Tax Preparation Client Intake Form

Taxpayer

Name

First

Last

Date of Birth

Age

Occupation

Phone Number

Client Email

Address

Address Line 1

Address Line 2

City

State

Zip Code

Spouse Information

Name

First

Last

Date of Birth

Age

Occupation

Phone Number

Client Email

Address

Address Line 1

Address Line 2

City

State

Zip Code

Depdendents

Name

Date of Birth

Relationship

Income Information

Social Security Benefit

Yes
No

Rental Property Income

Unemployment Compensation

Yes
No

Other Sources of Income

Expenses Information

Please fill-up the information within the current year only.

Medical Expenses

Insurance Premium Paid

Home Mortgage

Cash Contributions

Union Dues

Dental Expenses

Prescription Drugs and Medicines

Investment Interest

Non-Cash Contributions

Tax Preparation Fees

Total Expenses

$0.00

Acknowledgement & Signature

All information provided in this form is accurate and true to the best of my knowledge.
I have read and fully comprehended XYZ Company’s privacy and terms of service policies.
My signature here authorizes XYZ Company to obtain, use, and keep my name, address, phone number, email address, and other identifying information.
By signing here, I attest that I have read this agreement and fully understand my role and ABC Financial’s role in preparing my tax return.

Rental Client Occupation

Taxpayer Signature

Clear Signature

Date Signed