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2022 Personal Tax Preparation Client Intake Form
Greetings! Please fill out this form completely sign and date.
Global Tax Service LLC
Taxpayer 1 Name
*
First
Last
Social Security Number / ITIN Number
*
Occupation
*
Date of Birth
*
MM
/
DD
/
YYYY
Mailing Address
*
Street Address
Address Line 2
City
State / Province / Region
Postal / Zip Code
Antigua and Barbuda
Aruba
Bahamas
Barbados
Belize
Canada
Cayman Islands
Cook Islands
Costa Rica
Cuba
Dominica
Dominican Republic
El Salvador
Grenada
Guatemala
Haiti
Honduras
Jamaica
Mexico
Netherlands Antilles
Nicaragua
Panama
Puerto Rico
Saint Kitts and Nevis
Saint Lucia
Saint Vincent and the Grenadines
Trinidad and Tobago
United States
Argentina
Bolivia
Brazil
Chile
Colombia
Ecuador
Guyana
Paraguay
Peru
Suriname
Uruguay
Venezuela
Albania
Andorra
Armenia
Austria
Azerbaijan
Belarus
Belgium
Bosnia and Herzegovina
Bulgaria
Croatia
Cyprus
Czech Republic
Denmark
Estonia
Faroe Islands
Finland
France
Georgia
Germany
Greece
Hungary
Iceland
Ireland
Italy
Kosovo
Latvia
Liechtenstein
Lithuania
Luxembourg
Macedonia
Malta
Moldova
Monaco
Montenegro
Netherlands
Norway
Poland
Portugal
Romania
San Marino
Serbia
Slovakia
Slovenia
Spain
Sweden
Switzerland
Ukraine
United Kingdom
Vatican City
Afghanistan
Bahrain
Bangladesh
Bhutan
Brunei Darussalam
Myanmar
Cambodia
China
East Timor
Hong Kong
India
Indonesia
Iran
Iraq
Israel
Japan
Jordan
Kazakhstan
North Korea
South Korea
Kuwait
Kyrgyzstan
Laos
Lebanon
Malaysia
Maldives
Mongolia
Nepal
Oman
Pakistan
Palestine
Philippines
Qatar
Russia
Saudi Arabia
Singapore
Sri Lanka
Syria
Taiwan
Tajikistan
Thailand
Turkey
Turkmenistan
United Arab Emirates
Uzbekistan
Vietnam
Yemen
Australia
Fiji
Kiribati
Marshall Islands
Micronesia
Nauru
New Zealand
Palau
Papua New Guinea
Samoa
Solomon Islands
Tonga
Tuvalu
Vanuatu
Algeria
Angola
Benin
Botswana
Burkina Faso
Burundi
Cameroon
Cape Verde
Central African Republic
Chad
Comoros
Democratic Republic of the Congo
Republic of the Congo
Djibouti
Egypt
Equatorial Guinea
Eritrea
Ethiopia
Gabon
Gambia
Ghana
Gibraltar
Guinea
Guinea-Bissau
Cote d'Ivoire
Kenya
Lesotho
Liberia
Libya
Madagascar
Malawi
Mali
Mauritania
Mauritius
Morocco
Mozambique
Namibia
Niger
Nigeria
Rwanda
Sao Tome and Principe
Senegal
Seychelles
Sierra Leone
Somalia
South Africa
Sudan
Swaziland
United Republic of Tanzania
Togo
Tunisia
Uganda
Zambia
Zimbabwe
Country / Region
This address is the address that you will receive correspondence from the IRS, payment, and updates to. PO Boxes are not allowed.
Mailing Address
*
Street Address
Address Line 2
City
State / Province / Region
Postal / Zip Code
Antigua and Barbuda
Aruba
Bahamas
Barbados
Belize
Canada
Cayman Islands
Cook Islands
Costa Rica
Cuba
Dominica
Dominican Republic
El Salvador
Grenada
Guatemala
Haiti
Honduras
Jamaica
Mexico
Netherlands Antilles
Nicaragua
Panama
Puerto Rico
Saint Kitts and Nevis
Saint Lucia
Saint Vincent and the Grenadines
Trinidad and Tobago
United States
Argentina
Bolivia
Brazil
Chile
Colombia
Ecuador
Guyana
Paraguay
Peru
Suriname
Uruguay
Venezuela
Albania
Andorra
Armenia
Austria
Azerbaijan
Belarus
Belgium
Bosnia and Herzegovina
Bulgaria
Croatia
Cyprus
Czech Republic
Denmark
Estonia
Faroe Islands
Finland
France
Georgia
Germany
Greece
Hungary
Iceland
Ireland
Italy
Kosovo
Latvia
Liechtenstein
Lithuania
Luxembourg
Macedonia
Malta
Moldova
Monaco
Montenegro
Netherlands
Norway
Poland
Portugal
Romania
San Marino
Serbia
Slovakia
Slovenia
Spain
Sweden
Switzerland
Ukraine
United Kingdom
Vatican City
Afghanistan
Bahrain
Bangladesh
Bhutan
Brunei Darussalam
Myanmar
Cambodia
China
East Timor
Hong Kong
India
Indonesia
Iran
Iraq
Israel
Japan
Jordan
Kazakhstan
North Korea
South Korea
Kuwait
Kyrgyzstan
Laos
Lebanon
Malaysia
Maldives
Mongolia
Nepal
Oman
Pakistan
Palestine
Philippines
Qatar
Russia
Saudi Arabia
Singapore
Sri Lanka
Syria
Taiwan
Tajikistan
Thailand
Turkey
Turkmenistan
United Arab Emirates
Uzbekistan
Vietnam
Yemen
Australia
Fiji
Kiribati
Marshall Islands
Micronesia
Nauru
New Zealand
Palau
Papua New Guinea
Samoa
Solomon Islands
Tonga
Tuvalu
Vanuatu
Algeria
Angola
Benin
Botswana
Burkina Faso
Burundi
Cameroon
Cape Verde
Central African Republic
Chad
Comoros
Democratic Republic of the Congo
Republic of the Congo
Djibouti
Egypt
Equatorial Guinea
Eritrea
Ethiopia
Gabon
Gambia
Ghana
Gibraltar
Guinea
Guinea-Bissau
Cote d'Ivoire
Kenya
Lesotho
Liberia
Libya
Madagascar
Malawi
Mali
Mauritania
Mauritius
Morocco
Mozambique
Namibia
Niger
Nigeria
Rwanda
Sao Tome and Principe
Senegal
Seychelles
Sierra Leone
Somalia
South Africa
Sudan
Swaziland
United Republic of Tanzania
Togo
Tunisia
Uganda
Zambia
Zimbabwe
Country / Region
This address is the address that you will receive correspondence from the IRS, payment, and updates to. PO Boxes are not allowed.
Phone
*
###
-
###
-
####
Email
*
Type of Identificaton
*
Driver's License
State ID
Passport
Military ID
Must present valid non-expired identification to to file tax return.
If the IRS provided you with an Identitiy Protection Pin (IPPIN) for 2022 please list it below :
*
if you do not have an IPPIN type 0 in the box.
If you have been referred to or working with one of the following tax practitioners please select their name below:
*
Chris Smith
LaTasha Blake
Lindsey Martin
Regina Payton
Rossalyn McKenzie
Shara Bowling
Sheree Richardson
Walk-in
SPOUSE INFORMATION
If this section does not apply, please proceed to next section.
Spouse Name
*
Prefix
First
Last
Suffix
If filinfg married filing joint or married filing single sill this out. If not applicable place NA in both boxes and continue to next section.
Spouse Address
Street Address
Address Line 2
City
State / Province / Region
Postal / Zip Code
Antigua and Barbuda
Aruba
Bahamas
Barbados
Belize
Canada
Cayman Islands
Cook Islands
Costa Rica
Cuba
Dominica
Dominican Republic
El Salvador
Grenada
Guatemala
Haiti
Honduras
Jamaica
Mexico
Netherlands Antilles
Nicaragua
Panama
Puerto Rico
Saint Kitts and Nevis
Saint Lucia
Saint Vincent and the Grenadines
Trinidad and Tobago
United States
Argentina
Bolivia
Brazil
Chile
Colombia
Ecuador
Guyana
Paraguay
Peru
Suriname
Uruguay
Venezuela
Albania
Andorra
Armenia
Austria
Azerbaijan
Belarus
Belgium
Bosnia and Herzegovina
Bulgaria
Croatia
Cyprus
Czech Republic
Denmark
Estonia
Faroe Islands
Finland
France
Georgia
Germany
Greece
Hungary
Iceland
Ireland
Italy
Kosovo
Latvia
Liechtenstein
Lithuania
Luxembourg
Macedonia
Malta
Moldova
Monaco
Montenegro
Netherlands
Norway
Poland
Portugal
Romania
San Marino
Serbia
Slovakia
Slovenia
Spain
Sweden
Switzerland
Ukraine
United Kingdom
Vatican City
Afghanistan
Bahrain
Bangladesh
Bhutan
Brunei Darussalam
Myanmar
Cambodia
China
East Timor
Hong Kong
India
Indonesia
Iran
Iraq
Israel
Japan
Jordan
Kazakhstan
North Korea
South Korea
Kuwait
Kyrgyzstan
Laos
Lebanon
Malaysia
Maldives
Mongolia
Nepal
Oman
Pakistan
Palestine
Philippines
Qatar
Russia
Saudi Arabia
Singapore
Sri Lanka
Syria
Taiwan
Tajikistan
Thailand
Turkey
Turkmenistan
United Arab Emirates
Uzbekistan
Vietnam
Yemen
Australia
Fiji
Kiribati
Marshall Islands
Micronesia
Nauru
New Zealand
Palau
Papua New Guinea
Samoa
Solomon Islands
Tonga
Tuvalu
Vanuatu
Algeria
Angola
Benin
Botswana
Burkina Faso
Burundi
Cameroon
Cape Verde
Central African Republic
Chad
Comoros
Democratic Republic of the Congo
Republic of the Congo
Djibouti
Egypt
Equatorial Guinea
Eritrea
Ethiopia
Gabon
Gambia
Ghana
Gibraltar
Guinea
Guinea-Bissau
Cote d'Ivoire
Kenya
Lesotho
Liberia
Libya
Madagascar
Malawi
Mali
Mauritania
Mauritius
Morocco
Mozambique
Namibia
Niger
Nigeria
Rwanda
Sao Tome and Principe
Senegal
Seychelles
Sierra Leone
Somalia
South Africa
Sudan
Swaziland
United Republic of Tanzania
Togo
Tunisia
Uganda
Zambia
Zimbabwe
Country / Region
If spouse has a different address list here.
Spouse Identification
*
Driver's License
State ID
Passport
Military ID
N/A
Must present valid non-expired identification to to file tax return.
Spouse Social Security Number
If you have no spouse or u,known type 0
Can spouse be claimed as a dependent by anyone else?
Yes
No
Unsure
N/A
Select one.
Recovery Rebate Questions
This section applies to the recovery rebate (Stimulus Payments). Please answer questions correctly to avoid delays in IRS tax return processing.
Did you receive the third round stimulus payment? If so who did you receive it for?
*
Myself
My dependents
Did not receive for myself
Did not receive for dependents
Not eligible
Check the boxes that apply to you.
Filing Status Requirements
I need to file an extension.
Yes
No
If you will not be prepared to file your taxes by the tax deadline you will need to file an extension for timely filing.
What tax year(s) are you needing to have processed? Choose all that apply.
*
2021 (current year)
2020
2019
2018
2017
2016
2015
2014
2013
2012
2011
Do you need to file an amendment? If so for what year? Choose all that apply.
*
I DO NOT NEED TO FILE AN AMENDMENT
2021
2020
2019
2018
2017
2016
2015
2014
2013
2012
2011
Filing Status
*
Single
Head of Household
Married Filing Jointly
Married Filing Separate
Qualified Widow(er)
Unsure
Select one
Can you be claimed as a dependent by anyone else?
*
Yes
No
Unsure
Select one.
Were you disallowed any credits by the IRS?
*
Yes
No
Unsure
If your earned income credit (EIC), child tax credit (CTC)/additional child tax credit (ACTC)/credit for other dependents (ODC), or American opportunity tax credit (AOTC) was disallowed by IRS, you must complete and file the Form 8862.
Income Section
Did you receive W-2(s) ?
*
Yes
No
Form W2 is provided to you if you worked a job as an employee. Your employer(s) will provide this document to you.
Are you self-employed?
*
Yes
No
IF YOU ANSWERED YES PLEASE ANSWER THE FOLLOWING QUESTIONS.
Did you receive Form 1099-MISC?
Yes
No
Form 1099MISC is provided to you if typically if you worked as an independent contractor.
Did you receive a Forrm 1099-NEC?
Yes
No
Form 1099NEC is provided to you if typically if you worked as an independent contractor.
Did you receive unemployment compensation?
*
Yes
No
HEALTH INSURANCE INFORMATION
Do you have an HSA?
Yes
No
Family
Self
Health Savings Account
Do you have 1099-SA?
Yes
No
Did you have Health Insurance from the Marketplace in 2019?
*
Yes
No
Would you like Global Tax Service to discuss your return with the IRS as a third party representative if needed?
Yes
No
Select one.
Do you need additional state returns?
*
Yes
No
Select one.
If yes, which states?
DEPENDENT AND EDUCATION EXPENSES
Are you or any of your dependents students in a secondary institution such as a university, community college, or trade school?
*
Yes
No
Select one.
If yes list the student(s) name below
*
Put n/a if there is no student
Did you or dependents have any tuition expenses?
*
Yes
No
Select one.
If yes list the student(s) name below
*
Put n/a if there is no student
Did you receive a 1095-T form in the mail?
*
Yes
No
N/A
Select one.
DEPENDENT CARE EXPENSES
Do you have child care or eligible other dependent care expenses?
*
Yes
No
Please provide statement from child care facility. The statement must have the facility/provider name, child's name, EIN or Social Security number for the provider, Address, phone number to the facility and the amount paid for the year.
HOMEOWNER (SKIP IF YOU RENT)
Do you own your home?
*
Yes
No
N/A
Did you make any energy efficient home improvements?
Yes
No
Do you have proof of property taxes paid in 2020?
*
Yes
No
N/A
RENTERS
Do you rent?
*
Yes
No
Monthly rent amount you paid
*
Type 0 if it does not apply.
Months you rented
*
Type 0 if it does not apply.
Landlord Name
*
Type N/A if it does not apply.
Landlord Address
*
Type N/A if it does not apply.
SELF EMPLOYMENT
If you are self-employed answer the following questions. If you are not select N/A or fill out N/A.
Are you self employed?
*
Yes
No
Business Name
*
What is your EIN for your business?
*
If you are not self-employed or do not have an EIN type 0
If yes, how does your business operate?
*
Sole Proprietor
Single Member LLC
Partnership
Non-Profit
Corporation
I don't know
N/A
Do you have proof of business income?
*
Yes
No
N/A
Income is any money earned while providing a service or selling goods to consumers. Proof would include invoices, log books, 1099 MISC, 1099-K, 1099-NEC and receipts.
Do you have proof of expenses?
*
Yes
No
N/A
Proof od expenses would include money spent to operate your business. These would include receipts, bank statements, invoices, 1099Ks
Do you have proof of mileage?
*
Yes
No
Proof of mileage would include a mileage log, gas receipts, or other method you selected to keep track of mileage
Do you need assistance gathering all of your documents to show proof of INCOME, EXPENSES OR MILEAGE?
*
Yes
No
Please note that bookkeeping services are an additional cost and is not included in your tax preparation fee. If you opt-in fro bookkeeping servies you will be reuired to pay those fees according to company policy provided to you.
Would you be interested in lerning more about bookkeeping services for your business?
*
Yes
No
BANKING INFORMATION FOR REFUND OR BALANCE DUE (OPTIONAL)
If you receive a tax refund how would you like to receive your refund?
*
Direct Deposit (Account must be in Tax Payer's Name)
Check (check will be mailed to the address on file)
Debit Card Supplied by Global Tax Service LLC (Debit card provided in office)
Use Account For: (choose all that apply)
*
Refund
Balance Due Federal
Balance Due State
Payment Arrangements
Estimated Quarterly Tax Payment
Select Account Type
*
Checking
Savings
Routing #
Routing #(enter twice for verification)
Account#
Account# (enter twice for verification)
Bank Name
Taxpayer's name must be on the bank account in order for it to be deposited.
DEPENDENT ELIGIBILITY
Will your dependents be claimed by someone other than yourself?
*
Yes
No
If you answered yes list the dependent's name
Are any of your dependent(s) totally/permanently disabled?
*
Yes
No
N/A
If you answered yes list the dependent's name
Is your dependent(s) under the age of 18
*
Yes
No
N/A
Did you receive the Child Tax Credit Advance Payments in 2021
*
Yes
No
N/A
How months did your child/children/dependents live with you?
*
More than 6 months
Less than 6 months
Did not live with me
Did your children acquire health insurance through the Market Place?
*
Yes
No
Dependent Information
Below you will provide information for dependents you are filing on your tax return.
Dependent 1 Name
*
First
Last
if you do not have a dependent put a NA in each box
Dependent Relationship
*
Son
Daughter
Stepchild
Eligible Foster Child
Grandchild
Niece
Nephew
Mother
Father
Grandmother
Grandfather
Aunt
Uncle
Other Dependent Lived in Household entire year)
Select the dependent's relationship.
Date of Birth
MM
/
DD
/
YYYY
Social Security Number
Dependent 2 Name
First
Last
Dependent Relationship to you
Son
Daughter
Stepchild
Eligible Foster Child
Grandchild
Niece
Nephew
Mother
Father
Grandmother
Grandfather
Aunt
Uncle
Other Dependent Lie in Household entire year)
Select the dependent's relationship.
Date of Birth
MM
/
DD
/
YYYY
Social Security Number
Dependent 3 Name
First
Last
Dependent Relationship to you
Son
Daughter
Stepchild
Eligible Foster Child
Grandchild
Niece
Nephew
Mother
Father
Grandmother
Grandfather
Aunt
Uncle
Other Dependent Lie in Household entire year)
Select the dependent's relationship.
Date of Birth
MM
/
DD
/
YYYY
Social Security Number
Dependent 4 Name
First
Last
Dependent Relationship to you
Son
Daughter
Stepchild
Eligible Foster Child
Grandchild
Niece
Nephew
Mother
Father
Grandmother
Grandfather
Aunt
Uncle
Other Dependent Lie in Household entire year)
Select the dependent's relationship.
Date of Birth
MM
/
DD
/
YYYY
Social Security Number
General Engagement Letter For Tax Return Preparation
This is to inform you, the tax payer, of the services we will provide you, and the responsibilities you have for preparation of your tax return.
Tax Return Preparation
We will prepare your federal and state tax returns based on information you provide. Services for preparation of your return do not include auditing or verification of information provided. If you require the above mentioned it will result in additional fees.
Bookkeeping services provided will result in additional fees and require payment upfront or a payment arrangement with deposit prior to service commencing.
Tax consults to include: additional tax preparation outside of said preparation, tax planning, tax resolution, additional information requests by state agencies or any form of representation will require payment upfront and are not included with your tax preparation fees.
This engagement does not include any audit or examination of your books or records. In the event your return is audited, you will be responsible for verifying the items reported.
You must review the return carefully before signing to make sure the information is correct.
The tax preparation fee does not include receipts management. If we have to provide receipts management services additional fees will be assessed and required to be paid upfront.
The tax preparation fee does not include additional services you may elect.
Fees must be paid via refund transfer or if you are paying out of pocket for your tax return before it is delivered to you or filed for you. If you terminate this engagement before completion, you agree to pay a fee for work completed.
Failure to pay for services will result in further collection action plus any collection and legal fees.
Fees charged for tax return preparation do not include bank fees, audit representation or preparing materials to respond to correspondence from taxing authorities.
Preparation fees do cover limited assistance and consultation during the year. This limitation is 1 hour of consultation as it relates to tax returns prepared in our office. Any additional consultation will be charged based on the consultation fee for that particular service.
No additional consultations or service will be provided without payment.
Once we begin working on your account fees for tax preparation, consultancy or other services are non-refundable. No Exceptions. Our services are guaranteed and mistakes will be corrected.
Amended tax returns processed after your tax return has been filed require an additional fee of and will need to be paid up front prior to services rendered.
If you choose the refund transfer option to pay for your tax preparation fees you agree that if your return is offset or we do not receive payment for tax preparation services, for any reason, you are responsible for making the payment to us. If the above circumstances occur and you do not pay or confirm arrangements to pay further collection action will apply. You will be responsible for any additional fees incurred from the collection process.
The engagement to prepare your tax returns terminates upon the delivery of your completed returns and original documents to you. Please store your supporting documents and copies of your tax returns in a secure place for at least seven years.
*
Type name here if you accept this engagement.
Taxpayer Obligations and Responsibilities
You agree to provide us all income and deductible expense information. If you receive additional information after we begin working on your return, you will contact us immediately to ensure your completed tax returns contain all relevant information.
You affirm that all expenses or other deduction amounts are accurate and that you have all required supporting written records. In some cases, we will ask to review your documents.
You must be able to provide written records of all items included on your return if audited by either the IRS or state taxing authority. We can provide guidance concerning what evidence is acceptable.
Signatures.
By signing below, you acknowledge that you have read, understand, and accept your obligations and responsibilities and that you understand our responsibilities in preparing you tax returns as explained above. For a joint return, both tax payers must sign.
Taxpayer Signature
*
Clear
Date Time
*
MM
/
DD
/
YYYY
Spouse Signature
Clear
Date Time
MM
/
DD
/
YYYY
Submit your document
You may upload your documents to this form or you may email your documents to info@globaltaxservice4u.com.
If you are emailing please put your NAME and TAX DOCUMENTS in the subject line.
I will submit my documents virtually
*
Yes
No
If you choose to submit documents virtually please see the next section below for the types of documents that can be submitted.
Identification card(s) - Upload here
Add File
Example: Driver's License, State ID, Passport, Military ID
Social Security card(s) - Upload here
Add File
Upload a copy of all persons being filed on the tax return social security card here
W2 (s)- Uplpoad here
Add File
1099s - Uplpoad here
Add File
Miscellaneous Forms
Add File
Miscellaneous Forms (cont'd)
Add File
Miscellaneous Forms (cont'd)
Add File
Privacy Policy.
The nature of our work requires us to collect certain nonpublic personal information about you from various sources. We collect financial and personal information from applications, worksheets, reporting statements, and other forms, as well as interviews and conversations with our clients and affiliates. We may also review banking and credit card information about our clients in the performance of receipt of payment. Under our policy, all information we obtain about you will be provided by you or obtained with your permission. Our firm has procedures and policies in place to protect your confidential information. We restrict access to your confidential information to those within our firm who need to know in order to provide you with services. We will not disclose your personal information to any third party without your express permission, except where required by law. We maintain physical, electronic, and procedural safeguards in compliance with federal regulations that protect your personal information from unauthorized access. Please contact us with any questions regarding our privacy policy. I declare under penalty of perjury under the laws of the State Indiana that the foregoing is true and correct.