Client Intake Form Please enable JavaScript in your browser to complete this form. - Step 1 of 3Please select your tax advisorJae P.Sam. RSamantha E.Linda N.Any available advisorNew or Returning Client? *New ClientReturning ClientFor New clients, how did you hear about us?Yard Sign Business Card/FlyerFacebookInstagramReferralCraigslisteTax EmployeePERSONAL INFORMATIONFILLING STATUS: *Head of Household SingleMarried/Jointly Married/SeparatelyWidowerNot sure (please help me choose)TaxpayerSocial Security or ITIN *First & Last Name (as it appears on your social) *Birthdate *Occupation *Cell Phone *Email *Facebook name (to be used if we can't reach you by phone or email).AddressAddress Line 1Address Line 2CityAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodeSpouseSocial Security or ItinFirst & Last Name (as it appears on your social)BirthdateOccupationPhoneEmailFacebook name (to be used if we can't reach you by phone or email).NextDEPENDENT INFORMATION (First Kid)Dependent Name (First, Last)Date of BirthSocial SecurityDependent’s Relationship to youHow many months did the dependent live with you last year?College Student / Disabled/DaycareYesNoDEPENDENT INFORMATION (Second Kid)Dependent Name (First, Last)Date of BirthSocial SecurityDependent’s Relationship to youHow many months did the dependent live with you last year?College Student / Disabled/DaycareYesNoDEPENDENT INFORMATION (Third Kid)Dependent Name (First, Last)Date of BirthSocial SecurityDependent’s Relationship to youHow many months did the dependent live with you last year?College Student / Disabled/DaycareYesNoDEPENDENT INFORMATION (Fourth Kid)Dependent Name (First, Last)Date of BirthSocial SecurityDependent’s Relationship to youHow many months did the dependent live with you last year?College Student / Disabled/DaycareYesNoNextQUESTIONNAIRECan you provide any records that show the dependents lived with you? (medical/school records, daycare letter) *YesNoNot ApplicableWas anyone listed on this form a college student during the last year? (If yes, please upload form 1098T from the college).YesNoNot ApplicableDid you pay for daycare or afterschool care for any of your dependents that are under 12? (If so, please provide a daycare letter).YesNoNot ApplicableDid you receive a refund last year? *YesNoIf no, why?Refund AmountDid you receive an advance (refund loan) last year? *YesNoIf no, why?Did you purchase health insurance from the marketplace (Obamacare)? (Form 1095-A is needed if yes). *YesNoPlease upload the 1095A form from Healthcare.gov if you had marketplace insurance (Obamacare). Click or drag a file to this area to upload. Did you receive an IRS identity theft pin number? *YesNoIf you received an IRS identity theft pin number please upload the letter. Click or drag a file to this area to upload. SELF EMPLOYED/1099MISC/BUSINESS INFORMATION(Must complete business questionnaire form)Were you self employed and/or had business income/expenses last year? (If so, please complete the business questionaire provided by your tax advisor) *YesNoLicense (Please upload an ID for you and for your spouse if filling jointly). * Click or drag files to this area to upload. You can upload up to 2 files. All Social Security Cards Click or drag files to this area to upload. You can upload up to 6 files. Birth certificates of dependents or a supporting document to show they lived with you (i.e. medicaid eligibility letter, lease) Click or drag files to this area to upload. You can upload up to 4 files. Utility bill from last year or a Lease if Filling Head of Household Click or drag files to this area to upload. You can upload up to 2 files. Tax Forms (W2, 1099s, 1098T, Daycare letter, etc...) Click or drag files to this area to upload. You can upload up to 10 files. Do you certify that all information provided is accurate and true to your knowledge *YesNoATTESTATION STATEMENTUnder the penalties of perjury, I/We attest that all information supplied and contained on this form is true, correct, to the best of my/our knowledge.Paragraph TextWebsiteSubmit
