We thank you for your trust in us to provide you with the best possible tax preparation at the lowest possible price. In order to us to accurately file your Federal and State tax return we will need the following information. The information that you provide to us will remain confidential. We value your privacy and we promise not to violate that trust. You will not need to fill this form out again, unless your tax situation changes.

PLEASE PRINT ALL INFORMATION.

Primary Taxpayer Full name: _______________________________________________

SSN Number _______________________ DOB__________________________

Spouse Full Name: _______________________________________________________

SSN Number _______________________ DOB__________________________

Address: __________________________________________________ Apt: _________

City: _____________________________ State: ____________________ Zip_________

Home Phone: ________________________ Cell Phone: __________________________

E-mail: _________________________________________________________________
(Your E-mail address WILL NOT be given or sold to anyone else)

Please answer each question with a Yes or NO.

Do you have any W2’s? Yes____ No ____
Do you have any 1099’s? Yes ____ No ____
Do you have any Interest from bank accounts? Yes ____ No ____
Do you have any dividends? Yes ____ No ____
Have you sold or purchase Stocks or Bonds? Yes ____ No ____
Do you pay Alimony? Yes ____ No ____
Have you received any alimony? Yes ____ No ____
Did you receive a refund from state and local
income taxes from last year? Yes ____ No ____
Do you have an IRA? Yes ____ No ____
Does your spouse have an IRA? Yes ____ No ____
Has you or your spouse contributed to an IRA? Yes ____ No ____
Do you have any Rental Real Estate? Yes ____ No ____
Do you have any unemployment compensation? Yes ____ No ____
Do you own or operate a small business? Yes ____ No ____
Do you have a partnership or corporation income? Yes ____ No ____
Do you have any retirement Income? Yes ____ No ____
Client Intake Information Page 2

Do you have any social security income? Yes ____ No ____
Do you have any income from gambling? Yes ____ No ____
Do you have a home mortgage? Yes ____ No ____
Do you have any out of pocket medical expenses? Yes ____ No ____
Do you have any charitable contributions? Yes ____ No ____
Do you have any Student Loan Interest? Yes ____ No ____
Do you have any moving expenses Yes ____ No ____
Have you ever been denied the Earned Income Credit? Yes ____ No ____
Has the Internal Revenue Service ever audited you? Yes ____ No ____

Who prepared last years taxes for you?

____ H & R Block ____ Jackson Hewitt ____ Liberty Tax

____ CPA ____ VITA ____ other


DEPENDENTS

Please list all dependents you are claiming from the youngest to the oldest.
We must have all the social security cards of each dependent or verifiable documentation.


First Name Last Name SSN Number Relationship

________________________________________________________________________
________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________


Thanks

Debby Smith

Tom Ward