Intake Form

CLIENT INTAKE FORM
Prepared in compliance with:

IRS Circular 230, IRS Form 13614-C (Intake/Interview & Quality Review), and applicable federal & state data privacy laws (including IRC §7216, FTC Safeguards Rule, and state privacy statutes).
How did you hear about us?

FacebookInstagramReferralPrevious ClientWebsite
Tax Preparer Name
Tax Preparer Name*
If someone referred you, please type his or her name here.
Tax Payers Name *

First NameLast Name
Taxpayer's Phone Number*
Example: xxx-xxx-xxxx
Occupation
Taxpayer's Date of Birth*
Example: 01/01/2001
Taxpayer's Email Address*
example@example.com
Spouse's Full Name (if applicable)
First Name
Name

First NameLast Name
Spouse's Date of Birth
Example: 01/01/2001
Spouse's Email Address
Example: example@example.com
Spouse's Phone Number
Example: xxx-xxx-xxxx
Spouse's Job Title
example@example.com
Mailing Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Filing Status (check one):*

singleHead of HouseholdMarried Filing JointlyMarried Filing SeparateQualified Surviving Spouse
Are you self employed?*

YesNo
How many dependents are you claiming?*
If yes, did you live together at any time after June 30, 2022?*

YesNoNot Applicable
Dependent #1

First NameLast Name
Dependent #1 Date of Birth
01/01/2001
What is Dependent #1's Relationship to you (son, daughter, etc.)?
How many months did Dependent #1 live with you in 2024? (If all year, enter 12)
Is the child disabled? If YES, please provide documentation from healthcare provider
Dependent #2

First NameLast Name
Dependent #2 Date of Birth
Example: 01/01/2001
How many months did Dependent #2 live with you in 2024? (If all year, enter 12)
What is Dependent #2's Relationship to you (son, daughter, etc.)?
Is the child disabled? If YES, please provide documentation from healthcare provider
Dependent #3

First NameLast Name
Dependent #3's Date of Birth
ex 01/01/2001
How many months did Dependent #3 live with you in 2024? (If all year, enter 12)
What is Dependent #3's Relationship to you (son, daughter, etc.)?
Is the child disabled? If YES, please provide documentation from healthcare provider
Dependent #4's First Name
First Name
Dependent #4's Last Name
Last Name
Dependent #4's Date of Birth
01/01/2001
What is Dependent #4's Relationship to you (son, daughter, etc.)?
How many months did Dependent #4 live with you in 2024? (If all year, enter 12)
Is the child disabled? If YES, please provide documentation from healthcare provider
Dependent #5's First Name
First Name
Dependent #5's Last Name
Last Name
Dependent #5's Date of Birth
01/01/2001
What is Dependent #5's Relationship to you (son, daughter, etc.)?
How many months did Dependent #5 live with you in 2024? (If all year, enter 12)
Is the child disabled? If YES, please provide documentation from healthcare provider
Are there any dependents in daycare? If yes, please upload the form you received from your daycare provider.

YesNo
Upload a copy of your daycare form here.

Cancelof
Do you get an IP PIN from IRS each year? If so, upload here.

Cancelof
Did you pay over half the cost of keeping up your home in 2025? Upkeep expenses include rent, utilities, food eaten in the home, mortgage interest, real estate taxes, and insurance on the home. If you use payments you receive under a public assistance program to pay part of the cost of keeping up your home, you cannot count them as money you spent. However, you must include them in the total cost of keeping up your home to figure out if you paid over half the cost. By answering "YES" you are confirming that if requested by the IRS, you can provide documentation that verifies you paid for over half the cost of keeping up your home.*

YesNo
If married, Did you and your spouse live apart for the last 6 mos. of the the year?*

YesNoNot Applicable
Dependent(s) Proof of Residency (letter from school, doctor, social services benefit letter if you get Medicaid, Food Stamps (SNAP), or Cash Assistance from the state. Please upload award letter.)

Cancelof
What is your marital status as of December*

Single (Not Married)Married living with SpouseMarried not living with spouseQualified Surviving Spouse
Does anyone receive SNAP benefits?*

YesNo
Did your address change since last years return?

YesNo
Can someone else claim you as a dependent?

YesNo
How would you like to receive your tax refund?

Check (pick up or sent regular mail or you can pay $30 to be expedited)Direct DepositNet spend card (will be mailed sent regular mail or you can pay $30 to be expedited)
Name of Bank
Which type of account would you like your refund deposited into?

Checking AccountSavings AccountOther
Routing Number
Bank Account Number
Did you have health insurance during the year?

YesNo
Did you have health insurance for the entire year?

YesNo
Who was your insurance coverage through?*
Was your insurance through the Affordable Care Act (The Marketplace)?

YesNo
Did your dependents have health insurance for the entire year?

YesNoNot Appliable
Was YOUR DEPENDENTS' insurance through your employer?

YesNoNot Applicable
Who was your Dependents insured with?*
Upload Taxpayer & Dependent(s)Insurance Documents

Cancelof
Have you ever failed an audit or been disallowed for EITC/AOTC/CTC/ACTC or dependents from your tax return?

YesNo
Have you ever been denied the Earned Income Tax Credit (EITC)?

YesNo
Did you receive, sell, exchange, or otherwise dispose of digital assets during the year?

YesNo
Do you (or your spouse) owe any offsets to the IRS, State, Child Support, or any agency?*

YesNo
Does anyone receive Social Security/Disability benefits? If yes, please upload forms below*

YesNo
File Upload

Cancelof
Were you or any of your dependents in college at least half-time for at least one academic period this tax year?

YesNo
Do you have a 1098-T Form for either you or your dependents?

YesNo
Has the student ever been convicted of a felony for possession or distribution of a controlled substance?

YesNo
Has the student completed the first 4 years of postsecondary education (a grad student)?

YesNo
If you have a 1098-T form, or any receipts paid out of pocket for school, upload it here.

Cancelof
Taxpayer's W-2/ 1099'S - Income

Cancelof
If you have any additional supporting files, upload here.

Cancelof
Dependent(s) Birth Certificate(s) SS Card(s) ID (s)

Cancelof
If filing HOH, please upload a copy of lease, mortgage or a utility bill

Cancelof
Are you interested in AUDIT PROTECTION? 2024 its included for FREE!

YesNo
ADDITIONAL SERVICES Taxes R Us Elite LLC, we do more than just taxes. Please check below if you would be interested in any of the additional services we provide. We will schedule a time to speak with you at a later time.
Additional Services

Help buying and/or Selling a home?Book keeping serviceNotary
Thank you for choosing our firm to prepare your income tax returns for tax year 2025. This shall confirm the services we will provide.

We will prepare your federal and state returns for tax year 2025 based on information you provide. Although our work will not include procedures to discover irregularities or inaccuracies in the tax data you provide, we may ask for clarification of certain information, or additional information, so that we can prepare accurate and complete returns for you.

It is your responsibility to provide all necessary information related to income and deductions for tax year 2025, and to respond to our inquiries in a timely manner so that we are able to accurately complete your returns by the appropriate due dates.

You are responsible for maintaining appropriate records, such as official tax documents you receive, receipts and substantiation for your deductions, and purchase and sales information for assets.

It is your responsibility to review your returns before they are filed to determine that all income has been correctly reported and that you have substantiation for your deductions. Filing your returns by the due dates is your responsibility.

If your returns are later selected for review or audit by taxing authorities, we will be glad to assist or represent you if you desire. Our fees for preparing your returns do not include time that might be necessary to assist you during a taxing authority review.

Our fees for preparation of your returns are based upon our standard billing rates plus out-of-pocket expenses. Our invoices are due and payable upon presentation.

If this letter accurately summarizes your understanding of our agreement relating to the preparation of your tax returns, please sign below in the space indicated and return it to us.

Thank you again for choosing our firm to prepare your 2024 tax return. We appreciate your business.

Sincerely,

Taxes R Us Elite llc
IRC §7216 Consent for Use of Tax Information*

Powered by Jotform SignClear
I authorize Taxes R Us Elite LLC to use my tax return information for the purpose of preparing my tax return and providing related tax services. I also consent to electronic delivery of my tax documents and communication via secure electronic methods.
Date*

MonthDayYear
Date
Electronic Delivery & Communication Consent*

Powered by Jotform SignClear
I consent to electronic delivery of my tax documents and communication via secure electronic methods.
TAXPAYER CERTIFICATION (Circular 230 Compliance)*

Powered by Jotform SignClear
I certify that all information provided is true, correct, and complete to the best of my knowledge. I understand that I am responsible for the accuracy of my tax return.
Privacy Notice: Taxes R Us Elite LLC maintains administrative, technical, and physical safeguards to protect your information as required by federal and state law.

SECURE REMOTE SERVICES DISCLOSURE
Taxes R Us Elite LLC provides virtual tax preparation services using encrypted portals, secure document upload systems, and multi-factor authentication where available. Clients agree not to transmit tax information via unsecured email or text messaging.

To comply with IRS due diligence and identity theft prevention guidelines, clients may be required to submit:

☐ Government-issued photo ID
☐ Selfie or live identity verification
☐ Prior-year tax return (if available)
Should be Empty:

CLIENT INTAKE FORM

Prepared in compliance with: