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2023-2024 Client Information Form
This form is to be completed by all clients in order to complete a accurate tax return. Once you are done, please click 'submit'. When you submit, this will indicate to our team you are finished!
Are you READY to file your tax return OR would like a CONSULTATION?
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Yes, I'm READY for Tahkia to file my taxes🤑
Not yet, I would like to schedule a Paid Tax Consultation with Tahkia
Are you a NEW or LOYAL Client?
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New Client, Welcome to the Family😊
Loyal Client, WE LOVE YOU LIKE ALWAYS🥰
Tax Year
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2023 (Current Tax Year)
2022
2021
2020
Other
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Please choose which forms you want to file:
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Federal
State
We can help you resolve past due tax issues....Do you owe monies to the IRS, student loans, child support or any other federal/state government agency that may garnish your tax refund?
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Yes
No
Other
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Are you interested in improving your credit score?
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Yes
No
Other
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Who can we thank for referring you? (List their name)
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Enter Your Name
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First Name
Last Name
copy Name
First Name
Last Name
Date of Birth
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Social Security Number
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xxx-xx-xxxx
Occupation
Upload your PHOTO ID/DRIVER LICENSE
*
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Upload your Social Security Card
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Do you have a Identity Protection Pin issued by the IRS?
Yes
No
If yes, please upload your IP Pin from the IRS here.
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If you are filing a JOINT return with your spouse please answer the following questions:
Married filing Jointly or Married Filing Separately MUST include your spouse information.
Spouse Name
First Name
Last Name
Spouse Date of Birth
Spouse Social Security Number
xxx-xx-xxxx
Spouse Occupation
Upload SPOUSE PHOTO ID/DRIVER LICENSE
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Upload your SPOUSE Social Security Card
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Do your SPOUSE have a Identity Protection Pin issued by the IRS?
Yes
No
If yes, please upload your SPOUSE IP Pin from the IRS here.
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Filing Status as of 12/31/2023
Single
Head of Household
Married Filing Jointly
Married Filing Separately
Mailing Address
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Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Email Address
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Phone Number
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At any time during the tax year, did you receive, sell, exchange, or otherwise dispose of any virtual currency (cryptocurrency)?
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Yes
No
Can someone else claim you as a dependent?
Yes
No
UPLOAD a copy of your last year tax return (NEW CLIENTS ONLY)
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Dependent's Information
Please enter your dependents information below. All dependents MUST have a Birth Certificate AND Social Security Card. If you are a PREVIOUS client we may have your documents on file already. No need to upload each year unless our team request new documents.
Dependent's Residency Requirement
If you are claiming any dependents, be sure to upload their SS CARDS, BIRTH CERTIFICATES. In order to file a dependent on your tax return you are attesting that the child/dependent lived with you in the SAME home for more than 6 months of the tax year. If the dependent did NOT live with you for more than HALF of the tax year you CANNOT claim the dependent. If you are audited by the IRS you MUST be able to have DOCUMENTATION 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).
Name of Dependent
Date of Birth
Dependent #1 Social Security Number
Relationship
Months Lived with You During the Tax Year
Upload Birth Certificate
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Upload Social Security Card
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Name of Dependent
Date of Birth
Dependent #2 Social Security Number
Relationship
Months Lived with You During the Tax Year
Upload Birth Certificate
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Upload Social Security Card
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Name of Dependent
Date of Birth
Dependent #3 Social Security Number
Relationship
Months Lived with You During the Tax Year
Upload Birth Certificate
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Upload Social Security Card
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Do you need to add additional dependents?
Yes
No
If YES, please enter additional dependent(s) Name and Date of Birth below:
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Income
Please check the income sources you received at ANY time during the tax year. Please report ALL income received from ALL jobs during 2023.
Types of Income
Wages or Salary (W2 Income)
Unemployment
Pension/Retirement Income
Dividend/Sale of Stocks
Rental Income
Farm Income
Additional Types of Income
Interest Income 1099 INT
Self-Employment-Bus. Income (Sch.C)
Alimony Received
Lottery or Gambling Income W-2G
Public/State Aid Income
Social Security Income
Tips
Other Income
Upload Your Paystub
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Upload Your W2
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Upload Your 1099 (Independent Contractor Jobs like Uber, Door dash, Lyft, Travel Agent, Etc.)
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Upload Any Other Income Documents Not Listed Above
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Are you EXPECTING any other income documents from any other sources such as past employers, Uber, Lyft, Doordash, Shipt, etc.)
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Yes
No
Other
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Expenses
Check the expenses you paid for during the tax year and have documentation.
Types of Expenses
IRA's
Property Tax
Mortgage Interest (Form 1098-INT)
Business Owner/Self Employed
Tax Prep Expenses
Union Dues
Education Expense (1098-T)
Significant Loss or Theft
Additional Types of Expenses
Charity of Religous Contributions
Mortgage Investment
Moving Expenses
Medical Expense
Alimony Paid
Buy or Sell Home
Job Related Expenses
Other
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Please upload Your 1098-T (College Tuition Statement)
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Please upload Your 1098 (Mortgage Interest Form)
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Please upload Your 1099-INT (Bank Account Interest Statement)
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Please upload Any Additional Expense Documents
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Child Care Expense (Credit)
Please complete this section of you pay out of pocket for daycare or afterschool care for children UNDER age 13.
Daycare Name
Phone Number
 -
Area Code
Phone Number
Federal Tax ID Number (EIN)
Provider Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Total Amount Paid For ChildCare
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Health Insurance
Please make sure you answer this question to the best of your knowledge to avoid your refund being DELAYED!
Did you have health care coverage during the tax year?
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Yes
No
What type of coverage did you have?
Employer/Job Health Plan
Medicaid/State/Healthy Kids Plan
Medicare
Healthcare.Gov Marketplace/ObamaCare
Other
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Did you receive a Health Insurance Coverage Form (1095-A, 1095-B or 1095-C)?
Yes
No
Other
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If yes, please upload Form 1095-A from www.HealthCare.Gov
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E-File Options
Please select how would you like your refund.
Do you want to apply for the Refund Advance?
Yes
No
Not Sure
Please select your REFUND ADVANCE LOAN OPTIONS:
Up to $1,000 (No Interest Charges)
$1,250 to $7,000 (Interest Charges/Fees will apply)
Not Sure
Would you like to add AUDIT PROTECTION for $49.99 to your tax return? (MANDATORY FOR ALL SCHEDULE C/SELF-EMPLOYED RETURNS)
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YES
NO
NOT SURE
How would you like your refund deposited?
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Paper Check (We will call/text when check is ready for pick from our office)
Pre-Paid Debit Card
Direct Deposit
Bank Name for DIRECT DEPOSIT
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Bank Routing Number
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Bank Account Number
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How would you like to pay for your tax preparation services?
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Pay Later...Out of Your Tax Refund
Pay Upfront....Cash, Credit/Debit Card
Other
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I understand that One Cent Financial Services LLC is providing tax preparation services. Once my tax return is COMPLETE, payment for services is considered due regardless if I am getting a tax refund or have a balance due, SERVICES are rendered and payment is expected upon completion. (Initial Below)
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Client Signature
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Date
*
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Month
 -
Day
Year
Date
Spouse Signature
Date
 -
Month
 -
Day
Year
Date
Submit
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