Skip to content
Client Demographics
Contact Info:
Name
*
Birthday
*
DOD
Occupation
*
Phone
*
Email
*
Filing Status
*
Preferred contact method
*
Mailing Address
*
Spouse:
Name
Birthday
DOD
Occupation
Spouse Phone
Spouse Email
Dependents:
Name
DOB
Relationship
Name
DOB
Relationship
Name
DOB
Relationship
Name
DOB
Relationship
Name
DOB
Relationship
Please Check all That Apply
Income:
Wages (W-2)
Checkboxes
Check
Interest (1099-INT)
Checkboxes
Check
Dividends (1099-DIV)
Checkboxes
Check
Taxable State Refunds
Checkboxes
Check
Alimony Received
Checkboxes
Check
Business Income/Loss (Sch C)
Checkboxes
Check
Capital Gains (Sch D)
Checkboxes
Check
Other Gains (Form 4797)
Checkboxes
Check
IRA Distributions (1099-R)
Checkboxes
Check
Pensions & Annuities (1099-R)
Checkboxes
Check
Rental Properties (Sch E)
Checkboxes
Check
Partnerships/S-Corps (Form K1)
Checkboxes
Check
Farm Income (Sch F)
Checkboxes
Check
Social Security (1099-SSA)
Checkboxes
Check
Other Income Ex: Gambling
Checkboxes
Check
Unemployment
Checkboxes
Check
Required State Filings
Checkboxes
Check
Above the Line Deductions:
Educator Expenses
Tuition & Fees
Health Savings Acc (Form 8889)
Moving Expenses- Active Military Only
SEP/SIMPLE/Qualified Plans
Self-Employed Health Ins
Home Sale
Alimony Paid
ROTH / IRA Contribution Made
Student Loan Interest
Electric Vehicle Purchase
Residential Energy Efficient Upgrades
FED ES Date
Fed ES Amt
State ES Date
State ES Amnt
Taxpayer DL #
Taxpayer DL State
Taxpayer Issue Date
Taxpayer Expiration Date
Spouse DL #
Spouse DL State
Spouse Issue Date
Spouse Expiration Date
Taxes:
Medical Expenses
Checkboxes
Check
Mortgage Interest
Gambling Losses
Real Estate
Checkboxes
Check
Investment Interest Paid
State
Checkboxes
Check
Cash Donation
DMV Fees
Checkboxes
Check
Non-Cash Donations
Other client concerns:
By signing you confirm you have provided the most up to date information.
Client Signature
*
Submit
Save and Continue
