INITIAL INTAKE SHEET 
	
TAXPAYER NAME		Birthdate		
SSN		Occupation		
				
SPOUSE NAME		Birthdate		
SSN		Occupation		
ADDRESS		
Phone				
Email Address		
				
Children:	Social Security 	Date of birth	Months lived in your home	

				
Day Care Costs	Location of Day Care	EIN for Day Care	$ of Day Care for Child	

For new clients, bring your last years tax return with you.  
For all clients, bring in your driver’s license.

Do you qualify for the teachers $250.00 deduction?  ___ Yes  ___ No

Did you work in another state last tax year?  ___ Yes ___ No.  If yes, name the state, & attach the W-2 Form.
Did you make gifts of more than $15,000 to any individual;  ___ Yes  ___ No; If yes, tell me about this.

Besides your spouse and minor children, list who lives in the house with you and provide the following:

Name (First, Initial and Last Name)     DOB          SSN               Relationship to you      Months in your home
_______________________________________________________________________________________
_______________________________________________________________________________________
Are you a US citizen?  ___ Yes  ___ No.
Do you own BIT Coin?  ___ Yes  ___ No. If yes, attach purchase and sale documents. Sale of BIT Coin is a taxable event.
Do you have health insurance from the Market Place?  ___ Yes  ___ No.  If yes, attach 1098 C

Do you have §529 plans for your children?  ___ Yes  ___ No.  If yes, 
o	Attach statement showing contribution to plan for the last tax year.
o	If using plan to pay college expenses currently, attach 1099T from the school, distribution statement from the plan.
o	Beginning 2019, §529 can be use to pay student loans.  Have you?  ___ Yes  ___ No. 

Did you foreclose on your mortgage in last year?  ___ Yes ___ No. If yes, tell me about this.

Do you own foreign bank accounts or foreign trusts where the value of either was greater than $10,000 on any given day in the tax year?  ____ Yes   ____ No.

Attach the following documents:
□  Attach medical expenses if they exceed 7.5% of your total income.
□ If divorced, Judgment of Divorce and most recent custody order.
□ If you pay spousal support or alimony (same thing), attach or state the amount you paid last tax year and the date your Judgment of Divorce was entered by the Court.  __________________________

□ If you and your spouse lived apart, or per a Legal Separation Agreement.   List spouses address:

□ All W-2 forms, 1099 forms received from employment.
□ All 1099-B, Schedule K-1 documents.
□ All 1099 R forms from retirement or retirement savings plan distributions, if you made a made withdrawal from or contributions to IRA, Keogh, SIMPLE or SEP account
□ Do you have a health savings account?  If yes, attach the 1098 SA and distribution form.  Were all HSA distributions for medical expenses?      ___ Yes    ____ No
□  Did you purchased or sell a home last year?  ___ Yes  ___ No; if yes, attach the closing documents, and for sale, bring in the 1099.
□  If you own your home with a mortgage, attach form 1098, mortgage statement.
□ Property tax statements and SEV statement.
□ Did you purchase any energy efficient appliances, “green-approved” home improvements.
□ Vehicle/RV/Boat purchase agreement, specifically Michigan sales tax paid.  
□ Charitable Contribution letters/forms identifying donations;  otherwise, list donations:  $300.00 deduction for 1040 Simple forms.
CHECK ALL THAT APPLY
□ Lottery or Gambling Winnings	□ Own Business/Self Employed	□ Tips/Other Income
□ Disability income       □ Own Rental Property                                               □ Significant Loss/Theft										
Spouse’s    Signature__________________________________________  Date _________________
Spouse’s Signature___________________________________________ Date ________________