TAX PREPARATION INTAKE FORM TEMPLATE

DATE	TENDING CPA
CLIENT INFORMATION
NAME
DATE OF BIRTH	CURRENT ADDRESS
SOCIAL SECURITY NUMBER
HOME PHONE	FAX
ALT. PHONE	EMAIL
OCCUPATION	WORK PHONE
FILING STATUS	SINGLE___ MARRIED FILING JOINTLY___ MARRIED FILING SEPARATELY___ HEAD OF HOUSEHOLD___ QUALIFYING WIDOWER___
REFUND TYPE	CHECK___ DEBIT CARD___ DIRECT DEPOSIT___
SPOUSE INFORMATION
NAME
DATE OF BIRTH	CURRENT ADDRESS
SOCIAL SECURITY NUMBER
HOME PHONE	FAX
ALT. PHONE	EMAIL
OCCUPATION	WORK PHONE
DEPENDENTS
NAME	DATE OF BIRTH	SOCIAL SECURITY NUMBER
INCOME STREAMS
TYPE	SERVICE	AMOUNT
CLIENT'S IDENTIFICATION
TAXPAYER NAME	SOCIAL SECURITY NUMBER
PHOTO IDENTIFICATION #1	PHOTO IDENTIFICATION #2
SPOUSE'S NAME	SOCIAL SECURITY NUMBER
PHOTO IDENTIFICATION #1	PHOTO IDENTIFICATION #2
TAXPAYER SIGNATURE	DATE
SPOUSE'S SIGNATURE	DATE

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