CJ&K TAX INTAKE FORM

Please provide the name of your referrer or where you found our business

Full Name *

Street Address *

City *

State *

Country *

Postal code *

Please specify the audit year(s) and the outcome of each audit.

Primary Taxpayer - Please Check Any That Apply

Taxpayer can be claimed as a dependent on someone else's return.

Taxpayer was over age 18 and a full-time student at an eligible educational institution.

Taxpayer is blind.

Taxpayer is deceased.

Taxpayer has received, sold, sent, exchanged, or otherwise acquired financial interest in virtual currency during the current tax year.

Taxpayer prefers to receive written communications from the IRS in a language other than English.

Taxpayer prefers to receive written communications from the IRS in an accessible format.

Taxpayer is disabled.

Spouse Information

If applicable — skip this section if it does not apply to you

skip this

Spouse's Date of Birth

Spouse - Please Check Any That Apply

Spouse can be claimed as a dependent on someone else's return.

Spouse was over age 18 and a full-time student at an eligible educational institution.

Spouse is blind.

Spouse is deceased.

Spouse has received, sold, sent, exchanged, or otherwise acquired financial interest in virtual currency during the current tax year.

Spouse prefers to receive written communications from the IRS in a language other than English.

Spouse prefers to receive written communications from the IRS in an accessible format.

Spouse is disabled.

Dependent Information

Do you have any dependents?

Yes

No

Do you have any other dependents?

Yes

No

Do you have any other dependents?

Yes

No

Do you have any other dependents?

Yes

No

Do you have any other dependents?

Yes

No

Did you pay for child, dependent, or afterschool care?

Yes

No

Business Information

Please enter your Business EIN (Employer Identification Number)

How long has your business been established?

Business Adress

Did you use a vehicle for business purposes?

Yes

No

Please provide the year, make, and model of the vehicle

Do you own a separate personal vehicle?

Yes

No

College Student and Educator Expenses Information

(If applicable — skip this section if it does not apply to you)

Did any individuals listed on this return attend college during the tax year?

Yes

No

Name of individuals who attended college

Did all students attend college on at least a half-time basis?

Yes

No

Total amount spent on college-related expenses and/or educator expenses?

Has the student ever been charged with a drug-related felony?

Yes

No

Are you currently making payments on student loans?

Yes

No

Document Upload

PLEASE NOTE: YOU CAN UPLOAD MULTIPLE DOCUMENTS

Upload ID/DL for anyone 18 or older

HOH filers: Upload lease and utility bill in your name. Single filers: utility bill only

Upload Social Security cards for all individuals on this filing

Upload birth certificates for each dependent

Upload all W-2s here (multiple files allowed)

Upload 1099-G form if you received unemployment.

Upload 1099-R for 401K withdrawal

Upload any records of child, dependent, or afterschool care expenses

Upload Form 1098-T and other college documents

Upload your Form 1098-E if you have student loan interest

Upload your mortgage statement (Form 1098), any property-related documents, real estate records, or insurance information

Upload Marketplace Health Insurance form (1095-A) or any other Health Coverage forms you’ve received

Upload prior year tax return or transcript (include Schedule C if self-employed)

Self-employed ONLY: Upload your profit/expense records

Banking Information

Are you interested in applying for a Tax Loan Advance?

$1000 advance (no finance charge)

Up to $9500 (with finance charge)

Not interested

Please Check This Box To Agree To All Of The Terms Of This Document. You must read the statement below before checking the box to continue.

Signature Consenting to Form 7216 Bank Consent to Disclosure of Tax Return Information

Clear

How would you like your refund and/or loan deposited?

Direct Deposit

Pre-Paid Debit Card

I owe taxes and am not receiving a refund

Paper check printed to pick-up in CJ&K Tax office

Signatures

Please Review & Sign Consent Forms

Income Tax Preparation Engagement Letter. You must read the statement below before checking the box to continue.

Consent to Engagement Terms – Signature Required

Clear

Consent for Use of Tax Return Information. You must read the statement below before checking the box to continue.

Client Signature Acknowledging Consent to Use Tax Return Information *

Clear

Authorization Request. You must read the statement below before checking the box to continue.

Signature Authorizing Electronic Filing of Tax Return *

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Acknowledgment & Consent

By entering your name, signature, and date below, you confirm that:

All information provided is accurate and complete.

You authorize CJ&K Tax Professionals to collect and process your sensitive data, including personal ID, government-issued ID, and SSN.

You understand and accept your responsibilities and ours in the preparation of your tax return.

Your name

Your Signature

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