2023 Tax Preparation Client Intake Form

Tax Preparation Client Intake Form

This form is to be completed by Taxpayer
Tax Year*
EX: 2022
Filing Status*

SingleHead of HouseholdMarried Filing SeparateMarried Filing JointQualifying Widower

Street Address (Please Indicate Apt # if Applicable)

Apt #

CityState

Zip Code

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Select One*

YesNo

How Would You Like to Receive Your Refund?*

Direct DepositPrepaid Debit CardPaper Check
Bank Name
Official Bank Name
Routing Number
Please Check For Accuracy!!
Account Number
Please Check For Accuracy!!
Which Type of Account Is Provided?

CheckingSaving

Dependent Information

	Full Name of Dependent	Social Security Number	Date of Birth	Months Lived With You?	Did you pay more than 50% of the cost of support?	Relationship to you?
1
2
3
4
5
6
7
8

Regarding Qualifying Children for Earned Income Credit

According to the information you provided in regards to the dependent(s), the dependent(s) is/are your biological child, grandchild, niece, or nephew, etc.

I discussed with you a qualifying child cannot be used by more than one person per tax period. One person is one of the parent(s) if married filing jointly.

If filing Head of Household, you attest that you can provide a lease or utility bill in your name at your current address.

Please note: You are stating that you provide over 50% of care and support for the dependent(s), you are the sole provider for the dependent(s), the dependent(s) lives with you for more than half the year, and no one else is eligible to claim the dependent(s).

By signing below, you are stating that the dependent(s) information on your tax return is true, correct, and has been documented by your preparer. You are stating that you are not providing your preparer with any false/fraudulent information.

Provider Name
Name of Business/Person
EIN/SSN Number
Phone Number
Please enter a valid phone number.
Total Amount Paid in 2022?
Provider Address

Street Address

Street Address Line 2

CityState

Zip Code

Did you receive form 1098T from attending college in 2022?*

YesNo
Did you incur any educational expenses out of pocket in 2022?*

YesNo
If yes, how much?
Student Name

First NameLast Name
School Name and School Address

School Name

Street Address Line 1

CityState

Zip Code

General Expenses

	Amount
Medical Expenses
Dental Expenses
Insurance Premiums paid
Long Term Care Premiums
Prescription Drugs and Medications
Home Mortgage
Investment Interest
Cash Contributions
Charity of Religious Contributions
Business Expenses
Tax Preparation Fees
Investment Expenses
Mortgage Points(Closing points)
Significant Loss or Theft
Alimony Paid
Buy or Sell Home
IRA Expense

Preferred Wealth Financial is intentional on building generational wealth! We STRONGLY believes that we can be the change in the world by helping one family at a time.
Do you have life insurance OUTSIDE of your job?*

YesNo
Do you permit Preferred Wealth Financial to contact you to compare and LOWER the amount that you pay in life insurance?*

YesNo
Is your credit score above a 650?*

YesNo
If not, can we contact you to help you get there?

YesNo

We will prepare your tax return based on information you provide. In the event your return is audited, you will be responsible for verifying the items reported. It is important that you review the return carefully before signing to make sure the information is correct. You the taxpayer are responsible for the information on your return. Preferred Wealth Financial strongly urge you the taxpayer to provide all your tax documents at the time of filing to avoid IRS letters, tax penalties, and extremely long tax return delays.
Taxpayers Responsibilities

• You agree to provide us all the income and deductible 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 documentation.
• You must be able to provide written records of all items included on your return if audited by either the IRS or state tax authority. We can provide guidance concerning what evidence is acceptable.
• You must review the return carefully before signing to make sure the information is correct.
• You should keep a copy of your tax return and any related tax documents for a minimum of 3 years.
Signatures,

By signing below, you acknowledge that you have read, understand, and accept your obligations and responsibilities. You state under penalty of perjury that all the forgoing information is true, complete, and accurate. You also release Preferred Wealth Financial from any liability related to the information file on your federal and State income tax returns. I give Preferred Wealth Financial permission to electronically deduct their final tax fee(s) from my IRS refund. Your signature also authorizes Preferred Wealth Financial to electronically file and or mail your income tax returns to the IRS for processing. For joint return, both taxpayers must sign.
This is an prevenative security measure to reduce fraudulent tax returns! Please take a photo of yourself to ensure that it matches your ID!
Taxpayer*
Spouse
Date Signed*

MonthDayYear
Date
Taxpayer Signature*

Clear
Date Signed

MonthDayYear
Date
Spouse Signature

Clear
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Tax Preparation Client Intake Form

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