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Our Elite Services
Tax Client Intake Form
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Contact Us
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About Us
Our Elite Services
Tax Client Intake Form
Blog
Contact Us
Tax Intake Form
CLIENT INFORMATION
Full Name
(Required)
Date of Birth
(Required)
Day
Day
1
2
3
4
5
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31
Month
Month
1
2
3
4
5
6
7
8
9
10
11
12
Year
Year
2026
2025
2024
2023
2022
2021
2020
2019
2018
2017
2016
2015
2014
2013
2012
2011
2010
2009
2008
2007
2006
2005
2004
2003
2002
2001
2000
1999
1998
1997
1996
1995
1994
1993
1992
1991
1990
1989
1988
1987
1986
1985
1984
1983
1982
1981
1980
1979
1978
1977
1976
1975
1974
1973
1972
1971
1970
1969
1968
1967
1966
1965
1964
1963
1962
1961
1960
1959
1958
1957
1956
1955
1954
1953
1952
1951
1950
1949
1948
1947
1946
1945
1944
1943
1942
1941
1940
1939
1938
1937
1936
1935
1934
1933
1932
1931
1930
1929
1928
1927
1926
1925
1924
1923
1922
1921
1920
Social Security Number (Last 4 digits)
(Required)
Please enter a number from
4
to
4
.
Phone
Email Address
(Required)
Mailing Address
(Required)
Street Address
City
State / Province / Region
ZIP / Postal Code
Preferred Contact Method
(Required)
Pone Call
Email
Text/SMS
Filing Type
(Required)
New Client
Returning Client
Filing Status
(Required)
Single
Married Filing Jointly
Married Filing Separately
Head of Household
Qualifying Widow(er)
Spouse’s Full Name
(Required)
Spouse’s SSN (Last 4 digits)
(Required)
Spouse’s Date of Birth
(Required)
Day
Day
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
Month
Month
1
2
3
4
5
6
7
8
9
10
11
12
Year
Year
2026
2025
2024
2023
2022
2021
2020
2019
2018
2017
2016
2015
2014
2013
2012
2011
2010
2009
2008
2007
2006
2005
2004
2003
2002
2001
2000
1999
1998
1997
1996
1995
1994
1993
1992
1991
1990
1989
1988
1987
1986
1985
1984
1983
1982
1981
1980
1979
1978
1977
1976
1975
1974
1973
1972
1971
1970
1969
1968
1967
1966
1965
1964
1963
1962
1961
1960
1959
1958
1957
1956
1955
1954
1953
1952
1951
1950
1949
1948
1947
1946
1945
1944
1943
1942
1941
1940
1939
1938
1937
1936
1935
1934
1933
1932
1931
1930
1929
1928
1927
1926
1925
1924
1923
1922
1921
1920
DEPENDENT INFORMATION
Dependent’s Full Name
(Required)
Dependent’s Date of Birth
(Required)
Day
Day
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
Month
Month
1
2
3
4
5
6
7
8
9
10
11
12
Year
Year
2026
2025
2024
2023
2022
2021
2020
2019
2018
2017
2016
2015
2014
2013
2012
2011
2010
2009
2008
2007
2006
2005
2004
2003
2002
2001
2000
1999
1998
1997
1996
1995
1994
1993
1992
1991
1990
1989
1988
1987
1986
1985
1984
1983
1982
1981
1980
1979
1978
1977
1976
1975
1974
1973
1972
1971
1970
1969
1968
1967
1966
1965
1964
1963
1962
1961
1960
1959
1958
1957
1956
1955
1954
1953
1952
1951
1950
1949
1948
1947
1946
1945
1944
1943
1942
1941
1940
1939
1938
1937
1936
1935
1934
1933
1932
1931
1930
1929
1928
1927
1926
1925
1924
1923
1922
1921
1920
Dependents SSN (Last 4 digits)
(Required)
Relationship with Dependent
Number of Months Lived with You
INCOME INFORMATION
Check all that apply and provide supporting forms
(Required)
W-2 (Wages)
1099-NEC (Contractor Income)
1099-MISC
1099-G (Unemployment)
1099-R (Retirement)
1099-DIV / INT (Dividends or Interest)
Social Security Benefits
Business or Self-Employment Income
Rental Property Income
Other
Other, Specify
DEDUCTIONS & CREDITS
(Required)
Mortgage Interest (Form 1098)
Property Taxes
Charitable Donations
Education Expenses
Childcare Expenses
Health Insurance (1095-A / Marketplace)
Medical Expenses
Retirement Contributions
Other
Other, Specify
ADDITIONAL SERVICES NEEDED
(Required)
LLC Formation
Bookkeeping
Tax Planning
IRS Resolution / Offer in Compromise
Multi-State Filing
Notary Services
Virtual Filing
24-Hour Filing Service
BANK INFORMATION (for Refund Direct Deposit)
Bank Name
Routing Number
Account Number
Account Type
(Required)
Checking
Savings
AUTHORIZATION & SIGNATURE
I hereby certify that the information provided is true and complete to the best of my knowledge. I authorize Heritage Tax Services to prepare and electronically file my tax return based on the information I have provided.
