OBA Tax and Consulting Services

2020 Client Intake Form

(352) 290-2830

Have you been assigned a OBA Tax and Consulting Services Tax Professional?

Yes

Select Team Member

Were you referred to OBA Tax and Consulting Services? Please let us know who to thank!

Referred by: *

Today’s Date: *

Client’s Full Legal Name: *

Client's Social Security Number: *

Spouse’s Full Legal Name:

Spouse's Social Security Number:

Spouse’s Date of Birth:

Current Address (please include zip code): *

Current Home Phone Number:

Current Cell Phone Number: *

Spouse’s Cell Phone Number:

Email Address: *

Spouse’s Email Address:

Current Occupation: *

Your Spouse’s Current Occupation:

Have you been a victim of identity theft and been given an identity theft protection PIN by the IRS? If yes, enter the six digit identity protection PIN number. *

Has the spouse been a victim of identity theft and been given an identity theft protection PIN by the IRS? If yes, enter the six digit identity protection PIN number.

Were you, your spouse, or any of your dependents Enrolled at least part time in an accredited College, Trade School or University in 2020? *

Name of accredited College, Trade School or University? *

How many years of school have been completed prior to December 31, 2020? *

Were you, your spouse, or any of your dependents who were enrolled at least part time in an accredited College, Trade School or University issued a 1098T or 1098E form? *

What county did you live and work in as of December 31, 2020?

What SCHOOL DISTRICT did you live in as of December 31, 2020?

Did you file your 2019 Tax Return? *

Did you receive your expected refund? *

Have you ever had EARNED INCOME CREDIT DISALLOWED by the IRS? *

Was your tax return completely offset last year? *

Will you be filing more than one STATE return? If so, WHICH STATE?

DEPENDENT INFORMATION

Are you claiming any dependents that you provided MORE THAN HALF the support for? *

If yes, fill out their information below:

Dependent #1

Full Legal Name:

Relationship to Taxpayer:

Social Security Number:

Date of Birth:

Full Legal Name(s) of Biological Parent(s):

How long did the dependent live in your home during the tax year?

Dependent #2

Full Legal Name:

Relationship to Taxpayer:

Social Security Number:

Date of Birth:

Full Legal Name(s) of Biological Parent(s):

How long did the dependent live in your home during the tax year?

Dependent #3

Full Legal Name:

Relationship to Taxpayer:

Social Security Number:

Date of Birth:

Full Legal Name(s) of Biological Parent(s):

How long did the dependent live in your home during the tax year?

Do you have additional dependents? Add them below.

Dependent #4

Full Legal Name:

Relationship To Taxpayer:

Social Security Number:

Date Of Birth:

Full Legal Name(S) Of Biological Parent(S):

How Long Did The Dependent Live In Your Home During The Tax Year?

Dependent #5

Full Legal Name:

Relationship To Taxpayer:

Social Security Number:

Date Of Birth:

Full Legal Name(S) Of Biological Parent(S):

How Long Did The Dependent Live In Your Home During The Tax Year?

Dependent #6

Full Legal Name:

Relationship To Taxpayer:

Social Security Number:

Date Of Birth:

Full Legal Name(S) Of Biological Parent(S):

How Long Did The Dependent Live In Your Home During The Tax Year?

Dependent #7

Full Legal Name:

Relationship To Taxpayer:

Social Security Number:

Date Of Birth:

Full Legal Name(S) Of Biological Parent(S):

How Long Did The Dependent Live In Your Home During The Tax Year?

Do you have joint custody of the above listed DEPENDENT(S)? *

Did the above listed dependents live in the other parent’s home during the tax year, if so, how long? *

Do you have a signed IRS Form 8332? *

Per IRS new guidelines, please indicate where the dependent’s Non-Custodial parent/parents are and why they will not be filing this dependent? *

Will you claim the CHILD CARE DEDUCTION for this tax year? If so, full legal name, social security (tax ID), address and amount per child paid: *

Do you receive ANY supplemental, nontaxable income such as child support, Food stamps, Medicaid/ Medicare, TANF, social security, or disability if so, how much? (Please list each type that applies along with the amount) *

REAL ESTATE AND VEHICLE

Are you a homeowner? Did you purchase your first home in 2020?

If YES - the questions below are REQUIRED.

Enter amount of the home/property - IF YES:

Did you pay real estate taxes in 2020? IF YES enter AMOUNT:

Did you pay Property Taxes for your home in 2020? Enter amount IF YES:

Did you pay Mortgage Interest for your home in 2020? Enter amount IF YES:

Did you make any ENERGY IMPROVEMENTS to your MAIN HOME in 2020? IF YES enter AMOUNT:

Did you pay upkeep and repair expenses for your home in 2020? If Yes enter AMOUNT:

Did you pay for Property Insurance for your home in 2020? IF YES enter AMOUNT:

Did you RENT? IF YES, how many months and the AMOUNT paid in 2020:

Did you pay renters insurance? AMOUNT paid in 2020:

Did you purchase a NEW VEHICLE after February 16, 2020? IF YES enter AMOUNT:

Amount, IF any personal property taxes:

Amount of any significant MEDICAL/DENTAL expenses:

Amount IF any cash- noncash contributions to charity in 2020:

Amount IF any rental income property in 2020?

DISABLED

Are you, your spouse, or any dependent listed on your tax return disabled? *

If YES - the questions below are REQUIRED

What is the nature of the disability?

Has this dependent been declared disabled by a physician? If so, can you provide documentation?

Are you or your spouse listed as the Social Security Representative Payee for this dependent?

Is this the dependent(s) expected to recover in the next year?

Will you claim the DEPENDENT CARE DEDUCTION for the disabled dependent If so, full legal name, social security (tax ID), address and amount per disabled dependent paid:

Did you pay out of pocket for any uncovered Medical Expenses for the disabled dependent, if so, enter the amount for the year?

Please sign below - spouse signature if appropriate.

Taxpayers Signature *

Clear

Taxpayers Spouse’s Signature

Clear

Date *

Consent to Use of Tax Return Information

Printed name of tax preparer

“we,” “us,” and “our”) Printed name of tax preparer Federal law requires this consent form be provided to you (“you” refers to each taxpayer, if more than one). Unless authorized by law, we cannot use, without your consent, your tax return information for purposes other than the preparation and filing of your tax return.

You are not required to complete this form. If we obtain your signature on this form by conditioning our services on your consent, your consent will not be valid. Your consent is valid for the amount of time that you specify. If you do not specify the duration of your consent, your consent is valid for one year.

If you do not consent, then you may still have your tax return prepared and electronically filed by us for a fee.

For your convenience, we have entered into arrangements with a bank to provide qualifying taxpayers with the opportunity to apply for a Refund Anticipation Loan (RAL), or Electronic Refund Check or Electronic Refund Deposit. To determine whether these products may be available to you, we will need to use your tax return information by analyzing it and calculating the amount of your anticipated refund.

If you would like us to use your tax return information to determine whether these products may be available to you while we are preparing your return, please sign and date this consent to the use of your tax return information.

By signing below, you (including each of you if there is more than one taxpayer) authorize us to use the information you provide to us during the preparation of your 2019 tax return to determine whether to present you with the opportunity to apply for these products and services

Printed name of taxpayer: *

Taxpayer signature: *

Clear

Date *

Printed Name of joint taxpayer: *

Joint taxpayer signature: *

Clear

Date *

If you believe your tax return information has been disclosed or used improperly in a manner unauthorized by law or without your permission, you may contact the Treasury Inspector General for Tax Administration (TIGTA) by telephone at 1-800-366-4484, or by e-mail at [email protected].

DIRECT DEPOSIT

IF YOU WOULD LIKE DIRECT DEPOSIT: PLEASE BRING A VOIDED CHECK TO AVOID ERRORS:

Name of Bank: *

Account Number: *

Routing Number: *

Signature of Taxpayer *

Clear

Date *

Signature of Tax Preparer

Clear

Date

REFERRAL

We continue to grow our business through loyal customers like you. Please look in your cell phones and provide us with at least 3 names and phone numbers of people needing assistance in preparing their taxes and getting back the maximum amount of money they are legally entitled to:

Name of whom you are referring?

What is their phone number?

#2 Name of whom you are referring?

#2 What is their phone number?

#3 Name of whom you are referring?

#3 What is their phone number?

I agree to terms & conditions provided by the company. By providing my phone number, I agree to receive text messages from the business.