Tax Artists™ — Client Tax Intake

Tell Us What You’re Dealing With

What do you need help with? Select all that apply. Brief description

Filing Status & Contact Information

Tax year Filing status Street & apartment City State & ZIP County School code, if applicable

Taxpayer Information

First name Middle initial Last name Social Security Number Email Cell / other phone Work phone Date of birth Occupation Date of death, if applicable

Legally blind Dependent of another taxpayer

Spouse Information, If Applicable

First nameMiddle initialLast nameSocial Security NumberEmailCell / other phoneWork phoneDate of birthOccupationDate of death, if applicable

Legally blind Dependent of another taxpayer

Dependents

Add up to four dependents here. Additional dependents can be listed in the notes section.

Employment, Retirement & Planning

Please answer what applies

Employed Unemployed Contributing to 401(k), 403(b), or other pre-tax account Opened a pre-tax account in the past Considered a Roth conversion Wants a Roth conversion tax “what-if” prepared

State, Local & ACA Health Coverage

State return(s) requested?Local, school, RITA, city, or county return?

Did everyone on this tax return have health insurance coverage all 12 months? Coverage source(s)

Basic Tax Questions

Select any that apply to you or your spouse Comments / description

Income Received

Select income types received by you and/or spouse

Capital loss carryforward, if knownPassive activity loss carryforward, if known

Other income details

Deductions, Credits & Adjustments

Deductions / credits Adjustments to income

Child care amount / provider detailsAlimony paid / received details

Estimated Payments, Refund & E-File

Estimated tax payments or prior-year refund applied

Refund preferenceTaxes due payment plan

Direct deposit banking note

Schedule A — Itemized Deductions, If Applicable

Medical, dental, premiums, prescriptions, medical miles Taxes paid: state/local, real estate, personal property, other taxes Interest: mortgage, refinancing points, investment interest Contributions: cash, non-cash, volunteer mileage Miscellaneous: unreimbursed expenses, union dues, tax prep fees, gambling losses, casualty/theft

Schedule C — Business / Self-Employment, If Applicable

Business nameEIN, if anyBusiness addressDate business startedAccounting methodMaterial participation?

Claiming home office Depreciable assets Vehicle used for business Self-insured health insurance deduction

Business income, COGS, expenses, vehicle details, or “See P&L / balance sheet”

Home Office, If Applicable

Date home first used for businessBusiness square footageTotal home square footageDepreciable assets?

Home office expenses: mortgage interest, taxes, insurance, rent, repairs, utilities, other

Schedule E — Rental Property, If Applicable

Property descriptionProperty addressOwnerActive participant?

Income, personal-use days, rented days, depreciation, and property expenses

ACA Details, If Coverage Was Not Full-Year

Select any that apply

Previous insurance policy cancelled Marketplace exemption certificate Employer coverage offered Federally recognized Indian tribe / Indian health services Health care sharing ministry Lived outside the United States TRICARE or CHIP Hardship event / exemption concern

Coverage details by person/month, if needed

ID, Documents & Charitable Contribution Policy

Two forms of ID are required for all returns, and at least one must be photo ID. Backup documents should be provided for checked areas.

I understand two forms of ID are required, with at least one photo ID. I will provide a voided check only through a secure portal if direct deposit is requested. I understand charitable contributions must be substantiated with proper written records.

Documents / notes for Tax Artists

Final Review

Anything unique the preparer should pay special attention to?

I confirm the information submitted is accurate to the best of my knowledge. I understand this form does not create a professional-client relationship and that any engagement requires written confirmation from Tax Artists™.

Tax Artists™ Client Intake

Step 1: Tell Us What You’re Dealing With