First Name *

Please provide your full legal name as it appears on your official documents.

Last Name *

Please provide your full legal name as it appears on your official documents.

Date of birth *

Taxpayer's SSN *

Spouse Name

Contact Information

Please provide your current contact information for communication purposes.

Address *

City

State

Country

Postal Code

Email *

Phone *

Welcome to your personalized tax consultation! Before we dive into the details, let's catch up on any significant life events from the previous year.

Life Changes in the Past Year:

Have you gone through a divorce recently? *

Yes

Did you get married or experience a name change in the past year? *

Yes

Did you experience a change in employment? *

Yes

Was there a death in the family in the past year? *

Yes

Any new additions to the family? Births? *

Yes

Would you like to contribute $3 to the Presidential Election Campaign Fund? *

Yes

Other Personal Changes:

Filing Status and Dependents:

Are you Single? *

Yes

Are you Married? *

Yes

Do you have children? *

Yes

Did they live with you the entire year? *

Yes

If not, how many months did they reside with you? *

Do you have the dependents SSN/ATIN, ITIN documents? *

Yes

What are the dependents dates of birth? *

Can somebody else claim the dependents? *

Yes

Any interest from checking/savings/bonds/CDs or dividends? *

Yes

Any SS-benefits or railroad retirement benefits? *

Yes, receiving any SS or Railroad Retirement benefits.

No, not receiving any SS or Railroad Retirement benefits.

Did you receive money from a pension or a traditional/Roth IRA *

Yes

Not Applicable

Any other income from cryptocurrency/FEX? *

Yes

Did you pay interest on any student loans? *

Yes

Did you receive an Identity Protection PIN from the IRS ? *

Yes

If yes, put the name and ippin below *

Do you have medical expenses? *

Yes

Do you have debt from a mortgage or credit card canceled or forgiven by a commercial lender? *

Yes

Did you live in an area that was affected by a presidentially declared natural disaster? *

Yes

Did you receive the first-time homebuyer credit in 2008? *

Yes

Tax Payments and Other Taxes:

Did your childcare provider come to your house to babysit? *

Yes

Did you have healthcare coverage for the entire tax year? *

Yes

Did you withdraw money from your IRA or 401k? *

Yes

Total Tax Payments:

Did you make any estimated payments during the tax year? *

Yes

Did you have last year's refund applied to the current tax year? *

Yes

Did you take any higher education classes? *

Yes

Did you pay any money along with the request to file an extension? *

Yes

Banking Account Info

Bank Name: *

Routing # *

Account # *

Client Certification & Acknowledgment

By signing below, I certify that all information I have provided in this intake form is true, correct, and complete to the best of my knowledge. I understand that all tax preparation services are based solely on the information I provide. I acknowledge and agree to the following:

1. Accuracy & Truthfulness — I confirm that the information submitted is accurate and that no material facts have been omitted. Any changes to my information must be communicated to my tax professional immediately.

2. Offset Disclosure — I understand that if my refund is reduced, delayed, or taken due to any offset (including child support, IRS tax debt, student loans, unemployment overpayment, state tax debt, treasury offset, or any other government-held debt), I am still fully responsible for all tax preparation fees.

3. Refund Advantage Eligibility — I understand that certain debts, identity verification issues, or refund-based requirements may prevent me from qualifying for a Refund Advantage Bank Product or Refund Advance. In such cases, I may be required to pay my tax preparation fees upfront before my return is filed.

4. Fee Responsibility — I understand that tax preparation fees are owed regardless of my refund amount, refund status, or offset outcome. These fees are not waived, forgiven, or contingent upon receiving a refund.

5. Fee Collection Notice — I understand that unpaid fees may be collected through a secure invoice, an authorized debit by F & S Tax Service LLC from my bank account (if applicable), or a payment arrangement. Failure to resolve my balance may result in collection activity and denial of future services.

6. Electronic Communication Consent — I consent to receive communication, updates, and documents electronically via text message and email.

Signature *

Clear

Sign Here

Date Signed *

By checking this box, I consent to receive transactional messages related to my account, orders, or services I have requested. These messages may include appointment reminders, order confirmations, and account notifications among others. Message frequency may vary. Message & Data rates may apply. Reply HELP for help or STOP to opt-out.

By checking this box, I consent to receive marketing and promotional messages, including special offers, discounts, new product updates among others. Message frequency may vary. Message & Data rates may apply. Reply HELP for help or STOP to opt-out.

Thank you for completing your 2025 Tax Intake Form. Your tax professional will review your submission and contact you if additional information is needed.

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STEP 2

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