Clone of B. Brown’s Client intake Form

Client Intake Form

Thank You for taking the time to complete your Client Intake Form. This information is critical to ensure your tax return is filed accurately. Please take your time and review all information before you submit. Please note that if documents are missing or information is incorrect this will result in a delay in processing your return.

This intake form will take 20- 30 minutes to complete.

Please complete this form in its ENTIRETY and click SUBMIT when finished. Upload all documents at the end of the form.

Please wait until you have ALL of your documents before submitting this form.

Note: If you are claiming any dependents, be sure to upload their SS CARDS, BIRTH CERTIFICATES, and all items that show their address is the same as yours. (e.g. school records, medical records, doctor bills, Medicaid Statement, Social Services Records, or anything that shows your child's name and current address).

PLEASE READ THROUGH ITS ENTIREITY.

DO NOT SUBMIT THIS FORM UNTIL YOU HAVE ALL SUPPORTING DOCUMENTS.

BE SURE ALL SUPPORTING DOCUMENTS ARE VALID & CURRENT.

BE SURE LEASE AND OTHER FORMS HAVE THE DEPENDENTS NAME ON THEM IF APPLICABLE.

How did you hear about us?
If someone referred you, please type his or her name here.
If you are filing multiple years you must complete a separate form for each year.
Which Tax Year Are You Filing For?
Will this be an amended (corrected) return?

YesNo
Are you interested in applying for an advance loan up?*

GENERAL INFORMATION
Date of Interview

MonthDayYear
Date
Interview Setting

In PersonVirtualTranslator Used
Taxpayer's Name*

First NameLast Name
Taxpayer's Social Security Number*
Example: xxx-xx-xxxx
Taxpayer's Date of Birth*
Example: 01/01/2001
Taxpayer's Job Title*
Taxpayer's Phone Number*
Example: (xxx)-xxx-xxxx
Home Address*
Street Address
City
State/Province
Postal/Zip Code
County*
Taxpayer's Email Address*
example@example.com
What is your marital status as of December 31st?*

SingleMarriedDivorcedSeparatedSurviving Spouse
Taxpayer's Driver's License/ State ID (Stand directly over the item on a flat surface and zoom in for a clear shot)*

Cancelof
Taxpayer's Social Security Card (Stand directly over the item on a flat surface and zoom in for a clear shot)

Cancelof
Were you previously issues an Identity Protection Pin (IP PIN) by the IRS?
IP PIN IDENTITY THEFT IF (APPLICABLE) (Stand directly over the item on a flat surface and zoom in for a clear shot.)

Cancelof
Can someone else claim you as a dependent?*
Do you owe the IRS, Child Support or in default with student loans?*
Have you ever been disallowed for EITC/AOTC/CTC/ACTC? *
Are you self employed?*
Did you buy or trade Crypto Currency? (Bitcoin)
Do you have gambling winnings for the year?*
Upload W2-G Section*

Cancelof
Did you make any charitable contributions during the year?
Did you withdraw from your 401K during the year ?
How much did you withdraw?
How much Federal taxes were withheld?
What is the total amount of the third stimulus you received for YOU AND YOUR CHILDREN? If this number is off by $1 it can delay your tax return by 6 months
Example: $1400 for you and an additional $1400 for qualifying dependent would be $2800 stimulus check you received.

SPOUSE'S INFORMATION
Spouse's Full Name
First Name
Spouse's Social Security
Example: xxx-xx-xxxx
Spouse's Date of Birth
Example: 01/01/2001
Spouse's Phone Number
Example: xxx-xxx-xxxx
Spouse's Email Address
Example: example@example.com
Spouse's Driver's License/State ID (Stand directly over the item on a flat surface and zoom in for a clear shot)*

Cancelof
Spouse's Social Security Card (Stand directly over the item on a flat surface and zoom in for a clear shot)*

Cancelof
Did you and your spouse live apart for more than 6 months in 2022?
What months?

INCOME
Upload W2 statements (Stand directly over the item on a flat surface and zoom in for a clear shot.)

Cancelof
1099 NEC (Stand directly over the item on a flat surface and zoom in for a clear shot.)

Cancelof
Did you receive unemployment during the year?
1099 Unemployment Taxpayer/Spouse (Stand directly over the item on a flat surface and zoom in for a clear shot.)*

Cancelof
Upload other Misc. Income Documents such as 1099 INT, 1099 DIV, 1099 NEC. (Stand directly over the item on a flat surface and zoom in for a clear shot.)

Cancelof

CURRENT LIVING SITUATION
Do you receive Subsidized Housing or Section 8?*
Do you receive any Government Assistance Programs such as Food stamps, TANF, Medicaid, or Medicare in during the year?*
How much do you receive monthly? *
Do you have a 1098 Mortgage Interest Statement?*
Upload, lease agreement,or utility bill. 1095-A, 1098 Mortgage Interest Statement, or 1098- T School forms. (Stand directly over the item on a flat surface and zoom in for a clear shot.)*

Cancelof
Was your insurance through the Affordable Care Act (The Marketplace)?*
PLEASE UPLOAD YOUR 1095A IF APPLICABLE (Stand directly over the item on a flat surface and zoom in for a clear shot.)*

Cancelof
Did anyone in your household attend college for the selected tax year? *
What was the Name of the person who attended college?
Form 1098-T (School Credit) *Stand directly over the item on a flat surface and zoom in for a clear shot.

Cancelof

ACKNOWLEDGMENT & SIGNATURE
Are you interested in Life Insurance ?
Are you interested in Health Insurance?
STOP!

Did you finish uploading your documents?

IF YOU DID NOT UPLOAD ALL NECESSARY DOCUMENTS PLEASE RETURN AND MAKE SURE ALL DOCUMENS ARE UPLOADED TO AVOID ANY DELAYS IN PROCESSING.

CLIENT NON-PAYMENT/OFFSET CLAUSE

At B. Brown's Tax Preparation & Bookkeeping LLC, we strive to assist all of our clients in their tax needs, however, we understand that situations arise. If your refund is offset by the IRS, student loans, child support or your check is mailed, you are still obligated to pay our company the fees associated with filing your tax return.

By signing this agreement you acknowledge that if payment is not made in full within 30 days legal actions will be sought to resolve payment.

How would you like you refund disbursed if receiving on?*

Direct DepositCheckBy MailN/A
Name of Bank
Routing Number
Bank Account Number
Primary Taxpayer's Signature*

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Primary Taxpayer's Spouse Signature*

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I am giving B. Brown's Tax Preparation & Bookkeeping LLC permission to prepare all forms related to my tax return. I take full responsibility for the accuracy of this form and understand that B. Brown's Tax Preparation & Bookkeeping LLC and/or associated affiliates hold no responsibility for any misrepresentation or false claims.

Taxpayer's Signature

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Date*

MonthDayYear
Date
Spouse's Signature (If no spouse, leave blank)

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Date

MonthDayYear
Date
Form Status

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Arabic	Hebrew	Polish
Bulgarian	Hindi	Portuguese
Catalan	Hmong Daw	Romanian
Chinese Simplified	Hungarian	Russian
Chinese Traditional	Indonesian	Slovak
Czech	Italian	Slovenian
Danish	Japanese	Spanish
Dutch	Klingon	Swedish
English	Korean	Thai
Estonian	Latvian	Turkish
Finnish	Lithuanian	Ukrainian
French	Malay	Urdu
German	Maltese	Vietnamese
Greek	Norwegian	Welsh
Haitian Creole	Persian

Arabic	Hebrew	Polish
Bulgarian	Hindi	Portuguese
Catalan	Hmong Daw	Romanian
Chinese Simplified	Hungarian	Russian
Chinese Traditional	Indonesian	Slovak
Czech	Italian	Slovenian
Danish	Japanese	Spanish
Dutch	Klingon	Swedish
English	Korean	Thai
Estonian	Latvian	Turkish
Finnish	Lithuanian	Ukrainian
French	Malay	Urdu
German	Maltese	Vietnamese
Greek	Norwegian	Welsh
Haitian Creole	Persian