Tax Preparation Client Intake Form
Filing Status
*
Single
Head of Household
Married Filing Separate
Married Filing Joint
Qualifying Widower
Taxpayer Information
Name
*
First Name
Last Name
Age
Date of Birth
*
-
Month
-
Day
Year
Date
Phone Number
Please enter a valid phone number.
Email
example@example.com
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Occupation
*
Are you a full-time student?
*
Yes
No
Are you totally and permanently disabled?
*
Yes
No
Are you legally blind?
*
Yes
No
Spouse Information
Name
First Name
Last Name
Age
Date of Birth
-
Month
-
Day
Year
Date
Phone Number
Please enter a valid phone number.
Email
example@example.com
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Occupation
Are they a full-time student?
Yes
No
Are they totally and permanently disabled?
Yes
No
Are they legally blind?
Yes
No
Dependents
Enter your dependents here
Rows
Name
Date of Birth
Relationship
Social
1
2
3
4
5
6
Did you, your spouse, and your dependents have health insurance within 12 months last year? If yes, who covers it?
Rows
Yes/No
Employer
Spouse Ins
Exchange/ Marketplace
Direct with Insurer
Medicare
Medicaid
Taxpayer
Yes
No
Spouse
Yes
No
Dependent 1
Yes
No
Dependent 2
Yes
No
Dependent 3
Yes
No
Dependent 4
Yes
No
Dependent 5
Yes
No
Tax Related Questions
Employment Status
Employed
Unemployed
Self-employed
Are you contributing to 401k or other pre-tax account?
Yes
No
Is this your first time opening a pre-tax account?
Yes
No
Please select any state return are you requesting?
State return
School
Local
RITA
Country returns
Homestead
Did your dependents have tuition expenses?
Yes
No
Do you have any expenses for child care?
Yes
No
Did you have energy star rated improvements to your home?
Windows
Doors
Furnace
Other
Are you currently renting?(if applying for renter rebate and homestead)
Yes
No
What is the monthly rental amount?(if applying for renter rebate and homestead)
How long have you lived at the property?(if applying for renter rebate and homestead)
# of months
Do you own your home?
Yes
No
Did you pay property taxes?
Yes
No
Did you sell any stock?
Yes
No
Did you take money from your 401k?
Yes
No
Did you pay any personal property (Auto etc)?
Yes
No
Did you have mortgage interest?
Yes
No
Do you have real estate tax?
Yes
No
Did you receive a federal/state tax refund last year?
Yes
No
Are you a victim of identity theft?
Yes
No
IP PIN
Expenses
Please fill-up the information within the current year only.
General Expenses (if you are itemizing)
Rows
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
Total Expenses
Additional comments
File Upload
*
Browse Files
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Choose a file
Cancel
of
Please submit copies off all required documents from the list below:, Business License, Bank Statements)
Taxpayers Drivers License
Taxpayers Social Security Cards
All Dependents Social Security Cards
Proof Of Residence (Ex: lease agreement, current mail with mailing address)
Income (Ex: W-2, 1099/Self Employment Expense log or summery of income
Acknowledgment & Signature
Select Your Preparer
*
Please Select
Candice
Shaneka
Alexis
Ebony
Tiffany
Mon Rho
Ernest
James
Marie
Sulita
Latanya
LaToya
Shantayvia
jasmine
April
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I confirmed that all information I entered here is accurate and true.
I allow Strong and Associates DBA KC Fast Tax to capture my sensitive data like personal id, government id, and other information.
I have read the terms and conditions and privacy policy of Strong and Associates.
By signing below, you acknowledge that you have read and understood your responsibilities and our responsibilities in doing this tax return.
Date Signed
*
-
Month
-
Day
Year
Date
Taxpayer Signature
*
Date Signed
-
Month
-
Day
Year
Date
Spouse Signature
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