Client Intake Form

Thank you for allowing us to prepare your income taxes this year. Please fill out the intake form and send it back ASAP. Once we receive it we can start working on your taxes and getting you that MONEY. All * must be answered or completed.

We can be reached by email, phone, or text. Please allow 24 hours to respond to emails.

Call or text anytime.

Angie: 321-315-0771

Jorge: 321-277-0857 Se habla español

Email: angiestaxservices@yahoo.com

Today's Date * 🛈 +

Filing Status * 🛈

First Name *

Spouse's First Name

Middle Name * 🛈

Spouse's Middle Name 🛈

Last Name *

Spouse's Last Name

Date of Birth * 🛈 +

Social Security Number *

Spouse's Date of Birth +

Spouse's Social Security Number

Street Address *

Address Line 2

City *

State *

Zip *

Phone Number *

Email Address *

Referred By 🛈

IRS Identity Pin Number, If applicable

Did you purchase Marketplace insurance & receive a 1095A? * 🛈

Yes

Income Information

Occupation *

Do you own and operate a small business/home based business? *

Yes

Did you receive a 1099! *

Yes

Did you receive unemployment benefits in 2023? (If yes, you will be asked to upload your 1099-G below). *

Yes

REFUND OPTIONS

Would you like to apply for the Easy Advance up to $1,000 with no extra charge? * 🛈

Yes

How would you like your refund to be deposited when ready? *

Check

Direct Deposit

Pre-Paid Card

Provide banking information 🛈

Would you like more information on our Credit Repair packages? 🛈

Yes

Are there any other issues or concern regarding this year or any previous year tax returns? If yes, please explain.

0/250 characters

DEPENDENT INFORMATION

Number of dependents * 🛈

Please provide full name, date of birth, social security number, and your relation to each dependent.

0/200 characters

Did you pay any childcare in 2023? *

Yes

DOCUMENT UPLOAD

W2 or Income Verification Documents/1099

Dependents Birth Certificate or Passport & social security cards

Driver License or State ID *

Upload your Social Security Card *

College/Tuition expense *If filing for college credits a 1098T must be included

Daycare yearly expenses

Upload all supporting documents for your business (IF APPLICABLE). (DBA, receipts, log sheet, flyers, business cards or price list)

Upload form 1098 if you are claiming mortgage interest. (Homeowners Only)

Upload form 1099-G if you received Unemployment Benefits

Upload form 1095-A if you had insurance through Marketplace 🛈

DUE DILIGENCE QUESTIONNAIRE

The United States Congress have, as a reaction to the substantial tax fraud resulting from their original error of choosing to distribute federal social welfare program benefits via the tax return, placed new excessive inappropriate “due diligence” requirements on paid tax return preparers whose clients are claiming certain tax credits. This added to the excessive and inappropriate requirements previously implemented by the Internal Revenue Service, the IRS has forced tax preparers to, in many cases, become Social Workers and verify that their clients qualify to receive certain credits i.e. EIC, CTC, ACTC, and now HOH.
We preparers are not compensated by the IRS or the government for doing their job for them but must pass the costs of this required additional work on to our taxpayer clients.
You will be claiming an Earned Income Credit, Child Tax Credit, Additional Child Tax Credit, HOH, and/or an American Opportunity Credit on your 2023 tax return. Because of this you must complete, sign, and return this questionnaire to me. I will keep the original signed copy of this questionnaire with my file copy of your 2023 tax return and will include a photocopy of the completed questionnaire in the package I send you with the finished returns.

1. I/we certify that the child(ren) for whom the tax credit(s) will be requested can be claimed as my/our dependent(s), as per the information provided at the end of this questionnaire. *

Yes

N/A

2. The child(ren) for whom the tax credit(s) will be requested lived with me/us for the year, except for temporary absences. *

Yes

N/A

3. I am the custodial parent of the child(ren) for whom the tax credit(s) will be requested, and I released the dependency deduction to my former spouse for 2023 by signing Form 8332 (Release/Revocation of Claim to Exemption for Child by Custodial Parent). *

Yes

N/A

4. I am not the custodial parent of the child(ren) but I have been given a signed Form 8332 by my former spouse, the custodial parent, allowing me to claim the child(ren) as the dependent(s) on my 2023 tax returns (you must give me the Form 8332). *

Yes

N/A

5. I/we, or my child(ren), have documentation to substantiate the credit(s) being claimed, such as Form 1098-T, bills, statements, and receipts for college tuition, fees, and book and material costs (you are responsible for keeping this documentation and providing it to the IRS if you are audited or questioned). *

Yes

N/A

6. Was a Child Tax Credit, Additional Child Tax Credit, or American Opportunity Credit claimed by you disallowed or reduced by the IRS on a past tax return? *

Yes

N/A

7. I claim I am unmarried or separated, support a qualifying person as your dependent, and pay more than half the cost of maintaining your household. *

Yes

N/A

ATTESTATION AND DISCLAIMER

ANGIE'S TAX SERVICES is not responsible if the taxpayer provides us with incorrect information (i.e. social security numbers for self, spouse, or dependents, last names, birth dates). This may delay your refund. ANGIE'S TAX SERVICES is not responsible for any IRS audits. All information obtained from the taxpayer and/or spouse must be presentable if the IRS audits your tax return. ANGIE'S TAX SERVICES is not responsible for any incorrect tax figures provided by the taxpayer and/or spouse. If your tax figures change you will need to do an Amendment. Prices Vary. If you have any federal or government debts (i.e. school loans, child support, DPP, DFCS, etc….) there is a chance that your refund will be applied toward your debt. You can call the offset department at 1-800-304-3107 or 1-800-829-7650 to see if your refund will be partially or fully taken. If your refund is fully taken you are responsible for paying the preparation fees. ANGIE'S TAX SERVICES provides the taxpayer with ONE complimentary copy of their tax return. Should you need any additional copies, there is a $15 fee per copy (federal and state included). ANGIE'S TAX SERVICES is not responsible for any discussions or changes the IRS or bank may make on disbursement dates, filing status, or any other required information from the IRS. ANGIE'S TAX SERVICES is not responsible for any IRS glitch problems or IRS problems that may cause a delay in your tax refund. We DO NOT reimburse any bank fees in the event of this occurrence.

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Consent To Use
Federal law requires this consent form be provided to you (“you” refers to each taxpayer, if more than one). Unless authorized by law, we cannot use your tax return information for purposes other than the preparation and filing of your tax return without your consent.

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. 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.

For your convenience, we have entered into an arrangement with third parties to provide qualifying taxpayers with the opportunity to apply for an Electronic Refund Disbursement Service and/or Loan product. To determine whether these offerings may be of interest to you, we will need to use your tax return information in order to calculate the amount of your anticipated refund.

If you would like us to use your tax return information to determine whether these offerings are relevant to you while we are preparing your return, please sign and date this consent to the use of your tax return information.

By signing below, you authorize us to use the information you provide to us during the preparation of your 2023 tax return to determine whether to present you with the opportunity to apply for these products and services.

If you believe your tax return information has been disclosed or used improperly in a manner
unauthorized by law or without your permission, you may contact the Treasury Inspector General
for Tax Administration (TIGTA) by telephone at 1-800-366-4484, or by e-mail at complaints@tigta.treas.gov.

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CONSENT TO DISCLOSURE OF TAX RETURN INFORMATION
For the purposes of this consent form, “we,” “us,” and “our” mean
ANGIE'S TAX SERVICES

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 in our tax preparation services. If we obtain
your signature on this form by conditioning our 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.

You have indicated that you are interested in receiving an Electronic Disbursement Service
and/or Loan (or collectively, “Products or Services”) from Pathward, National Association. In
order to provide you with the opportunity to apply for one of these Products or Services, we must
disclose all of your 2023 tax return information necessary for evaluating the request to Pathward.
If you request a more limited disclosure of tax return information, you will not be eligible to submit
an application request for these Products or Services. If you would like us to disclose your 2023
tax return information for this purpose, please sign and date your consent to the disclosure of
your tax return information.

By signing below, you authorize us to disclose to Pathward all of your 2023 tax return information
necessary for the evaluation and processing of your request for a Product or Service. You
understand that if you are unwilling to authorize the disclosure and sharing of your tax return
information with Pathward, you will not be able to obtain a Product or Service, but you may still
choose to have your tax return prepared and filed by us for a fee.

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The information contained in this office or on this website is of a general nature. It should not be construed as legal advice nor should it be acted upon in your specific situation without further details and/or professional assistance. Any use of information contained in this office or on our website is done so at the risk of the user, and ANGIE'S TAX SERVICES is not responsible for the result or outcome of its use ANGIE'S TAX SERVICES does not guarantee and is not liable for the truthfulness, accuracy, effectiveness, or any effects of the use of any information contained in this office or on the web site. It is advised and it is the responsibility of the visitor of this office or website to seek proper instruction and/or seek professional assistance in all matters regarding taxes and the IRS. ANGIE'S TAX SERVICES is thus held harmless, release of, and users of information contained in this office or on this website assume full responsibility for, any violation of Tax laws and/or IRS procedure, and any other legal liability resulting from the use of any information contained in this office or on this web site. I attest that all information contained in this income tax return was obtained from the taxpayer or spouse and is true and correct to the best of his/her knowledge.

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By signing this I give ANGIE'S TAX SERVICES, permission to file my taxes using a 3rd party site. I understand that ANGIE'S TAX SERVICES, is not responsible for any denials given by the state and/or government and therefore there will not be any refunds issued. *

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