Client Intake Form 2021

CLIENT INTAKE FORM

PLEASE FILL OUT ALL INFORMATION APPLICABLE
Thank you for choosing KHL Tax& financial Services for your tax preparation needs. In order for us to file your federal and state return, we need the following information listed in this form. The information you provide to us will remain confidential. Please complete this form in its entirety. We are here to provide all clients with a professional, prompt and proficient experience. Would you like to proceed?
Personal Information
Taxpayer Name

First NameMiddle NameLast Name
Apartment/ Unit
City
State
Zip Code
Cell Phone
Home Phone
Email
Birth Date

MonthDayYear
Society Security Number
TaxPayer Employer
TaxPayer Workphone
Driver Licensed
issued Date

MonthDayYear
Expiration Date

MonthDayYear
Spouse Information
Spouse Information

Spouse First NameSpouse Middle NameSpouse Last Name
Social Security Number
Occupation
Spouse's Email
example@example.com
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Spouse's Bith Date

MonthDayYear
Spouse’s Driver License/I.D.#
Spouse’s Issued Date

MonthDayYear
Spouse’s Expiration Date

MonthDayYear
Residence State (List the state you resided in)
Residence State (List the state you resided in)
Filing Status:
HEAD OF HOUSEHOLD FILERS MUST PRESENT ONE OF THE FOLLOWING TO FILE THIS STATUS. PICK ONE OF THE 3 OPTIONS THAT YOU WILL SUBMIT TO BE APPROVED TO FILE HEAD OF HOUSEHOLD.
In case your contact information changes; we can contact you regarding your refund.

FacebookEmail
Dependent 1

First NameMiddle NameLast Name
Date of Birth

MonthDayYear
Relationship
Dependent Information

First NameLast NameSuffix
Social Security Number
Date of Birth

MonthDayYear
Relationship
Date of Birth

MonthDayYear
Relationship
IF YOU ARE CLAIMING A DEPENDENT, PLEASE ANSWER THE QUESTIONS BELOW THAT PERTAINS TO YOUR DEPENDENT RELATIONSHIP. PER THE IRS REQUEST, WE MUST PROVE THAT NOBODY ELSE IS ELIGIBLE TO CLAIM YOUR DEPENDENT BUT YOURSELF.
If claiming son/daughter, where is the other parent of the dependent/dependents? Is the other parent providing any financial support?
If claiming niece, nephew, aunt, or uncle, how are you related to the dependent? Where are the parents to the dependent/dependents?
If claiming brother or sister, how are you related to the dependent? Why are the parents not claiming the dependent/dependents?
Did you pay someone to watch your child/children?
Did you have a child care expenses
Child Care Provider

Child Care Provider AddressCity/ State/ Zip
SOCIAL SECURITY # OR FED ID NUMBER
Amount Paid
How many jobs did you work this year?
Did you collect social security or retirement income?
Did you purchase health insurance through healthcare.gov marketplace (Obama Care)?
If yes, did you receive a 1095-A Form from the marketplace?
Were you ever disallowed the E.I.T.C prior to this year?
Did you receive unemployment compensation (1099-G) regular or PUA last year?
How many jobs did you work this year?
Did you attend college, night school, internet schooling, or any post-secondary educational facility to gain a skill or degree?
If yes, did you receive regular unemployment or PUA?
Did you make college tuition payments and received a 1098-T Form last year?
Do you have any other income than your w-2(s)?
Do you own a home
Do you owe for home buyers credits?
Did you pay church tithes and offerings?
Do you owe any delinquent:
ALTERNATE ELIGIBILTY RECORD (Due Diligence)

In accordance with Internal Revenue Service (IRS) Bulletin 97-65 and Internal Revenue Code (IRC), this form serves as Alternate Eligibility Checklist, and may be used IN LIEU of other forms of Due Diligence, including form 8867. Maintain this form with your client files.
HEAD OF HOUSEDHOLD ELIGIBILITY

You may file Head of Household if you can answer YES to ALL the following questions. (See Publication 17, Chpt 2&3)

HEAD OF HOUSEDHOLD ELIGIBILITY

Rows	Yes	Now
You paid more than half the cost of keeping up a home for the year.
You are unmarried, or are considered unmarried on the last day of the year.
A qualifying person (definition below) lived with you in the home for more than half the year (except temporary absences, such as school), and you can claim an exemption for him/her except as noted under Category 3 below.

A qualifying person requirements are: (See Table 2-1, Publication 17)

A qualifying relative such as parent, grandparent, brother, sister, stepbrother, stepsister, stepmother, stepfather, father-in-law, half-brother, half-sister, brother-in-law, sister-in-law, daughter-in-law, uncle, aunt, nephew, or niece who is related to you by blood and lived with you for the entire year. Child, grandchild, stepchild, or adopted child. Eligible foster child. (Note: For eligibility for dependent only a foster child is a child who is in your care, that you care for as your own child, and who lived with you the entire year. It does not matter how the child became a member of the household)
EARNED INCOME CREDIT (EIC) ELIGIBILTY

You may claim the EIC if you can answer YES to ALL 4 tests below. (See publication 17, Chapter 36)

EARNED INCOME CREDIT (EIC) ELIGIBILTY

Rows	Yes	No
Your child/ children is/are one of the following: a son, daughter, adopted child, stepchild, grandchild, or eligible foster child or is your brother, sister, stepbrother, stepsister (or the child or grandchild of your brother, sister, stepbrother, or stepsister), and you care for it/them as you would your own child.
Your child/children is/are under 19 years of age at the end of the year, or is under 24 years of age at the end of the year and is a full-time student, or was permanently and totally disabled at any time during the tax year, regardless of age.
Your child/ children lived with you for more than half the year (or the whole year if an eligible foster child)
Your home is in the United States
If your child/ children is/are the qualifying child/ children of another individual, you are the only person claiming the credit for that/ those child/children during the tax year. (Note: If the answer is NO, refer to the tiebreaker rule. You may still be able to take the credit.

FOSTER CHILD ELIGIBILTY

The definition of a foster child has changed. For establishing eligibility for dependency, see above. For establishing eligibility for the Child Tax Credit and Earned Income Credit you must be able to answer YES to ALL the questions below.

FOSTER CHILD ELIGIBILTY

Rows	Yes	No
You cared for the child/ children as you would your own child.
The child/ children lived with you for the entire year, except for temporary absences.
The child/ children was/ were placed in your care by a State, one of its subdivision, or placement agency.

Were you self-employed?
Self-Employment Form
Tax Year
Meals/ Entertainment
Cost of Goods for Sale
Office Expenses
Professional Fees
Contacts Labor
Equipment Rent/ Lease
Advertising
Auto Mileage or Cost
Property Rent
Commissions & Fees
Insurance
Meals/ Entertainment
Travel
How would you like to receive your refund?

Bank Information

Rows	Name of Bank	Routing Number	Account Number
ENTER BANK DATA

I, hereby, state that all the information above is true to the best of my knowledge and that I am allowing On Time Taxes to prepare my taxes based on that fact. I understand that I am financially responsible for any outstanding balance due to any false information given.

If there is a balance due, you must pay the tax preparation fee upfront. If for any reason you owe an entity and they take the entire refund, you are STILL responsible to pay the tax preparation fee for services rendered.

*For any reason an amendment has to be filed with no fault of the tax preparer, an upfront fee of $150.00 is required! Please view your tax return, which is emailed to you (it is sent prior to submission). Any copy after the first copy is a fee of $10.00.

ALL FEES (bank and service fees) are found in the return and are non-refundable nor negotiable! NO EXCEPTIONS TO THIS!!

Please utilize www.irs.gov for all federal refund tracking. Please utilze your state Department of Revenue site for any State Refund tracking. Do NOT add the amounts together. Federal taxes are federal, and state taxes are state when tracking your status. Please allow 8 weeks to surpass from the date of submission before calling the IRS, if you have any tracking questions.

For any direct assistance please email ontimetaxes.79@gmail.com

IRS Contact 800-829-1040

Please click this link to check your federal refund status. You will need your filing status, social security number, and the total amount of the refund before fees

https://sa.www4.irs.gov/irfof/lang/en/irfofgetstatus.jsp
Agreed

I (we) have reviewed the information in this questionnaire (including the business and rental data sheets, if applicable) and to the best of my (our) knowledge it is accurate, correct and complete. Anything that is false or inaccurate may be prosecuted or their taxes may be forfeited/rejected. By signing this affidavit, you are stating that everything above and on previous forms is the truth and accurate and KHL Tax Services is not responsible for anything that is falsified on your client tax information sheets. We agree to hold KHL taxes & financial service Services harmless for any errors that they may make on my/our tax return. I (we) also understand that error on my/our return will cause a delay/audit in the processing of the return and the receipt of the refund, if any.
Signature
Comment
Date

MonthDayYear

CLIENT INTAKE FORM

Personal Information

Spouse Information

ALTERNATE ELIGIBILTY RECORD (Due Diligence)

HEAD OF HOUSEDHOLD ELIGIBILITY

A qualifying person requirements are: (See Table 2-1, Publication 17)

EARNED INCOME CREDIT (EIC) ELIGIBILTY

FOSTER CHILD ELIGIBILTY

Self-Employment Form

KHL TAXES