CLIENT INTAKE FORM (1040)

CLIENT INTAKE FORM

Complete all related info accurately so we can process your return timely
Time

Hour Minutes

AM/PM Option
Which Tax Year are you filing?*

2022 (current tax season)2021 (previous tax year)File an Extension ONLY (2022)Other
Are you a new or returning client?

I'm New!I'm Returning!
Did someone refer you this year?

YesNo
Who referred you?

First NameLast Name
Who is your Redeemed Tax Preparer?*
Filing Status*

Taxpayer Info*

	FirstName, MI, Last Name	Taxpayer SSN	Birthday	Cell Phone number	OccupationTitle	IP PIN (if you have one)
Taxpayer #1
Spouse (if MFJ or MFS)

Taxpayer (Current) Address*

Street Address

Street Address Line 2

CityState

Zip Code
Taxpayer Email*
example@example.com
Spouse Email (mandatory if MFJ)
example@example.com
REFUND DISBURSEMENT INFO
How would you like to receive your refund?*

DEPENDENT INFO
Do you have any Dependents you are claiming on this return?

DEPENDENT CARE

Child care for children 13 and under
If a family member provided the care you will need the Name, address and social security number of the provider to claim this credit.

If a facility provided the child/day care you will need the Name, address and EIN of the provider to claim this credit.
Did you have a child who was 13 and under in childcare during any part of the year?

YesNo
How much was paid to the provider?
Name of provider
EIN or Social Security number
Address of provider

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
HEALTH COVERAGE
Did everyone have Health Coverage in 2022?*

YesNo
BUSINESS OWNERS

For individuals who were Self-Employed at any time during this tax year
Did you have ownership in a business?*

YesNo
Business Type & Tax form filed

Sole Proprietor (Sch C)Single Member LLC (Sch C)Multi Member LLC (1065)S Corporation (1120s)C Corporation (1120)
Business Info
This business entity was established in (year) . This Business was formed in the state of blank .

Total Business Income
(Total for the Year)
What does this business do?
Do you have another Business you need to file?
Business Type & Tax form filed

Sole Proprietor (Sch C)Single Member LLC (Sch C)Multi Member LLC (1065)S Corporation (1120s)C Corporation (1120)
Business Info
This business entity was established in (year) . This Business was formed in the state of (state) .

Total Business Income
(Total for the Year)
What type of business?
UPLOAD HERE

Submit all documents necessary to process your return correctly. (Include ID & all tax forms)
Documents I am including

ID(s) (MANDATORY)Social Security Card(s)W21095-A (Healthcare Ins./ Marketplace)1095-B/C (Healthcare Ins.)1098-(Mortgage)1098-T (Education)1099-G (Unemployment)1099-K (Payment Cards, 3rd party transactions)1099- Misc (Independent Contractor)1099 - NEC (non emp. Compensation)1099-R (Pension/IRA/ Annuity Income)1099-Int, Div, OID (Interest,Dividend Income)1099-B/S (Sales of Stock or Other Property)1099-SA (Health Savings Account)Form 8332 (Childs Custodial Parent Release)Corporation - Articles of IncorporationLLC's - Articles of OrganizationOther
Upload documents here

ID, SOCIAL, INCOME STATEMENTS, ETC.
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If more than 10 documents please upload the rest below...
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Additonal Detail

Is there anything you would like us to know or answer for you?
COMMENTS:
DISCLOSURES
The information submitted on these pages and affixed attachments are those of which I can validate for back up documentation if requested from the IRS.*

I agree
If I have SSI, AFDC, TANF, CASH AID, Section 8 I have reported my income to the proper agency before I filed my taxes and truthfully omitted my obligation to my tax preparer.*

I agree
By checking the box below I have truthfully provided all documentation and information to my tax preparer.*

I agree
Redeemed Tax Services is not responsible for services of income not reported to agency such as SSI, AFDC, TANF, CASH AID, and Section 8 where your benefits are affected.

I understand
By signing boxes below, you're effectively providing your signature, agreeing that all information on this form is true and accurate to your best knowledge...*

Clear
As a measure to protect your identity through our virtual tax preparation, we ask you to take a photo of yourself as validation for ID proofing.
Thank you for supporting our small business. Please like our page below! We appreciate your business & referrals.
Should be Empty:

	First Name, MI, Last Name	SSN	Date of Birth	Relationship
Dependent 1
Dependent 2
Dependent 3
Dependent 4
Dependent 5

	First Name, MI, Last Name	SSN	Address	Phone	Percentage of ownership
Owner 1
Owner 2
Owner 3

	First Name, MI, Last Name	SSN	Address	Phone	Percentage of ownership
Owner 1
Owner 2
Owner 3

CLIENT INTAKE FORM

REFUND DISBURSEMENT INFO

DEPENDENT INFO

DEPENDENT CARE

HEALTH COVERAGE

BUSINESS OWNERS

UPLOAD HERE

Additonal Detail

DISCLOSURES