To learn about all of our tax, tax preparation, and family planning services click here!Tax-Prep Checklist Name * First Name Last Name Email * Company Phone * (###) ### #### Occupation Date Of Birth * MM DD YYYY Address * Address 1 Address 2 City State/Province Zip/Postal Code Country Social Security Number * Filing As: * Single Head of Household Married, Filing Jointly Married, Filing Seperately Widow(er) Unsure, Please Evaluate Best Position Married as of 12/31 of tax year? N/A Yes No New or Returning Client? * New! More questions to come! Returning! Ready to submit form! How did you find us? * Facebook Google Search Instagram Referral Other Who referred you to us? Message Spouse Information Lived with spouse more than 6 months of year / or since marriage if just married this year? N/A Yes No Spouse's Name First Name Last Name Spouse's Date of Birth MM DD YYYY Spouse's Social Security Number Spouse's Phone (###) ### #### Spouse's Occupation Number Of Dependents 1 2 3 4 5 6 7 8 9 10 11 12 Wage/Income Information - check all that apply and make sure to provide documentation W2 Wages 1099 NEC/Self-Employed 1099G Unemployment Wages Investment Income W2 Gambling or Lottery Winnings Rental Property Income Cash Income Not Reported on 1099 Interest Income From Savings, CDs, ect Other Check all that apply Child Care Expenses Medical Expenses Taxes Paid Business Expenses Charitable Gifts Stimulus Payments Bought a Home Bought a Car Home Office for Business Use Student Loan Payments None Other Did you take any college or trade school courses this year? Yes No Do you own a home? (must provide 1098) Yes No Do you owe back child support? Yes No If yes to back child support, how much? Do you owe the IRS? Yes No Have you had a return audited, rejected, or adjusted by the IRS? If yes to previous question, please explain: Do you have health insurance? Yes No Is your health insurance through an employer, the marketplace or something else? Employer Marketplace None Other If other, please list provider: Do your dependents have health insurance? Yes No Is their health insurance through an employer or the marketplace or something else? Employer Marketplace None Other If other, Please list provider: If you are due a refund, choose how you want your refund: * Check Direct Deposit I state that the information provided by me/my spouse as listed here and in all files given to Epiphany Administrative Solutions, LLC to be true and acurate and will be used solely in the delivery of services as contracted with Epiphany Administrative Solutions, LLC. * Yes No Completed returns will be shared by Epiphany with clients electronically only unless client agrees to an additional fee above and beyond tax preparation fees based on the number of pages in the return. * Yes No I understand it is my responsibility as the client to provide information in as timely a fashion as possible when requested by Epiphany and that Epiphany is responsible for being timely with sharing information with me, the client. * Yes No Tax preparation fees will be agreed upon before work begins, with the understanding that if something changes during the prepwork, the fees may also change, but any changes would be communicated before moving forward. * Yes No Prior to filing of tax returns, client will be advised of any refund or liability and an opportunity to review return & ask questions will be provided. Further, client will be required to sign an e-file authorization form. * Yes No I am ready to submit this form to Epiphany Administrative Solutions, LLC. * Yes No Thank you! To get started with your tax preparation, we ask that you fill out the form below. and submit any necessary/supporting documents via email to Danel@epiphanyadmin.com
