1040 CLIENT INTAKE FORM – TaxWorld Accounting & Financial Services LLC

Returning Client

Client Status

New Client

Taxpayer Full Name *

Address *

Address Line 1

Address Line 2

City

State / Province / Region

Zip / Postal Code

Country

I HAVE AGREED AND CONSENT TO SUBMIT MY PERSONAL INFORMATION TO TAX WORLD ACCOUNTING & FINANCIAL SERVICES LLC TO PREPARE AND FILE MY INCOME TAXES *

I AGREE
I DO NOT AGREE

Email *

Are you a U.S. citizen? *

Phone *

Taxpayer Date of Birth *

School District

Taxpayer Soc. Security# *

Filing Status *

Did you, your spouse, or a dependent have insurance under the Affordable Care Act?*If so, select Yes – you must report Form 1095-A for the IRS to accept your return. If you did not have an Affordable Care Act insurance plan, select No. *

Do you receive any of the following federal or state assistance? *

Cash Assistance- TANF, SSI, SSDI, Food- SNAP
None

Are you interested in getting a life insurance policy for you and your family?

List the names, date of birth, and relationship to you, of everyone you supported that lived with you last year (Dependents)… IF NO DEPENDENTS PLEASE TYPE “NO DEPENDENTS” *

Date *

** ALL DOCUMENTS NEED TO BE CLEAR AND VISIBLE. IF YOU CANNOT UPLOAD DOCUMENTS HERE PLEASE EMAIL ALL DOCUMENTS to shana@taxworldafs.com

TAXWORLD AFS

IF YOU HAVE MORE THAN 2 DEPENDENTS, W2s, 1099 OR ANY ADDITIONAL DOCUMENTS PLEASE SCROLL DOWN PAGE AND UPLOAD THEM UNDER THE APPROPRIATE UPLOAD FIELD!

Leave any additional information here

Signature

Upload Taxpayer ID (Drivers/State License, Passport) *