TAX PREP CLIENT INTAKE FORM

Filing Status *

TAXPAYER INFORMATION:

Full Name *

Social Security #

Date of birth

Phone *

Email *

Address

Street Address

City

State

Country

Postal code

Occupation

Are you a full-time student?

Yes

No

Are you totally and permanently disabled?

Yes

No

Are you legally blind?

Yes

No

SPOUSAL INFORMATION

Spouse Full Name

Spouse Social Security #

Spouse Date Of Birth

Phone Number

Email Address

Spouse Occupation

Are they a full-time student?

Yes

No

Are they totally and permanently disabled?

Yes

No

Are they legally blind?

Yes

No

Are they your dependent?

Yes

No

LIST DEPENDENTS YOU ARE CLAIMING THIS YEAR

Full Name Ind. 1

Social Security #1

Dependent #1 Date Of Birth

Relationship to Taxpayer/Spouse (#1)

Full Name Dep. 2

Social Security #2

Dependent #2 Date of Birth

Relationship to Taxpayer/Spouse (#2)

Full Name Dep. 3

Social Security #3

Dependent #3 Date of Birth

Relationship to Taxpayer or Spouse #3

Full Name Dep. 4

Social Security #4

Dependent #4 Date of Birth

Relationship to Taxpayer or Spouse #4

TAX RELATED QUESTIONS:

Employment Status

Are you contributing to 401k or other pre-tax account?

Yes

No

Is this your first time opening a pre-tax account?

Yes

No

Are you currently renting?

Yes

No

What is the monthly rental amount?

GENERAL EXPENSES:

Enter the following expenses total amount

Medical Expenses
Dental Expenses
Insurance Premiums paid
Long Term Care Premiums
Prescription Drugs and Medications
Home Mortgage
Investment Interest
Cash Contributions
Non-Cash Contributions
Unreimbursed Business Expenses
Union Dues
Tax Preparation Fees
Investment Expenses

ACKNOWLEDGMENT & SIGNATURE

I confirmed that all information I entered here is accurate and true.
I allow ABC Financial to capture my sensitive data like personal id, government id, social security number (SSN), and other information.
I have read the terms and conditions and privacy policy of ABC Financial.
By signing below, you acknowledge that you have read and understood your responsibilities and our responsibilities in doing this tax return.

Date Signed

I Agree.

By selecting "I agree", I confirm that all information provided is accurate, complete, and up-to-date to the best of my knowledge. I understand that providing false or incomplete information may result in delays or complications. I acknowledge that it is my responsibility to review and verify the details submitted.