TAX COMPLIANCE & RESOLUTION INTAKE FORM
Kindly Fill This Form Out So We Can Assist You Better
Client Information
Full Legal Name (and Spouse if filing jointly)
Social Security Number or Tax Identification Number
Date of Birth
-
Month
-
Day
Year
Date
Current Mailing Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Email Address
example@example.com
Filing Status
Please Select
Single
Married Filing Jointly
Married Filing Separately
Head of Household
Qualifying Widow(er)
Do you have dependents?
Yes
No
If Yes: Then Show Dependent Information (Name, DOB, SSN)
Income Information
Did you receive any W-2 forms?
Yes
No
If Yes: Upload W-2 Forms
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Did you receive any 1099 forms (NEC, MISC, INT, DIV, R, etc.)?
Yes
No
If Yes: Upload 1099 Forms
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Did you have self-employment or business income?
Yes
No
Did you sell stocks, cryptocurrency, or other investments?
Yes
No
Did you receive rental income?
Yes
No
Did you receive unemployment benefits?
Yes
No
Did you receive Social Security benefits?
Yes
No
Did you receive any other income not listed above?
Yes
No
If Yes:Please describe the source of income
Deductions & Credits
Do you own a home?
Yes
No
Did you pay mortgage interest?
Yes
No
Did you pay property taxes?
Yes
No
Did you make charitable contributions?
Yes
No
Did you incur significant medical expenses?
Yes
No
Did you pay for childcare?
Yes
No
Did you pay higher education expenses?
Yes
No
Did you contribute to retirement accounts (IRA, 401(k), etc.)?
Yes
No
Did you make estimated tax payments?
Yes
No
Business Owner Section (If Applicable)
Do you own a business?
Yes
No
If Yes:Business Entity Type
Please Select
Sole Proprietor
LLC
S-Corp
C-Corp
Partnership
Total Business Revenue for the Year
Are business financial records up to date?
Yes
Partially
No
Do you have employees?
Yes
No
Are payroll tax filings current?
Yes
No
IRS or State Tax Issues
Have you received IRS or state tax notices?
Yes
No
If Yes:Upload IRS/State Notices
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of
Type of Issue
Audit
Balance Due
Tax Lien
Tax Levy
Wage Garnishment
Unfiled Returns
Other
Tax Years Involved
Total Amount Owed (if known)
Are wages currently being garnished?
Yes
No
Have bank accounts been levied?
Yes
No
Have you spoken with the IRS/state about this issue?
Yes
No
Unfiled Returns
Do you have unfiled tax returns?
Yes
No
If Yes: List Unfiled Years
Do you have income documentation for those years?
Yes
No
Financial Situation (For Resolution Evaluation)
Current Employment Status
Please Select
Employed
Self-Employed
Unemployed
Retired
Average Monthly Income
Average Monthly Living Expenses
Do you own real estate?
Yes
No
Do you own vehicles?
Yes
No
Do you have significant savings or investment accounts?
Yes
No
Have you filed bankruptcy in the past?
Yes
No
Authorization
Do you authorize us to communicate with the IRS/state on your behalf?
Yes
No
Have you previously worked with another tax preparer or resolution firm?
Yes
No
What outcome are you hoping to achieve?
Tax Refund
Payment Plan
Offer in Compromise
Penalty Abatement
Audit Defense
Currently Not Sure
Additional Details About Your Tax Situation
Signature
Date
-
Month
-
Day
Year
Date
Providing complete and accurate information ensures proper financial reporting and compliance.
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