Intake Sheet Test

Intake Sheet PDF

Fill Out Digital Intake Form
Intake Form 2019





YOUR PERSONAL INFORMATION











Text OK?


A full-time student?
Getting Unemployment?
Paying dependent care expenses?
United States Citizen?
Can anyone claim you on their tax return?
Did you have Health Insurance?
Marital Status?
*




If Married: Did you live with your spouse during any part of the last six months?

SPOUSE'S PERSONAL INFORMATION









TEXT OK?


A Full Time Student?
Getting Unemployment?
Paying dependent care expenses?
United States Citizen?
Can anyone else claim you on their tax return?
Did you have Health Insurance?

DEPENDENTS

Other than your spouse, list the names of everyone you provided more than 1/2 total support who lived with you last year. you can list up to 6. (You may skip this entire section if inapplicable)






Dependent 1 is a US Citizen?
Dependent 1 is Single or Married as of 12/31/2019?
Dependent 1 is a Full-Time Student?
Dependent 1 is Totally & Permanently Disabled? (IRS Form 524)





Dependent 2 is a US Citizen?
Dependent 2 is Single or Married as of 12/31/2019?
Dependent 2 is a Full-Time Student?
Dependent 2 is Totally & Permanently Disabled? (IRS Form 524)





Dependent 3 is a US Citizen?
Dependent 3 is Single or Married as of 12/31/2019?
Dependent 3 is a Full-Time Student?
Dependent 3 is Totally & Permanently Disabled? (IRS Form 524)





Dependent 4 is a US Citizen?
Dependent 4 is Single or Married as of 12/31/2018?
Dependent 4 is a Full-Time Student?
Dependent 4 is Totally & Permanently Disabled? (IRS Form 524)





Dependent 5 is a US Citizen?
Dependent 5 is Single or Married as of 12/31/2019?
Dependent 5 is a Full-Time Student?
Dependent 5 is Totally & Permanently Disabled? (IRS Form 524)





Dependent 6 is a US Citizen?
Dependent 6 is Single or Married as of 12/31/2019?
Dependent 6 is a Full-Time Student?
Dependent 6 is Totally & Permanently Disabled? (IRS Form 524)

Tell us anything important here (keep it short)

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