Client Intake – House Of Phinance

Tax Year

Taxpayer Name

First Name

Last Name

Suffix

Social security number

Birth Date

Occupation

Phone number

Spouse Information

First Name

Last Name

suffix

social security number

Birth Date

occupation

Address

NO P O BOX/ PHYSICAL ADDRESS ONLY

Street Address Line 2

city

state / province

postal / zip code

Did you receive a stimulus payment?

No, I did not. Yes, first round. Yes, second round

HEAD OF HOUSEHOLD FILERS MUST PRESENT ONE OF THE FOLLOWING TO FILE THIS STATUS. PICK ONE OF THE 3 OPTIONS THAT YOU WILL SUBMIT TO BE APPROVED TO FILE HEAD OF HOUSEHOLD.

lease utility bills mortgage statement other

SCHOOL INFORMATION

School Name

School Tax ID No.

School Address

Tuition Information

Dependant-1

first name

last name

suffix

social security number

birth date

relationship

Dependant-2

first name

last name

suffix

social security number

birth date

relationship

Dependant-3

first name

last name

suffix

social security number

birth date

relationship

IF YOU ARE CLAIMING A DEPENDENT, PLEASE ANSWER THE QUESTIONS BELOW THAT PERTAINS TO YOUR DEPENDENT RELATIONSHIP. PER THE IRS REQUEST, WE MUST PROVE THAT NOBODY ELSE IS ELIGIBLE TO CLAIM YOUR DEPENDENT BUT YOURSELF.

If claiming son/daughter, where is the other parent of the dependent/dependents? Is the other parent providing any financial support?

If claiming niece, nephew, aunt, or uncle, how are you related to the dependent? Where are the parents to the dependent/dependents?

If claiming brother or sister, how are you related to the dependent? Why are the parents not claiming the dependent/dependents?

Did you pay someone to watch your child/children?

yes no

Are you married?

yes no

Have you been married before?

yes no

Can you provide separation/divorce paperwork?

yes no

Did you collect social security or retirement income?

yes no

Did you purchase health insurance through healthcare.gov marketplace (Obama Care)?

yes no

If yes, did you receive a 1095-A Form from the marketplace?

yes no

If yes, did you receive regular unemployment or PUA?

yes no

Did you make college tuition payments and received a 1098-T Form last year?

yes no

Do you have any other income than your w-2(s)?

yes no

Do you have an IP Pin?

yes no

IP Pin

Are you applying for the refund advance loan?*

interest free p to $1000 with interest up to $6000 no!

How would you like to receive your refund?

refund transfer direct deposit refund transfer debit card refund transfer paper check

Bank Information

name of bank

routing number

account number

I, hereby, state that all the information above is true to the best of my knowledge and that I am allowing Granted Tax Service to prepare my taxes based on that fact. I understand that I am financially responsible for any outstanding balance due to any false information given.

If there is a balance due, you must pay the tax preparation fee upfront. If for any reason you owe an entity and they take the entire refund, you are STILL responsible to pay the tax preparation fee for services rendered.

*For any reason an amendment has to be filed with no fault of the tax preparer, an upfront fee of $150.00 is required! Please view your tax return, which is emailed to you (it is sent prior to submission). Any copy after the first copy is a fee of $10.00.

ALL FEES (bank and service fees) are found in the return and are non-refundable nor negotiable! NO EXCEPTIONS TO THIS!!

Please utilize www.irs.gov for all federal refund tracking. Please utilze your state Department of Revenue site for any State Refund tracking. Do NOT add the amounts together. Federal taxes are federal, and state taxes are state when tracking your status. Please allow 8 weeks to surpass from the date of submission before calling the IRS, if you have any tracking questions.

For any direct assistance please email grantedtaxservice@gmail.com

IRS Contact 800-829-1040

Please click this link to check your federal refund status. You will need your filing status, social security number, and the total amount of the refund before fees

https://sa.www4.irs.gov/ irfof/lang/en/irfofgetstatus.jsp

Files

indentification

Social Security Card

Head Of Household

Dependent Birth Certificate

Dependent Social

Self Employment

College Forms

Healthcare Forms

IP Pin (paper from the IRS)

Direct Deposit

Misc. Forms

Previous Year Tax Return (2022 Tax Return If Possible)

Were you referred?

Yes No

Client Signature:

Spouse Signature

Employee Signature

Submission ID No

date