYear

Take A Selfie

Appointment*

2025 TAX CLIENT INTAKE