TAX INTAKE FORM
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Did you file a 2024 tax return?
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Yes
No
Unsure
Upload 2024 Tax return
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2021 Tax Return
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What is your 2025 AGI (Adjusted Gross Income)
Tax Payers Name
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First Name
Last Name
Taxpayer's Email Address
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Taxpayer's Phone Number
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Example: xxx-xxx-xxxx
Taxpayer's Job Title
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Taxpayer's Date of Birth
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Example: 01/01/2001
Taxpayer's SSN
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Example: xxx-xx-xxxx
Home Address
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Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Can someone else claim you as a dependent?
Yes
No
What is your marital status as of December
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Single (Not Married)
Married living with Spouse
Married not living with spouse
Did you and your spouse live apart during the year?
Yes
No
Not Applicable
If yes, did you live together at any time after June 30, 2025
Yes
No
Not Applicable
Spouse's Full Name
First Name
Spouse's SSN
Example: xxx-xx-xxxx
Spouse's Date of Birth
Example: 01/01/2001
Spouse's Phone Number
Example: xxx-xxx-xxxx
Spouse's Email Address
Example: example@example.com
Spouse's Job Title
Are you trying to buy a new home within the next year?
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Yes
No
Did you pay over half the expenses of maintaining your residence for the entire year?
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Yes
No
ARE YOU LOOKING FOR CREDIT REPAIR?
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Yes
No
Did you support a child or family member for more than 6 months out of the year?
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Yes
No
How many dependents are you claiming?
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Please Select
0
1
2
3
4
Dependent #1
First Name
Last Name
Dependent #1 Date of Birth
01/01/2001
Dependent #1 SSN
What is Dependent #1's Relationship to you (son, daughter, mother, etc.)?
How many months did Dependent #1 live with you in 2025? (If all year, enter 12)
Dependent #2
First Name
Last Name
Dependent #2 Date of Birth
Example: 01/01/2001
Dependent #2s SSN
Example: xxx-xx-xxxx
How many months did Dependent #2 live with you in 2025? (If all year, enter 12)
What is Dependent #2's Relationship to you (son, daughter, etc.)?
Dependent #3
First Name
Last Name
Dependent #3's Date of Birth
01/01/2001
How many months did Dependent #3 live with you in 2025? (If all year, enter 12)
Dependent #3s SSN
Example: xxx-xx-xxxx
What is Dependent #3's Relationship to you (son, daughter, etc.)?
Dependent #4's First Name
First Name
Dependent #4's Last Name
Last Name
Dependent #4's Date of Birth
01/01/2001
Dependent #4's SSN
Example: xxx-xx-xxxx
What is Dependent #4's Relationship to you (son, daughter, mother, etc.)?
How many months did Dependent #4 live with you in 2025? (If all year, enter 12)
Are there any dependents in daycare? If yes, please upload the form you received from your daycare provider.
Yes
No
Upload a copy of your daycare form here.
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If you do not have a daycare form, please provide Name, Address, and EIN/ SSN and amount paid for childcare:
DO YOU AND DEPENDENTS HAVE MEDICAID?
PLEASE UPLOAD MEDICAID CARDS HERE
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If requested by the IRS, do you have documentation (i.e. receipts, records) to substantiate your eligibility for the Child Tax Credit, Earned Income Tax Credit and/or Head of Household Filing Status?
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Yes
No
Are you self employed?
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Yes
No
What is your business name?
What type of business do you have or what type of services do you provide?
Provide a copy of your Business EIN.
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Upload a copy of your DBA or LLC Certificate.
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Did you have health insurance in 2025?
Yes
No
Was your insurance through:
Your Employer
Medicaid
Affordable Care Act (the healthcare.gov marketplace)
Other
Upload Taxpayer & Dependent(s)Insurance Document- 1095-A (if applicable)
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Have you ever been denied the Earned Tax Credit (EITC)?
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Yes
No
Were you or any of your dependents in college in 2025?
Yes
No
Do you have a 1098-T Form from a college for either you or your dependents?
Yes
No
Did you trade any Virtual Currency
Yes
No
Monthly Rent/ Mortgage
Amount paid monthly in rent or mortgage
Anything else we should know to prepare your taxes?
Taxpayer's and Driver's License
*
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Spouse's Driver's License
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Taxpayer's and Dependent(s ) Social Security Card(s)
*
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Taxpayer's W-2/ 1099'S/
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If you have a 1098-T form, upload it here.
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Self-Employment Expense Log, Summary of Income, Business License, Bank Statements, receipts, etc
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Dependent(s) Birth Certificate(s)
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Dependent(s) Proof of Residency (Lease/Utility Bill)
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Additional Documents
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How would you like to receive your tax refund?
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Check
Direct Deposit
Name of Bank
Which type of account would you like your refund deposited into?
Checking Account
Savings Account
Other
Routing Number
Bank Account Number
I acknowledge that all information provided to Universal Taxes is true and accurate to the best of my knowledge. I understand that I am required to have any supporting documentation to validate the information provided. Furthermore, I understand that knowingly providing false information on my tax return and reporting it to the IRS, that I am taking part in a potentially criminal penalty situation and is punishable by law including but not limited to: facing court dates, restitution, and possible imprisonment. I waive Universal Taxes and the preparer of any error due to incorrect information provided by me. By signing below, I authorize Universal Taxes to file my tax return. I acknowlege by signing this form if I and/or my spouse owes a federal/governement debt such as IRS, child support, student loans etc., I/we are still responsible for tax preparation fees due to Universal Taxesat the time of service. Also, if the federal refund amount is mailed, I/we are still responsible for the tax preparation fees stated on the invoice. If the tax preparation fees are not paid, I understand Universal Taxeswill take legal action to collect the unpaid tax preparation fees. Signature*
*
Date
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Month
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Day
Year
Date
Spouse's Signature
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