PNZ Financial Tax Services

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Tax Client Intake Form

Disclaimer: Thank you for your interest in being a client of PNZ FINANCIAL TAX SERVICES. This form is used to collect information about new clients and is for internal purposes only. The information you provide is confidential  and will be treated accordingly.

Filing Status

Staus

Taxpayer Info

Address
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Taxpayer Info

Address
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Dependent

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Student?
Disable

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Student?
Disable

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Student?
Disable

Income

Did You Receive W2 Income?
Did you receive any self-employment income?
Did you receive income from rental property?
Did you receive unemployment income?
Did you receive any money from stock sales?
Did you receive any interest or dividends?
Did you receive any social security income?
Did you receive any miscellaneous (1099) income?
Did you receive any alimony?
Did you receive any any other income from assets sold?
Did you take any money from your 401k?
Did you receive any taxable refunds/credits/offsets?
Did you receive any foreign income?
Did you receive any other income?

Adjustments to Income:

Did you have any educator (teaching) expenses?
Did you have any health savings account deductions?
Did you have any moving expenses (military only)
Did you pay for self-employed health insurance?
Did you make contributions to a retirement plan?
Did you have any student loans or tuition/fees deductions?
Did you pay any alimon?

Deduction

Do you have any mortgage interest?
Did you pay any real estate tax?
Did you pay any vehicle tax?
Did you pay tithes?
Did you pay any childcare expenses?
Did you have any other deductions or credits?

Payments

Did you file taxes last year?
Did you owe the state last year?
Did you pay the state last year?
Do you owe the IRS?
Did you receive a federal refund last year?
Have you received any letters from the IRS?
Did you borrow funds for college tuition?
Did you make any estimated payments toward this year's tax return?

MISCELLANEOUS

Are you part of a business partnership or corporation?
Are you an Armed Forces Reservist?
Are you a victim of identity theft?

SIGNATURE

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