Tax Client Intake Form

Tax Client Intake Form

This is an all in one Intake Form so not every section will apply to every client. Please feel free to scroll past or skip anything that does not apply to your specific tax profile. You can also save this form and continue later (scroll to bottom, press save, copy link or enter email address), it does not have to be done in one sitting. Also, if you prematurely submit the form, not to worry, you will receive an email with an "edit submission" link.
Filing Status

SingleHead of HouseholdMarried Filing SeparateMarried Filing JointQualifying Widower
Taxpayer Name

First NameMiddle NameLast NameSuffix
Driver License

Driver License #Expiration DateIssue DateState
Date of Birth

MonthDayYear
Date
Phone Number
Please enter a valid phone number.
Email
example@example.com
Occupation
SSN
Spouse Name

First NameMiddle NameLast NameSuffix
Driver License

Driver License #Expiration DateIssue DateState
Date of Birth

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

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Enter your dependents here

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

Day Care Provider for Children

	Name	TAX ID	Address	Amount Paid	Phone Number
Dependent 1
Dependent 2
Dependent 3
Dependent 4
Dependent 5
Dependent 6

Did you have health insurance coverage through the marketplace? If so, make sure to upload form 1095A (Federal) and 3895 (CA)

YesNo
Was there any Paid Family Leave (Maternity and/or Paternity Leave) included in your W2?

YesNo
If so, please provide dollar amounts.
Has Taxpayer ever Contributed or rolled over into a Traditional or Roth IRA (Not to be confused with a 401k)? (If so, provide annual contribution amount below and upload your most recent form 5498)

TraditionalRothBothNeither
Traditional IRA Contribution Amount (specify contribution tax year)
Provide Date of Contribution

MonthDayYear
Date
Roth IRA Contribution Amount (specify contribution tax year)
Provide Date of Contribution

MonthDayYear
Date
Did Taxpayer perform a Backdoor Roth IRA conversion (not to be confused with a Mega Backdoor Roth Conversion via your Employer)?

YesNo
Provide Date of Conversion to Roth

MonthDayYear
Date
As of 12/31, what is Main Taxpayer Traditional IRA basis (after tax contributions without earnings)
As of 12/31, what is Main Taxpayer Roth IRA basis (after tax contributions without earnings)
Did Taxpayer ever take a Corona Virus Distribution from your Retirement account?(If so, what was the amount)

YesNo
Taxpayer Corona Virus Retirement Distribution Amount
Has Spouse ever Contributed or rolled over into a Traditional or Roth IRA (Not to be confused with a 401k)? (If so, provide annual contribution amount below and most recent form 5498)

TraditionalRothBothNeither
Spouse Traditional IRA Contribution (specify contribution tax year)
Provide Date of Contribution

MonthDayYear
Date
Spouse Roth IRA Contribution (specify contribution tax year)
Provide Date of Contribution

MonthDayYear
Date
Did Spouse perform a Backdoor Roth IRA conversion (not to be confused with a Mega Backdoor Roth Conversion via your Employer)?

YesNo
Provide Date of Conversion to Roth

MonthDayYear
Date
Did Spouse ever take a Corona Virus Distribution from their Retirement account?(If so, what was the amount)

YesNo
Spouse Corona Virus Retirement Distribution Amount
As of 12/31, what is Spouse Traditional IRA basis (after tax contributions without earnings)
As of 12/31, what is Spouse Roth IRA basis (after tax contributions without earnings)
Did you contribute to a Coverdell Education Account or Qualified Tuition Plan (Sec 529)?

YesNo
Amount of Educational Contribution
Did you pay any Federal and/or State quarterly estimated taxes or apply any of your prior year tax refund (Not referring to payroll tax withholdings or what you paid with your prior year tax filing)?

YesNo
Provide Amounts and Dates of Quarterly Tax Payments to both Federal and State
Do you have an HSA in which you invest into index or mutual funds?

YesNo
If Yes to the above, then provide amount of Dividends earned (It is taxable in the state of CA and NJ)
HSA Dividends Earned in the year
Providing Banking info For Direct Deposit or Direct Debit

Bank NameRouting NumberAccount Number
Bank Account Type

CheckingSavings
Select all that apply:

Received an inheritanceHave a foreign bank account or foreign investments, including real property*Invest in a Qualified Opportunity ZoneGifted money or property over $16,000Receive, sell, exchange, dispose of any Virtual Currency
* For foreign bank accounts or foreign investments, select all that apply:

FBAR: $10k aggregate in foreign bank accounts8938: The total value of your specified foreign financial assets is more than $100,000 on the last day of the tax year or more than $150,000 at any time during the tax year8621: direct or indirect shareholder of a Passive Foreign Investment Company (PFIC), although may not need to file if none of the 8621 requirements apply (see following options on Form 8621 filers)None of the above (but did have foreign accounts or foreign investments less than amounts listed in options above)
* For Form 8621 filers specifically. If you are a direct or indirect shareholder of a Passive Foreign Investment Company (PFIC), select all that apply:

Received certain direct or indirect distributions from a PFICRecognized a gain on a direct or indirect disposition of PFIC stockAre reporting information with respect to a QEF or section 1296 mark-to-market electionAre making an election reportable in Part II of the formAre required to file an annual report pursuant to section 1298(f)Are a direct or indirect shareholder of a PFIC, but none of the above apply
Have you sold any Real Estate this year?

YesNo
If you sold real estate during the year, was it a primary residence, rental property, or both at one time or another?

PrimaryRentalBothNo real estate sold this year
If the property you sold was both a rental and a primary residence, please provide dates and descriptions below:
Purchase Price
Dollar amount of Improvements over the years:
Closing Costs at time of Purchase
Sale Price
Closing Costs at time of Sale
CA FTB Withholding Payment
Date of Purchase

MonthDayYear
Date
Date of Sale

MonthDayYear
Date
Date it began as Primary Residence

MonthDayYear
Date
Date it became a Rental Property

MonthDayYear
Date
Foreign Tax paid on sale of property if rental was international
Was depreciation taken each year on the rental property or was depreciation taken at any time on the Primary Residence?

YesNoOther
Value of Land
Value of Building Structure
Do you receive compensation in the form of Equity? Check all that apply

RSUESPPISONSOPSUQSBS
If ISOs, please provide:

Exercise DateSale Date, if applicableFMV at time of Exercise
If ISOs, please provide:

Strike/Exercise PriceNumber of Shares Exercised
Amount of AMT credit carryforward
Itemized Deductions and Credits
Insurance Premiums (Don't include premiums paid through your employer since those are already pretax)
Doctor, Dentist, Vision, Prescriptions
LT Care Insurance
Hospital, Ambulance
Mortgage Interest (provide 1098)
Mortgage Interest (provide 1098)
Property Tax (provide statements)
Property Tax (provide statements)
Vehicle License Fee (Tax portion only)
Prepaid Interest on Refinance of Home
Investment Interest - Margin Accounts
Medicare Insurance Premiums (not payroll tax)
Cash Charitable Contributions (upload Tax ID and name of Organization)
Non-cash donation (upload Tax ID and name of organization as well as Cost basis and FMV)
Did you install Solar electric generation or Qualified Energy property that meets Government energy standards during the tax year? (if "Yes", upload documentation)

YesNo
Did you purchase an all Electric Vehicle in during the tax year?

YesNo
If yes, then provide description of energy property, vehicle, VIN, year, date, and cost.
Unreimbursed Employee Expenses and Other Misc. Deductions

Only eligible for State (and only in excess of 2% of AGI) This section is not for business owners.
Tax Preparation Fees
Union Dues
Travel away from home
Meals
Parking and Tolls
Apps and Software
Office Supplies
Telephone (Business calls only)
Occupational Licenses, Fees, Credentials, Etc.
Uniform Purchases (Not including street wear)
Business Gifts – Limited to $25 per recipient per year. Must be ordinary and necessary.
Continuing Education
Items with a useful life of one year or more
Provide Description of item, date put into use and amount
Personal Vehicle (if you used for employer and did not get reimbursed)

MakeModelYear
Unreimbursed Vehicle Expenses (if used for employer, Part 2)

Date it was put into Service of BusinessPersonal Mileage Unreimbursed Employer Mileage
Unreimbursed Vehicle Expenses (if used for employer, Part 3)

Daily commuting milesTotal Commuting MilesTotal Mileage for year
Unreimbursed Vehicle Expenses (if used for employer, Part 4)

Purchase PriceFuel CostMaintenance and Repairs
Unreimbursed Vehicle Expenses (if used for employer, Part 5)

Insurance (do not duplicate elsewhere)Registration (do not duplicate elsewhere)Lease payments (annual)
Unreimbursed Vehicle Expenses (if used for employer, Part 6)

Loan InterestWash & WaxParking and Tolls
Square Footage of Home Strictly used for Home Office
Square Footage of Entire Home
Annual Rent Expense (if not a homeowner) of Home
Annual Mortgage Interest (if homeowner)
Annual Property Tax (if homeowner)
Annual Home Utilities Expense, Including Internet and Phone
Annual Homeowners or Renters Insurance premium
Annual Maintenance and Repairs Expense of Home
All other Annual expenses to maintain home
Purchase Price of Home
Date Home office was put into use

MonthDayYear
Date
Real Estate Rental Income & Expenses (up to 2 properties)

(if more than 2 properties, please submit an additional Client Intake Form)
Rental 1 Income
Rental 2 Income
Advertising 1
Advertising 2
Cleaning & Maintenance 1
Cleaning & Maintenance 2
Insurance 1
Insurance 2
Legal and Professional 1 (which can include allocated portion of last year's tax prep fees)
Legal and Professional 2 (which can include allocated portion of last year's tax prep fees)
Management Fees 1
Management Fees 2
Repairs 1
Repairs 2
Mortgage Interest 1
Mortgage Interest 2
Supplies and Hardware 1
Supplies and Hardware 2
Property Tax 1
Property Tax 2
Utilities 1
Utilities 2
HOA 1
HOA 2
Description and Cost of Capital Improvements 1
Please include date put into use
Description and Cost of Capital Improvements 2
Please include date put into use
Rental 1 Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Rental 2 Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Number of Days Rented or advertised for Rent 1
Number of Days Rented or advertised for Rent 2
Number of Personal Days 1
Number of Personal Days 2
Depreciable/Cost Basis 1
Depreciable/Cost Basis 2
Closing Costs at time of Purchase 1
Closing Costs at time of Purchase 2
Closing Costs at time of Refi 1
Closing Costs at time of Refi 2
Date it originally became a Rental 1

MonthDayYear
Date
Date it originally became a Rental 2

MonthDayYear
Date
Prior Accumulated Depreciation taken Rental 1
Prior Accumulated Depreciation taken Rental 2
If you rented out a room or two in your primary residence, please provide details so we can properly calculate deductible expenses proportionately. How many rooms were rented? How many total rooms? Headcount of tenants to non-tenants? Square footage of area rented vs. Square footage of entire home?
Business Vehicle used for Rental Property (Part 1)

MakeModelYear
Business Vehicle used for Rental Property (Part 2)

Date it was put into Service of BusinessPersonal/Commuting MileageBusiness Mileage
Business Vehicle used for Rental Property (Part 3)

Purchase PriceFuel CostMaintenance and Repairs
Business Vehicle used for Rental Property (Part 4)

Insurance (do not duplicate elsewhere)Registration (do not duplicate elsewhere)Lease payments (annual)
Business Vehicle used for Rental Property (Part 5)

Loan InterestWash & WaxParking and Tolls
Sole Proprietorship or Single Member LLC Business

If you have multiple businesses, please submit an additional client intake form with just this section completed again.
Revenue/Sales
Employer Identification Number
Secretary of State Number (LLC's only)
LLC Registration Date
Advertising
Commissions and Fees
Contract Labor
Dues and Subscriptions
Business Meals
Insurance (not health)
Interest
Internet/Data
Legal and Professional (which can include allocated portion of last year's tax prep fees)
Licenses
Office Expense
Rent
Repairs
Supplies
Telephone
Utilities
Wages (W-2)
Employer Portion of Payroll Taxes
Other Expenses
Professional Licenses
Continuing Education
Travel
Self Employed Health Insurance - only if you are not covered by or do not have the ability to obtain Health insurance through an employer (TP or Spouse)
If taking business use of home office, please select your preferred method:

Actual (must take depreciation if you own the home, depreciation recapture applies when home is sold)Simplified (only need square footage of home strictly used for business, which will be multiplied by $5)
Square Footage of Home Strictly used for business
Square Footage of Entire Home
Annual Rent Expense Home (if not a homeowner)
Annual Property Tax (if homeowner)
Annual Mortgage Interest (if homeowner)
Annual Homeowners or Renters Insurance Premium
Annual Home Utilities Expense, Including Internet and Phone
Annual Maintenance and Repairs Expense of Home
All other Annual expenses to maintain home
Business Vehicle (Part 1)

MakeModelYear
Business Vehicle (Part 2)

Date it was put into Service of BusinessPersonal/Commuting MileageBusiness Mileage
Business Vehicle (Part 3)

Purchase PriceFuel CostMaintenance and Repairs
Business Vehicle (Part 4)

Insurance (do not duplicate elsewhere)Registration (do not duplicate elsewhere)Lease payments (annual)
Business Vehicle (Part 5)

Loan InterestWash & WaxParking and Tolls
Corporations, Partnerships, Multi-member LLCs
Entity Information

Name of BusinessPhoneEIN (Employer ID Number)
Entity Information (Cont'd)

EmailDesignated Partner/Shareholder
Entity Information (Cont'd)

Secretary of State NumberRegistration Date
Business Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Entity Structure

CorporationS-CorporationGeneral PartnershipLimited PartnershipLimited Liability CompanyLimited Liability PartnershipEstateTrust
Principal Business Activity
Date Business Started
Principal Product or Service
Business Code
Method of Accounting

CashAccrual
State of Incorporation
State ID Number
Date of Incorporation

YearMonthDay
Date
If S-Corporation, Effective Date of Election

YearMonthDay
Date
If an S-Corporation, Are Shareholders/Officers paid a reasonable salary? Include W2's

YesNo
List amount of distributions/draws taken by shareholders (Not W2 wages)

Principal Shareholders or Partners or LLC Members

	Name	Tax ID Number/SSN	Address	Ownership %
1
2
3
4

Did the Shareholder or the Entity make any Federal or State quarterly estimated tax payments? If so, provide details below:
Upload all Relevant Documents in PDF format to your SmartVault Secure Client Portal by going to bayareacpa.smartvault.com and entering your user name and password
Even if you have responded to all questions above, we still need the supporting tax forms uploaded to your secure client vault as well. See examples below:

If Applicable, Upload the following to the Client Source Documents Folder:

(Common forms are outlined in red. Please upload all forms that apply)

Driver Licenses

Prior Year Tax Return (if not completed by this office)

W-2, Employment Wages

1098 Mortgage Interest and Property Tax Statements

1098-E, Student Loan Interest

1098-T, Tuituion

K-1 and supplemental statement

1098-C, Donations of Vehicles

1098-F, Fines and Penalties

1098-MA, Mortgage Assistance

1098-Q, Qualifying Longevity Annuity

1099-A, Acquisition or Abandonment of Secured Property

1099-B, Proceeds From Broker and Barter Exchange Transactions

1099-C, Cancellation of Debt

1099-CAP, Changes in Corporate Control and Capital Structure

1099-DIV, Dividends and Distributions

1099-G, Certain Government Payments

1099-H, Health Coverage Tax Credit (HCTC) Advance Payments

1099-INT, Interest Income

1099-S, Proceeds from Real Estate Transactions

1099-K, Merchant Card and Third Party Network Payments

1099-LTC, Long-Term Care and Accelerated Death Benefits

1099-NEC, Non Employee Compensation

1099-MISC, Miscellaneous Income

1099-OID, Original Issue Discount

1099-PATR, Taxable Distributions Received From Cooperatives

1099-Q, Payments From Qualified Education Programs (Under Sections 529 and 530)

1099-R, Distributions From Pensions, Annuities, Retirement or Profit-Sharing Plans, IRAs, Insurance Contracts, etc.

1099-SA, Distributions From an HSA, Archer MSA, or Medicare Advantage MSA

5498 - Brokerage Account Annual Statement

Supplemental Stock Transaction Documentation for Adjusted Cost basis

*If you are a Business Client or Self-Employed/Sole-Proprietor, we will need your Profit & Loss Statement and Balance Sheet as of 12/31*
Please provide additional comments about your situation that you'd like our office to know.
Please let us know via email when you have uploaded all your current year tax documents, prior year tax filing, driver licenses, and any other documentation you need us to look at.
Signature

Clear
Signature

Clear
Date

MonthDayYear
Date
Date

MonthDayYear
Date
Should be Empty:

Tax Client Intake Form

Itemized Deductions and Credits

Unreimbursed Employee Expenses and Other Misc. Deductions

Real Estate Rental Income & Expenses (up to 2 properties)

Sole Proprietorship or Single Member LLC Business

Corporations, Partnerships, Multi-member LLCs

Upload all Relevant Documents in PDF format to your SmartVault Secure Client Portal by going to bayareacpa.smartvault.com and entering your user name and password