Client Intake 2023

Are you a new client? *

Yes

Prior Year Filing Status: *

Full Name *

DOB *

SSN/ITIN *

Occupation *

Are you assigned an Identity Protection PIN (IP PIN) ? Letter CP01A will be required *

Yes

N/A

Spouse Full Name

DOB

SSN/ITIN

Occupation

Are you assigned an Identity Protection PIN (IP PIN) ? Letter CP01A will be required

Yes

N/A

Street Address *

Address Line 2

City *

State *

Zip Code *

Phone Number *

Email Address *

Dependent Full Name

DOB

SSN/ITIN

Months lived with you for 2023?

Full Time College Student? *

Yes

Disabled? *

Yes

Dependent Information #2

Dependent Full Name

DOB

SSN/ITIN

Months lived with you for 2023?

Full Time College Student? *

Yes

Disabled? *

Yes

Dependent Full Name

DOB

SSN/ITIN

Months lived with you for 2023?

Full Time College Student? *

Yes

Disabled? *

Yes

Did you pay child care? *

Yes

Did you receive unemployment? *

Yes

Are you a homeowner? *

Yes

Did you attend college? *

Yes

Do you have Rental Income? *

Yes

Did You pay for Health Coverage With Covered CA/ Market Place? (If yes, 1095-A/CA 3895 tax form will be required) *

Yes

Are You Current With Your Taxes? *

Yes

At any time during 2023, did you receive, sell, exchange, or otherwise dispose of any financial interest in any virtual currency? *

Yes

If you sell stocks, bonds, derivatives or other securities through a broker, you can expect to receive one or more copies of Form 1099-B in January. This form is used to report gains or losses from such transactions in the preceding year. Did you have any activity in 2023? *

Yes

Service payment options. *

Pay nothing out of pocket with Refund Transfer

We always accept cash, credit card, and debit card.

BANK ROUTING #

BANK ACCOUNT #

To the best of my knowledge the information enclosed in this client tax intake is correct and includes all income, deductions, and other information necessary for the preparation of this years income tax returns for which i have adequate records. *

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