TAX PREP CLIENT INTAKE FORM - This document at this time if for informational purposes only, which includes the information we will need to start processing your return. An Online form will be available shortly for your convenience.

SECTION 1: PERSONAL INFORMATION

1. Social Security Number (SSN):
2. Date of Birth:
3. Marital Status: ( ) Single ( ) Married Filing Jointly ( ) Married Filing Separately ( ) Head of Household ( ) Widowed
4. Did you live in more than one state during the tax year? ( ) Yes ( ) No
   
   • If yes, which states?

SECTION 2: DEPENDENTS

1. Do you have any dependents to claim? ( ) Yes ( ) No
   If yes, please provide the following for each dependent:
   
   • Full Name:
   • Social Security Number:
   • Date of Birth:
   • Relationship to You:
   • Did the dependent live with you all year? ( ) Yes ( ) No
   • Did you provide more than half of their support? ( ) Yes ( ) No

SECTION 3: INCOME INFORMATION

Please check all sources of income that apply and provide supporting documents:

( ) W-2 from employer(s)

( ) 1099-NEC (self-employment, gig work)

( ) 1099-MISC

( ) 1099-K (PayPal, CashApp, etc.)

( ) Unemployment (Form 1099-G)

( ) Social Security (SSA-1099)

( ) Pension / Retirement Income (1099-R)

( ) Interest or Dividends (1099-INT / 1099-DIV)

( ) Rental Income

( ) Cryptocurrency transactions

( ) Alimony Received

( ) Other (please describe):

SECTION 4: DEDUCTIONS AND CREDITS

Check all that apply and provide amounts or documents if applicable:

( ) Childcare expenses (include provider name, EIN/SSN, and total paid)

( ) College tuition (Form 1098-T)

( ) Student loan interest (Form 1098-E)

( ) Charitable donations

( ) Health insurance from the Marketplace (Form 1095-A)

( ) Mortgage interest or property taxes (Form 1098)

( ) Retirement account contributions (IRA, 401k, etc.)

( ) Large medical expenses (over 7.5% of income)

( ) I want to take the standard deduction

( ) I want to itemize my deductions

SECTION 5: BUSINESS OR SELF-EMPLOYMENT INCOME

1. Do you own a business, LLC? ( ) Yes ( ) No
   
   If yes, complete the following, if multiple businesses, please complete the information below for each:

• Business Name:
• EIN (if applicable):
• Business Address:
• Type of Entity: ( ) Sole Proprietor ( ) LLC ( ) S Corp ( ) C Corp ( ) Partnership
• State of Registration:
• Business Start Date:
• Brief description of services/products:
• Did you file business taxes last year? ( ) Yes ( ) No
• Do you use bookkeeping software? ( ) Yes ( ) No
• Do you have a business bank account? ( ) Yes ( ) No

Annual Business Income:

• Total Gross Income:
• Total Expenses:
  
  • Rent/Lease:
  • Utilities:
  • Phone/Internet:
  • Supplies/Inventory:
  • Contractor payments:
  • Marketing/Advertising:
  • Insurance:
  • Business meals/travel:
  • Other (list):
• Did you receive any grants or loans (PPP, EIDL, etc.)? ( ) Yes ( ) No
• Did you issue any 1099s to contractors? ( ) Yes ( ) No
• Do you need help organizing receipts or expenses? ( ) Yes ( ) No

SECTION 6: DOCUMENT CHECKLIST (Please attach/upload the following if applicable)

• Government-issued ID (Driver’s License or State ID)
• Social Security card(s)
• W-2s, 1099s, and other income forms
• Last year’s tax return
• Childcare provider receipts
• Business expense receipts
• IRS letters received
• Any additional documents

SECTION 7: AUTHORIZATION & DISCLAIMER

• I certify that the information provided is true and complete to the best of my knowledge.
• I understand that HR PROF SVCS LLC & HR PROS PLUS LLC is not a CPA, tax attorney, or licensed tax professional.
• I agree that I am fully responsible for the accuracy of the information I provide.
• I release HR PROF SVCS LLC & HR PROS PLUS LLC from any liability regarding errors, omissions, or IRS audits resulting from this information.

Signature: __________________________    Date: __________________________