Client Intake/Interview Form

You will need:

• Social security cards or ITIN letters for all persons on your tax return.

• Picture ID (such as valid, unexpired Driver's License or State ID) for you and your spouse & all adult dependents on your tax return.

• Birth Certificates for all minor dependents on your tax return.

Please complete all pages of this form. You are responsible for the information on your return. Please provide complete and accurate information.

If you have questions, please ask your IRS- certified return preparer.

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

6. Last year, were you:

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9. Last year, was your spouse:

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Part II – Marital Status and Household Information

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

Dependent 1

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Did this person have less than $4,400 of income?
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Dependent 2

a. Relationship to You
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g. Was this person Single or Married as of 12/31/2022?
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Dependent 3

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Dependent 4

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Dependent 5

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  • Part III – Income – Last Year, Did You (or Your Spouse) Receive

  • Part IV - Expenses – Last Year, Did You (or Your Spouse) Pay

  • Part IV - Expenses – Last Year, Did You (or Your Spouse) Pay

  • Additional Information and Questions Related to the Preparation of Your Return

If you do want an advance loan, do you want a fee free loan up to $1k (bank determines amount $250, $500 or $1000) or a loan up to $6k with a 36% APR finance charge?

  • Privacy Act and Paperwork Reduction Act Notice

  • Federal Disclosure:

Federal law requires this consent form be provided to you. Unless authorized by law, we cannot disclose your tax return information to third parties for purposes other than the preparation and filing of your tax return without your consent. If you consent to the disclosure of your tax return information, Federal law may not protect your tax return information from further use or distribution. You are not required to complete this form to engage our tax return preparation services. If we obtain your signature on this form by conditioning our tax return preparation services on your consent, your consent will not be valid. If you agree to the disclosure of your tax return information, your consent is valid for the amount of time that you specify. If you do not specify the duration of your consent, your consent is valid for one year from the date of signature.

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Office: 123 Street

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