Income Tax Filing Client Intake Form

Income Tax Filing Application Form

Income Tax Filing Client Intake Form

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DATE OF CONSULTATION

REFFERAL

ONLINE ADS
OFFICE WALK-IN Location
TAX PREPARE REFFERAL
FRIENDS OR FAMILY

TAXPAYER INFORMATION

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FIRST NAME

LAST NAME

DATE OF BIRTH

ADDRESS

Address Line 1

Address Line 2

City

State

Zip Code

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HOME PHONE

WORK PHONE

EMAIL ADDRESS

DRIVER LICENSE NUMBER

MOBILE PHONE

DRIVER LICENSE ISSUE DATE

SOCIAL SECURITY NUMBER

IDENITITY PROTECTION PIN [IPPIN]

DRIVING LICENSE ISSUED STATE

OCCUPATION

DRIVER LICENSE EXPIRATION DATE

PERSONAL STATUS

FULL-TIME STUDENT
TOTALLY AND PERMANENTLY DISABLED
LEGALLY BLIND
DEPENDENT OF OTHERS

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LIFE EVENTS – LAST YEAR, DID YOU (OR YOUR SPOUSE)

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4. Have Earned Income Credit, Child Tax Credit or American Opportunity Credit disallowed in a prior year?

Yes
No
Unsure

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7. Make estimated tax payments or apply last year’s refund to this year’s tax?

Yes
No
Unsure

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8. File a federal return last year containing a “capital loss carryover” on Form 1040 Schedule D?

Yes
No
Unsure

9. Have health coverage through the Marketplace (Exchange)? [Provide Form 1095-A]

Yes
No
Unsure

INCOME – LAST YEAR, DID YOU (OR YOUR SPOUSE) RECEIVE

EXPENSES – LAST YEAR, DID YOU (OR YOUR SPOUSE) PAY

TAX-SPECIFIC QUESTIONS

1.WHAT IS YOUR CURRENT EMPLOYMENT STATUS?

Employed
Unemployed
Self-employed / Business Owner

2.ARE YOU CURRENTLY CONTRIBUTING TO A 401K OR OTHER PRE-TAX ACCOUNTS?

3.HAVE YOU MADE A WITHDRAWAL FROM YOUR 401K THIS YEAR?

4.IS THIS YOUR FIRST TIME OPENING A PRE-TAX ACCOUNT?

6.HAVE YOUR DEPENDENTS INCURRED ANY TUITION EXPENSES?

7.HAVE YOU INCURRED ANY CHILD CARE EXPENSES?

8.DID YOU INSTALL SOLAR SYSTEM ON YOUR HOME THIS YEAR?

9.DID YOU PURCHASE AN ELECTRIC VEHICLE THIS YEAR?

10.PLEASE LIST ALL ENERGY STAR RATED IMPROVEMENTS YOU HAVE MADE TO YOUR HOME?

11.ARE YOU CURRENTLY RENTING YOUR RESIDENCE?

13.DO YOU OWN ANY RENTAL PROPERTY ?

14.DO YOU OWN YOUR RESIDENCE?

15-HAVE YOU PAID PROPERTY TAXES THIS YEAR?

16.HAVE YOU PAID REAL ESTATE TAXES THIS YEAR?

17.HAVE YOU PAID MORTGAGE INTEREST THIS YEAR?

18.HAVE YOU PAID ANY INHERITANCE TAXES THIS YEAR?

19.HAVE YOU SOLD ANY STOCKS THIS YEAR?

20.DID YOU BOUGHT OR SOLD ANY CRYPTOCURRENCY ?

21.HAVE YOU PAID VEHICLE TAXES THIS YEAR?

22.HAVE YOU BEEN A VICTIM OF IDENTITY THEFT IN THE PAST YEAR?

EXPENSES (CURRENT YEAR ONLY)

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Medical

Single Item

Dental

Single Item

Insurance Premiums Paid

Single Item

Long-Term Care Premiums

Single Item

Child-Care And Day-Care Expenses

Single Item

School Expenses

Single Item

Prescription Drugs and Medication

Single Item

Home Mortgage Interest

Single Item

Charity Contribution

Single Item

Investment Interest

Single Item

Property Taxes

Single Item

Cash Contributions

Single Item

Non-Cash Contributions

Single Item

Unreimbursed Business Expenses

Single Item

Union Dues

Single Item

Tax Preparation Fees

Single Item

Investment Expenses

Single Item

Total

$0.00

NOTES AND COMMENTS

Disclaimer: The information on this form is intended for informational purposes only and does not constitute professional tax advice. It is important to note that tax laws and regulations can be complex and subject to change. We strongly recommend that you consult with a qualified tax professional to ensure your tax return is prepared accurately and complying with all applicable laws. By providing your information on this form, you acknowledge that we are not responsible for any errors or omissions in the information provided. Additionally, we are not responsible for any adverse consequences that may arise from relying on the information provided on this form.

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Income Tax Filing Application Form