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Client Intake Form
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Client Intake Form
Client Name
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SSN or ITIN
*
Date of Birth
*
Occupation
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Current Mailing Address
Address Line 1
Address Line 2
City
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District Of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces (AA)
Armed Forces (AE)
Armed Forces (AP)
State / Province / Region
Zip / Postal Code
Afghanistan
Åland Islands
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antarctica
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belau
Belize
Benin
Bermuda
Bhutan
Bolivia
Bonaire, Saint Eustatius and Saba
Bosnia and Herzegovina
Botswana
Bouvet Island
Brazil
British Indian Ocean Territory
Brunei
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos (Keeling) Islands
Colombia
Comoros
Congo (Brazzaville)
Congo (Kinshasa)
Cook Islands
Costa Rica
Croatia
Cuba
Curaçao
Cyprus
Czech Republic
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Guiana
French Polynesia
French Southern Territories
Gabon
Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Heard Island and McDonald Islands
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Isle of Man
Israel
Italy
Ivory Coast
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
Kuwait
Kosovo
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macao
North Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Namibia
Nauru
Nepal
Netherlands
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
Northern Mariana Islands
North Korea
Norway
Oman
Pakistan
Palestinian Territory
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn
Poland
Portugal
Puerto Rico
Qatar
Reunion
Romania
Russia
Rwanda
Saint Barthélemy
Saint Helena
Saint Kitts and Nevis
Saint Lucia
Saint Martin (French part)
Saint Martin (Dutch part)
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
San Marino
São Tomé and Príncipe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
South Africa
South Georgia/Sandwich Islands
South Korea
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard and Jan Mayen
Swaziland
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Trinidad and Tobago
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom (UK)
United States (US)
United States (US) Minor Outlying Islands
Uruguay
Uzbekistan
Vanuatu
Vatican
Venezuela
Vietnam
Virgin Islands (British)
Virgin Islands (US)
Wallis and Futuna
Western Sahara
Samoa
Yemen
Zambia
Zimbabwe
Country
Previous Mailing Address (if different than above address)
Address Line 1
Address Line 2
City
State / Province / Region
Zip / Postal Code
Can you be claimed as a dependent by someone else?
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Yes
No
Are you an active member or the spouse/dependent of an active member of the military?
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Yes
No
Check all that apply (you should have a corresponding document to support)
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Employer Wage Statement (W-2)
Self Employment or Freelance Work (1099 NEC, 1099 MISC)
Interest (1099-Int)
Social Security/Retirement (1099SA, 1099 SSI)
Dividends (1099-DIV)
Rental Property
Stock or Mutual Fund Sale (1099-B)
Unemployment
Partner or Other Business Income (K-1)
Check all that apply (you should have supporting documentation)
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Self Employment Expenses
Expenses unreimbursed by your employer
Education expenses
rental property expenses
Out of pocket medical expenses
Does not apply
CREDIT & DEDUCTIONS (Check all that apply and provide supporting documentation)
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Donate cash or goods to a charity?
Pay Student Loan Interest?
Pay Child/Dependent Care expense?
Have a Mortgage Payment? (1098)
Make an IRA Contribution?
Make a major taxable purchase? i.e. car, boat
Stock or Mutual Fund Sale (1099-B)
Pay Property Taxes?
Does not Apply
Health Insurance: Were you or any members of your household:
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Covered by a qualified private or government health insurance plan?
Enrolled in a health insurance plan through the federal or state marketplace?
None
Do you receive health insurance through the Marketplace?
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Yes
No
Did you or your spouse:
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Sell a home?
Take an IRA or 401(k) distribution?
Pay/Receive alimony?
Adopt a child?
Suffer catastrophic loss?
Have gambling winnings/losses?
Does not apply
I am interested in learning more about the following services offered by Giles Consulting.
Start-up and New Business Assistance
Financial Planning and Retirement
Accounting and Bookkeeping
Health Insurance
Payroll Assistance
Funding Assistance
Tax Planning and Strategy
Business Banking and Lending
Business Certification
Business Planning
Email
*
Best Contact Phone Number
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Preferred Contact Method
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Email
Phone
Marital Status
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Single
Married filing Jointly
Married filing Separately
Widowed
If Married, please provide full name of spouse.
If Marital Status MFJ or MFS is chosen, please provide secondary taxpayer information below.
Spouse Information: DOB, SSN, Occupation, Address if different, Phone Number, and Email Address
Do you have any dependents to claim?
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Yes
No
Please enter the full name, date of birth, social security number and relationship to you and the number of months that they lived in your during the tax year for each dependent that you are claiming (Type N/A if not applicable)
Did you file a prior year Tax Return? If so, do you have a copy of it?
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Yes
No
Do you currently have an outstanding balance with any of the following: IRS, child support, student loans, liens, etc?
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Yes
No
Did you live in an area that was declared a Federal disaster area?
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Yes
No
Did you, or your spouse if filing jointly, receive a letter from the IRS?
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Yes
No
Banking Options and Account Information
For Refund Transfers, IRS Payments, and/or Service Fee balance
If you are due a refund, which method would you prefer?
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Direct Deposit
Mailed Check
Printed Check
Refund Advantage Debit Card
If you owe a balance, would you like to have it direct debited from your account?
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Yes
No
Please select a security question from below and provide the answer.
What is your mother's maiden name?
What is the name of your first pet?
What was the name of your high school?
What is the name of your oldest child?
What is your father's middle name?
Answer to security question.
Banking Account Information
For Refund Transfers, IRS Payments, and/or Service Fee balance
Routing Number
Account Number
Is there anything you would like to share before meeting with the tax specialist?
How did you hear about us?
*
Social Media
Family/Friend
Coworker/Colleague
Internet or Business Website
Other
If other, please specify:
Upload all supporting documentation. If unable to attach, email to info@gilesfc.com
Drop your files here or click here to upload
You can upload up to 10 files.
PRIVACY ACT AND PAPERWORK REDUCTION ACT NOTICE
The Privacy Act of 1974 requires that when we ask for information we tell you our legal right to ask for the information, why we are asking for it, and how it will be used. We must also tell you what could happen if we do not receive it, and whether your response is voluntary, required to obtain a benefit, or mandatory. Our legal right to ask for information is 5 U.S.C. 301. We are asking for this information to assist us in contacting you relative to your interest and/or participation in the IRS volunteer income tax preparation and outreach programs. The information you provide may be furnished to others who coordinate activities and staffing at volunteer return preparation sites or outreach activities. The information may also be used to establish effective controls, send correspondence and recognize volunteers. Your response is voluntary. However, if you do not provide the requested information, the IRS may not be able to use your assistance in these programs. The Paperwork Reduction Act requires that the IRS display an OMB control number on all public information requests. The OMB Control Number for this study is 1545-1964. Also, if you have any comments regarding the time estimates associated with this study or suggestion on making this process simpler, please write to the Internal Revenue Service, Tax Products Coordinating Committee, SE:W:CAR:MP:T:T:SP, 1111 Constitution Ave. NW, Washington, DC 20224
CONSENT TO DISCLOSE TAX RETURN INFORMATION TO VITA/TCE TAX PREPARATION SITES
Federal Disclosure: Federal law requires this consent form be provided to you. Unless authorized by law, we cannot disclose your tax return information to third parties for purposes other than the preparation and filing of your tax return without your consent. If you consent to the disclosure of your tax return information, Federal law may not protect your tax return information from further use or distribution. You are not required to complete this form to engage our tax return preparation services. If we obtain your signature on this form by conditioning our tax return preparation services on your consent, your consent will not be valid. If you agree to the disclosure of your tax return information, your consent is valid for the amount of time that you specify. If you do not specify the duration of your consent, your consent is valid for one year from the date of signature.
CONSENT TO DISCLOSE TAX RETURN INFORMATION TO VITA/TCE TAX PREPARATION SITES
TERMS: Global Carry Forward of data allows TaxSlayer LLC, the provider of the VITA/TCE tax software, to make your tax return information available to ANY volunteer site participating in the IRS’s VITA/TCE program that you select to prepare a tax return in the next filing season. This means you will be able to visit any volunteer site using TaxSlayer next year and have your tax return populate with your current year data, regardless of where you filed your tax return this year. This consent is valid through November 30, 2024. The tax return information that will be disclosed includes, but is not limited to, demographic, financial and other personally identifiable information, about you, your tax return and your sources of income, which was input into the tax preparation software for the purpose of preparing your tax return. This information includes your name, address, date of birth, phone number, SSN, filing status, occupation, employer’s name and address, and the amounts and sources of income, deductions and credits that were claimed on, or contained within, your tax return. The tax return information that will be disclosed also includes the name, SSN, date of birth, and relationship of any dependents that were claimed on your tax return. You do not need to provide consent for the VITA/TCE partner preparing your tax return this year. Global Carry Forward will assist you only if you visit a different VITA or TCE partner next year that uses TaxSlayer. Limitation on the Duration of Consent: I/we, the taxpayer, do not wish to limit the duration of the consent of the disclosure of tax return information to a date earlier than presented above (November 30, 2024). If I/we wish to limit the duration of the consent of the disclosure to an earlier date, I/we will deny consent. Limitation on the Scope of Disclosure: I/we, the taxpayer, do not wish to limit the scope of the disclosure of tax return information further than presented above. If I/we wish to limit the scope of the disclosure of tax return information further than presented above, I/we will deny consent.
Consent
I/we, the taxpayer, have read the above information. I/we hereby consent to the disclosure of tax return information described in the Global Carry Forward terms above and allow the tax return preparer to enter a PIN in the tax preparation software on my behalf to verify that I/we consent to the terms of this disclosure.
Signature
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Date Signed
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Comment
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