Client Intake Form

1Your Info

2Income Info

3Deduction Info

4Credit & Payment Info

5Agreement

Taxpayer*
First Last
Date of Birth*
Month
Day
Year
Occupation
Spouse
First Last
Date of Birth
Month
Day
Year
Occupation
Email
Phone
Address
Street Address Address Line 2 City State ZIP Code
Marital Status on 12/31/2021*
Names and Birthdays of Dependent Children
Name Birthday (mm/dd/yyy)
Did any of the children have unearned income in excess of $1100?
If you received any advance Child Tax Credit payments, please include letter 6419 with your tax data.
Did you receive, sell, exchange or otherwise dispose of any financial interest in any virtual currency?*
I authorize Kristin Cooper to discuss my tax return with the IRS.*
Do you or your spouse want $3 of your federal tax to go to the Presidential Election Campaign Fund?*

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General Engagement Letter for Tax Return Preparation
This letter is to inform you of the services I will provide you, and the responsibilities you have for preparation of your tax return.
Tax Return Preparation
- I will prepare your federal and state tax returns based on information you provide. Services for preparation of your return do not include auditing or verification of information provided by you.
- This engagement does not include any audit or examination of your books or records. In the event your return is audited, you will be responsible for verifying the items reported.
- Fees charged for tax return preparation do not include audit representation.
- Preparation fees do cover limited assistance and consultation during the year. If you get a letter from the IRS, please contact me right away. I am happy to help. If the response requires a complex or lengthy response, I will discuss options with you, and we will come up with a plan.
- The engagement to prepare your tax returns terminates upon delivery of your completed returns and original documents to you. Please store your supporting documents and copies of your tax returns in a secure place for at least seven years. You may be assessed a fee if you request a copy in the future. Your tax return is also accessible to you on the client portal, which you can access via my website.
Tax Return Preparation*
I agree to the terms under Tax Return Preparation.*
Taxpayer Responsibilities
- You agree to provide all income and deductible expense information. If you receive additional information after I begin working on your return, please contact me 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, I 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). I can provide guidance concerning what evidence is acceptable.
- Please review the return carefully before signing to make sure the information is correct.
- Fees must be paid before your tax return is delivered to you or filed for you. If you terminate this engagement before completion, you agree to pay a fee for work completed. A retainer may be required for preparation of late returns.
Taxpayer Responsibilities*
I agree to the terms under Taxpayer Responsibilities.*
Privacy Policy

The nature of my work requires me to collect certain non-public, personal information about you from various sources. I collect financial and personal information from forms, worksheets, reporting statements, as well as interviews and conversations with you. Under my policy, all information I obtain about you will be provided by you or obtained with your permission. I have procedures and policies in place to protect your confidential information. I will not disclose your personal information to any third party without your express permission, except where required by law. I maintain physical, electronic, and procedural safeguards in compliance with federal regulations that protect your personal information from unauthorized access. Please contact me with any questions regarding the privacy policy.
Privacy Policy*
I agree to the Privacy Policy.*
Signatures

By signing below, you acknowledge that you have read, understand, and accept your obligations and responsibilities and that you understand my responsibilities in preparing your tax returns as explained above. For a joint return, both taxpayers must sign.
Primary Taxpayer Signature*
Spouse's Signature

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Income Information

Other Income

Small Business (self-employed or independent contractor business owner)

Rental Property

Sale of Real Estate or Mortgage Refinance

Deduction Information

Medical Expenses

Credit and Payment Info

2021 Economic Impact Payment

General Engagement Letter for Tax Return Preparation

Tax Return Preparation

Taxpayer Responsibilities

Privacy Policy

Signatures

Name	Birthday (mm/dd/yyy)