Diverse Tax Gem – 2027 Tax Client Intake Form

Diverse Tax Gem – 2027 Tax Client Intake Form

Complete this intake with your household, income, deductions, and document availability for the 2027 tax year.
Due Diligence Information
Preparer review note: This intake helps support due diligence, but it does not replace any required IRS preparer due-diligence forms or records.
Head of Household or other filing-status due-diligence screening
Did you live apart from your spouse for the full last 6 months of the year?
Did you and your spouse share the same home during the year?
Did you pay more than half the cost of keeping up the home?
Did anyone else contribute more than half of the home expenses?
Can another person claim any of your dependents?
Dependent relationship details
Dependent age
Did the child live with anyone else during the year?
Do you have documentation to support the dependent’s residency and relationship?
Do you have documentation to support Head of Household, EITC, Child Tax Credit, Additional Child Tax Credit, Other Dependent Credit, or American Opportunity Tax Credit claims?
Do you have any facts that may be inconsistent, unusual, or need explanation?
Explain any inconsistent or unusual facts
Student name for education credits
Eligible institution
Enrollment status for education credits
Years the American Opportunity Credit was previously claimed
Was there a felony drug conviction where legally relevant?
Tuition and qualified expense amounts
Scholarships, grants, and supporting records
Taxpayer Information
Legal Name

First NameMiddle NameLast Name
Preferred Name
Date of Birth

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Tax Identification Number
Occupation
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Email Address
example@example.com
Mailing Address

Street Address

Street Address Line 2
CityState / ProvincePostal / Zip Code
County
Preferred Contact Method
IRS Identity Protection PIN
Filing Status and Household
Tax year
Filing status
Marital status changes during the year
Can another person claim you as a dependent?
If married, can another person claim your spouse as a dependent?
Spouse Information
Spouse Legal Name

First NameMiddle NameLast Name
Spouse Date of Birth

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Spouse Tax ID
Spouse Occupation
IRS Identity Protection PIN
Dependents and Childcare
Dependent details
Dependent legal name
Dependent date of birth

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Dependent tax identification number
Relationship to taxpayer
Months lived with taxpayer
Student status
Disability status
Income Checklist
Which income source forms do you have?

Other
Do you have any self-employment income not reported on a form?
Do you have any business income from side work or contract work?
Did you receive unemployment benefits?
Did you receive Social Security benefits?
Did you receive retirement or pension distributions?
Did you receive interest income?
Did you receive dividend income?
Did you have investment sales or capital gains?
Did you have cryptocurrency transactions?
Did you receive partnership, S-corporation, or trust income?
Did you receive rental income?
Did you receive alimony?
Self-Employment and Business Income
Business name
Business type
Employer Identification Number
Business address

Street Address

Street Address Line 2
CityState / ProvincePostal / Zip Code
Business start date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Gross business income
Advertising expenses
Vehicle and mileage expenses
Supplies expenses
Office expenses
Phone and internet business portion
Insurance expenses
Rent expenses
Repairs and other business expenses
Deductions and Credits
Did you pay childcare or dependent care expenses during the year?
Which education-related expenses or tax forms do you have?

Other
Did you pay student loan interest during the year?
Did you pay mortgage interest during the year?
Did you pay property taxes during the year?
Which charitable contributions did you make?

Other
Did you have significant medical expenses during the year?
Did you make retirement contributions or estimated tax payments?

Other
List any other deductions, credits, or tax documents that may apply to your return.
Marketplace Health Coverage
Did you or anyone in your household have Marketplace health insurance for this tax year?
Upload Form 1095-A if you received Marketplace coverage

Cancelof
Prior-Year Returns and Notices
Have you filed all prior-year tax returns?
Which prior tax years are unfiled?

Other
Did you receive any IRS or state notices?

Other
Refund and Payment Preferences
Refund preference
If a balance is due, how would you like to pay?
Document Checklist
Photo ID
Social Security or ITIN documentation
W-2s
All 1099s
SSA-1099
1099-R
1099-G
1099-INT / 1099-DIV / 1099-K
Schedule K-1
Investment or crypto statements
Form 1095-A
Form 1098-T
Form 1098
Childcare records
Estimated tax payment records
Business income and expense records
Prior-year return
Other documents or notes
Acknowledgments and Signature
Typed Legal Name

First NameMiddle NameLast Name
Signature
Should be Empty:

Diverse Tax Gem – 2027 Tax Client Intake Form

Due Diligence Information

Taxpayer Information

Filing Status and Household

Spouse Information

Dependents and Childcare

Income Checklist

Self-Employment and Business Income

Deductions and Credits

Marketplace Health Coverage

Prior-Year Returns and Notices

Refund and Payment Preferences

Document Checklist

Acknowledgments and Signature