Individual Tax Intake Checklist

Individual Tax Intake Checklist
Please complete all required fields below so we can gather the information needed before moving forward. Do not include any personal or sensitive information in this form. A secure link will be provided separately for uploading personal details and supporting documents.
Services Needed*

PreparationTax PlanningConsultation
Please provide more details:

Enter your dependents here

Does you, your spouse, and your dependents have health insurance within 12 months last year? If yes, who covers for it?

General Expenses

	Amount
Medical Expenses
Dental Expenses
Insurance Premiums paid
Long Term Care Premiums
Prescription Drugs and Medications
Home Mortgage
Investment Interest
Cash Contributions
Non-Cash Contributions
Unreimbursed Business Expenses
Union Dues
Tax Preparation Fees
Investment Expenses

Acknowledgment & Signature
- I confirmed that all information I entered here is accurate and true.
- I allow ABC Financial to capture my sensitive data like personal id, government id, and other information.
- I have read the terms and conditions and privacy policy of ABC Financial.
- By signing below, you acknowledge that you have read and understood your responsibilities and our responsibilities in doing this tax return.
Date Signed

MonthDayYear
Date
Taxpayer Signature

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Date Signed

MonthDayYear
Date
Spouse Signature

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