Insure One Accounting & Insurance Solutions / The Tax Ladies - The Tax Ladies

Thank you for taking the time to complete our intake package. For our new clients, this information is critical to ensure an accurate filing of your tax returns. For our existing clients, while we may have some of this information from past engagements, we kindly request you provide any updates so we can make sure our records are 100% accurate and up to date.

Please also note that to comply with federal and state identity theft protection efforts our firm will ask for a valid state issued photo identification card during your engagement. ***The page is highly secure. We use industry-leading technology Secured Socket Layer (SSL) to keep your information safe. All sensitive information is securely transmitted and can not be compromised.

This questionnaire may take you up to 10 minutes to complete.

***YOU MUST HIT SUBMIT OR THE FORM WILL NOT GO THROUGH!!

Please text (844) 362-6837 or email admin@insure-one.info if you do not get a submission confirmation. We will confirm receipt for you

Please list the name of the person that referred you.

First Name*

Middle Initial

Last Name*

Suffix

Primary Email*

Primary Phone*

Current Physical Address (include city, state, zip)*

What county do you live in?*

What is the tax payer’s DOB?

What is the primary taxpayers social security number?

Tax Payer’s Occupation*

Have you ever been audited by the IRS? If so, please list dates & outcome of audit. If not, type NO.*

Primary Tax Payer- Please Check Any That Apply*

Taxpayer can be claimed as a dependent on someone else’s return.

Taxpayer was over age 18 and a full-time student at an eligible educational institution

Taxpayer is blind.

Taxpayer has received, sold, sent, exchanged, or otherwise acquired financial interest in virtual currency during the current tax year.

Taxpayer prefers to receive written communications from the IRS in a language other than English

Taxpayer prefers to receive written communications from the IRS in an accessible format.

None of these apply to me.

Are you needing to claim a deceased Spouse, Child, or Relative?*

Upload a copy of deceased spouse/child/relative death certificate.

Upload previous year tax return (most recent) including Schedule C (if applicable)

Spouse’s full name, DOB, Occupation, and email (if applicable)?

Check all that apply to Spouse*

None of these apply to the spouse or I’m unmarried

Spouse can be claimed as a dependent on someone else’s return.

Spouse was over 18 and a full time student at an eligible institution.

Spouse is blind

Spouse is deceased

Spouse has received, sold, sent, exchanged, or otherwise acquired financial interest in virtual currency during the current tax year.

Spouse prefers to receive written communications from the IRS in a language other than English.

Taxpayer prefers to receive written communications from the IRS in an accessible format.

DEPENDENT INFORMATION

Please Note:

The Earned Income Credit (EIC) increases with the first 3 dependents you claim.

You MUST also meet other requirements related to your Adjusted Gross Income (AGI) to qualify for EIC. If you are MARRIED and FILING SEPERATE you CAN’T claim the credit.

Provide the name, DOB, and relation of all dependents you want to claim on your return. (Including children, elderly parents, and/or others you provided for during the year)

Did you have any day care expenses? If so, upload the form from the daycare in the school upload further below.

Yes

I did but don’t have any provider information

No.

Does Taxpayer, Spouse, or dependents get an Identity Protecion (IP) Pin letter from the IRS every year? I*

Upload IP Letter Here (if applicable)

Are you self employed or a business owner?*

I am in Independent Contractor and have received a 1099-NEC or 1099-MISC

I have a small business

Both

Neither

Please Provide Your Business EIN Number, if applicable (skip if you don’t have a business)

What is your business address? Skip if you do not have a business.

Use this space to upload any expenses related to business (P&L, purchase receipts, end of year spreadsheet, etc). Skip if you do not have a business.

Did you use a vehicle for your business?

Yes

Did you have a separate vehicle for personal use? Skip if you didn’t use a vehicle for business.

Make/Model/Year of business vehicle and mileage driven during the tax year (skip if you didn’t use a vehicle for business).

Did you have health insurance for all 12 months of the tax year?

Did you receive health insurance through the Marketplace?*

Upload 1095-A: Health Insurance Marketplace Statement here

Did anyone on this return attend college this tax season? If so, upload 1098-T and other college related documents below.

Upload 1098-T or other college documents here

Does anyone have any student loans in forbearance or deferment?*

Are you currently paying student loans?*

Upload the driver’s license or picture ID for yourself, spouse, and any dependents age 18 or over here. You may upload multiple documents.

Upload yours, spouse, and any dependents social security card here. You may upload multiple items.

Upload income documents here (including any W2, 1099, K-1, etc). You may upload multiple documents.

Upload Form 1099-NEC or 1099-MISC here. You may upload multiple documents.

Upload all other income docs here. Such as form 1099-DIV, 1099-INT, 1099-B, 1099-R, 5498, etc).

Do you owe the IRS?*

How would you like to pay for your tax preparation fees?*

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Form 7216

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Requesting Bank Products that include but are not limited to: Rapid Refunds, Withdrawing Tax Preparation fees from tax returns and other banking products require consumer consent of information disclosure.

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, without your consent, your tax return information for purposes other than the preparation and filing of your tax return. You are not required to complete this form. Our need to disclose your tax return information to another a 3rd party - Refund Advantage affects the tax return representation service(s) that we provide to you and its (their) cost, we may decline to provide you with the tax return preparation service or change the terms (including the cost) of the tax return preparation services that we provide to you. 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.

In order to process your return, we must disclose all of your tax return information to Refund Advantage. For your convenience, we have entered into agreements with a bank to provide qualifying taxpayers with the opportunity to apply for a (bank product) Refund Transfer (RT), or Electronic Refund Check or Electronic Refund Deposit. To determine whether these products may be available to you, we will need to use your tax return information by analyzing it and calculating the amount of your anticipated refund.

By signing below, you (including each of you if there is more than one taxpayer) authorize us to disclose to Refund Advantage all of your tax return information.

PROVIDE BANKING INFORMATION HERE: Bank institution Name, type of account, account number, and routing number. You can upload a copy of a voided check or screenshot bank info in next field

Use this space to upload any additional documents for your Tax return (including social security cards, additional income, documents and expenses)

We will contact you once your return is completed. What is your preferred method of contact?*

Text

Phone Call

Zoom Video Call

In Person Office Visit

Make an Appointment: You will be able to choose from available Appointments on the next step. Hacer una cita: podrá elegir entre las citas disponibles en el siguiente paso.

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The Tax Ladies - Tax Intake 2023

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