Client Intake Form

Select Tax Preparer *

Taxpayer Full Name *

Street Address *

City *

State *

Postal Code *

Email *

Phone *

Date of birth *

Filing Status *

Social Security Number *

ID Type *

Job Occupation *

Are you or your spouse permanently disabled? *

Spouse Information

Spouse Full Name *

Please write N/A if not applicable.

Spouse Email *

Please write N/A if not applicable.

Spouse Phone *

Please write N/A if not applicable.

Spouse Date of Birth *

Please write N/A if not applicable.

Spouse ID Type *

Spouse Job Occupation *

Please write N/A if not applicable.

Upload ID's and Social Security Card. If you are filing HOH, please upload the necessary forms (see more information below). *

If you are filing as Head of Household, please upload documents showing your dependent’s residency and support. Upload at least one of the following: utility bill, lease agreement, mortgage statement, bank statement, divorce decree, separation agreement, or rent statement.

Will you be claiming any dependents for this tax year? *

Dependent 1

Full Name

Date of Birth

Social Security Number

Relationship

Disabled

Provided more than 50% support

Has this dependent lived with you more than half the year in 2025?

Is anyone else claiming the child or allowed to claim the child?

Do you want to add another dependent?

Dependent 2

Full Name

Date of Birth

Social Security Number

Relationship

Disabled

Provided more than 50% support

Has this dependent lived with you more than half the year in 2025?

Is anyone else claiming the child or allowed to claim the child?

Do you want to add another dependent?

Dependent 3

Full Name

Date of Birth

Social Security Number

Relationship

Disabled

Provided more than 50% support

Has this dependent lived with you more than half the year in 2025?

Is anyone else claiming the child or allowed to claim the child

Do you want to add another dependent?

Dependent 4

Full Name

Date of Birth

Social Security Number

Relationship

Disabled

Provided more than 50% support

Has this dependent lived with you more than half the year in 2025?

Is anyone else claiming the child or allowed to claim the child?

Do you want to add another dependent?

Dependent 5

Full Name

Date of Birth

Social Security Number

Relationship

Disabled

Provided more than 50% support

Has this dependent lived with you more than half the year in 2025?

Is anyone else claiming the child or allowed to claim the child?

File Upload

Upload proof of relationship and residency for each dependent.

Accepted files: Birth certificate, school record, medical record, lease, or court document.

Upload all income Tax forms that you selected

Upload all Deductions tax forms.

Are you filing Self-Employed? *

Yes

Business Name/Address

If no business name, leave blank.

Home or Apartment Business Use

If you operated your business from your home or apartment, please provide the following information to determine your business-use-of-home deduction.

Total Square Footage of Home or Apartment
Square Footage Used Exclusively for Business (300sq ft is the max)

Job Description

EIN Number or Social Security Number

Grand Total of Income your business or job made?

Grand Total of Expense your business or job occur?

Check:

I agree that I have uploaded accurate receipts and/or a valid profit and loss statement reflecting my business income and expenses. I confirm that I have materially participated in my business during the tax year.

Upload profit and loss statement or receipts

You can only upload 30 files. If it is more, please email me. See email above.

Have you ever been disallowed the EITC/AOTC/CTC? *

Yes

Do you have Joint Custody of your child? *

Yes

Does not apply to me

Do you have a signed Form 8332? (Custodial Parent Release of Claim of Dependent(s) on tax return)

Yes

Are you applying for a loan advance? *

Yes

How would you like to receive your refund? *

Direct Deposit, checking

Direct Deposit, saving

Direct Deposit, other

Faster Moneycard

Name of the Bank

Routing Number

Checking Account Number

How did you hear about us? *

If someone referred you, please type his/her name above.

IRS Form 7216 – Consent to Use or Disclose Tax Return Information

In accordance with Internal Revenue Code §7216, KTA Consulting Group LLC must obtain your consent before using or disclosing your tax return information for purposes other than preparing or filing your tax return.

By signing below, you authorize KTA Consulting Group LLC and its representatives to use and/or disclose your tax return information for the following services (check all that apply below):

Tax preparation and e-filing

IRS correspondence or audit support

Tax planning and consulting

Bookkeeping, payroll, or financial services

Marketing and promotional offers for related financial products

Tax business education, training, or mentorship programs

This consent is valid for one (1) year from the date signed unless revoked in writing. You are not required to sign this form; however, KTA Consulting Group LLC may not use or disclose your information for other purposes without it.

Qualifying Children for Earned Income Credit (EIC) Acknowledgment

Based on the information you provided regarding your dependent(s), you confirm that each dependent listed is your biological child, grandchild, niece, nephew, or other qualifying relative.

I have explained that a qualifying child can only be claimed by one taxpayer per tax year. In cases where both parents are eligible, only one parent (or both if filing jointly) may claim the dependent.

If you are filing as Head of Household, you affirm that you can provide proof of residency such as a lease agreement or utility bill showing your name and current address.

By signing below, you acknowledge and affirm that:

You provide more than 50% of the total care and financial support for each dependent listed.
The dependent(s) live with you for more than half of the year.
No other person is eligible to claim the same dependent(s).
All information provided to KTA Consulting Group LLC is true, accurate, and complete to the best of your knowledge.
You have not provided, and will not provide, false or fraudulent information to your preparer.

By signing this document, you authorize KTA Consulting Group LLC to use the information you have provided for the purpose of preparing and filing your tax return.

Signature *

Clear

Your Trusted Tax Partner

Amaryllis Vargas

REQUIRED DOCUMENTS

Personal Identification

Income Documents

Receipts for Business Return

Prior-Year Tax Return

Client Intake Form

Spouse Information

Dependent 1

Dependent 2

Dependent 3

Dependent 4

Dependent 5

IRS Form 7216 – Consent to Use or Disclose Tax Return Information

Qualifying Children for Earned Income Credit (EIC) Acknowledgment

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