client intake

You will need:

- Tax Information such as Forms W-2, 1099, 1098, 1095.
- Social security cards or ITIN letters for all persons on your tax return.
- Picture ID (such as valid driver's license) for you and your spouse.
- You are responsible for the information on your return. Please provide
  complete and accurate information

Part I – Your Personal Information (If you are filing a joint return, enter your names in the same order as last year’s return)

First Name

Middle Name

Last Name

Phone

Are you a U.S. citizen?YesNoAre you a U.S. citizen?

First Name

Middle Name

Last Name

Phone

Is your spouse a U.S. citizen?YesNoIs your spouse a U.S. citizen?

Mailing address

Apt #

City

State

Zip Code

4. Your Date of Birth

5. Your job title

7. Your spouse’s Date of Birth

8. Your spouse’s job title

Part II – Marital Status and Household Information

1. As of December 31, 2024, were you:

Never Married(This includes registered domestic partnerships, civil unions, or other formal relationships under state law)

A. If Married, Did you get married in 2024?YesNo

B. If married, Did you live with your spouse during any part of the last six months of 2024?YesNo

If divorced, Date of final decree

If Legally Separated, Date of separate maintenance agreement

If widowed, Year of spouse’s death:

2. List the names below of:

Everyone who lived with you last year (other than your spouse)
Anyone you supported but did not live with you last year

Name (first, last) Do not enter your name or spouse’s name below (a)

Date of Birth (mm/dd/yy) (b)

Relationship to you (for example: son, daughter, parent, none, etc) (c)

Number of months lived in your home last year (d)

US Citizen (yes/no) (e)

Resident of US, Canada, or Mexico last year (yes/no) (f)

Single or Married as of 2024 (S/M) (g)

Full-time Student last year (yes/no) (h)

Totally and Permanently Disabled (yes/no) (i)

Check appropriate box for each question in each section

Visit http://www.healthcare.gov/ or call 1-800-318-2596 for more information on health insurance options and assistance.

If advance payments of the premium tax credit were paid on your behalf to help pay your health insurance premiums, you should report life changes, such
as, income, marital status or family size changes, to your Marketplace. Reporting changes will help to make sure you are getting the proper amount of
advance payments.

1. Provide an email address (this email address will not be used for contacts from the Internal Revenue Service)

2. If you are due a refund, would you like:a. Direct depositb. To purchase U.S. Savings Bondsc. To split your refund between different accounts

3. If you have a balance due, would you like to make a payment directly from your bank account?YesNo

4. Have you or your spouse received any letters from the Internal Revenue Service?YesNo

Checking Account #

Saving Account #

Name of Bank:

Routing #

Signature of Taxpayer:

Signature of Spouse:

Additional Tax Preparer notes:

Taxpayer:Presidential Election Campaign Fund (If you check a box, your tax or refund will not change) Check here if you, or your spouse if filing jointly, want $3 to go to this fund

Spouse:Presidential Election Campaign Fund (If you check a box, your tax or refund will not change) Check here if you, or your spouse if filing jointly, want $3 to go to this fund

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IRS Circular 230 Disclosure

To ensure compliance with requirements imposed by the IRS, we inform you that any U.S. tax advice contained in this communication (including any attachments) is not intended or written to be used, and cannot be used, for the purpose of (i) avoiding penalties under the Internal Revenue Code or (ii) promoting, marketing or recommending to another party any transaction or matter addressed herein.

This message is intended only for the designated recipient(s). It may contain confidential or proprietary information and may be subject to the attorney-client privilege or other confidentiality protections. If you are not a designated recipient, you may not review, copy or distribute this message. If you receive this in error, please notify the sender by reply e-mail and delete this message. Thank you.

You will need:

IRS Circular 230 Disclosure

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