Tax Preparation

Client Intake Form

Please complete all sections as accurately as possible. This information is used solely for the purpose of preparing your tax return.

Privacy & Confidentiality Notice

The information you provide on this form is confidential and will be used exclusively for tax preparation purposes. Established Grace Enterprises is committed to protecting your personal information in accordance with IRS Publication 4600 and applicable federal and state privacy laws.

Taxpayer Information

First Name *

Last Name *

Social Security Number (SSN) *

Required for IRS filing. Transmitted securely.

Date of Birth *

Email Address *

Phone Number *

Street Address *

City *

State *

ZIP Code *

Occupation

Filing Status & Dependents

Filing Status *

Number of Dependents

Include children and qualifying relatives you will claim.

Did you file a return last year?

Prior Year Adjusted Gross Income (AGI)

Found on last year's return — used to verify your identity with the IRS.

Income Sources

Select all income types that apply to your household for this tax year.

W-2 Wages (employer)

1099 / Freelance / Contract Income

Self-Employment / Business Income

Rental Income

Investment / Dividend / Capital Gains

Other Income (SSA, alimony, gambling, etc.)

Deductions & Credits

Select all that apply. Bring documentation to your appointment.

Student Loan Interest (Form 1098-E)

Mortgage Interest (Form 1098)

Charitable Donations

Child / Dependent Care Expenses

Education Expenses (Form 1098-T)

Business / Home Office Expenses

Health Insurance Premiums (self-employed)

HSA / FSA Contributions (Form 5498-SA)

Other Deductions

Refund / Payment Preference

How would you like to receive your refund?

Bank Name

Account Type

Routing Number

Account Number

Consent & Signature

By signing below, I authorize Established Grace Enterprises to prepare my federal and/or state income tax return(s) for the applicable tax year. I certify that:

All information provided is accurate and complete to the best of my knowledge.
I understand that I am responsible for the accuracy of my return and that providing false information may result in penalties under IRS regulations.
I consent to the use of my personal information solely for tax preparation purposes in accordance with IRS Publication 4600 (Safeguarding Taxpayer Data).
I understand that Established Grace Enterprises will not share my information with third parties without my written consent, except as required by law.

Electronic Signature (Full Legal Name) *

Typing your name constitutes a legally binding electronic signature under the E-SIGN Act.

Initials *

Date *

Questions? Call or text Sabrina at (803) 855-4466