NEW CLIENT INTAKE FORM

Spouse information is needed if filing jointly or separately
Please select Yes ONLY if the question applies to you. Otherwise select No. *
 YESNO
You (or spouse) are Self-Employed. If yes, please attach a list of income and expenses
Someone can claim you (or spouse) as a dependent
You (and/or spouse) have health insurance
You (or spouse) contribute to a traditional IRA or ROTH IRA
You (or spouse) contribute to Education IRA or Keogh Pension
You (or spouse) pay or receive alimony
You (or spouse or dependents) were a student and had education expenses
You (or spouse) purchased a home in 2008 and received the $7500 First Time Homebuyers credit
You (or spouse) were a resident of another state
You (or spouse) made estimated tax payments last year

DEPENDENTS

Please list your dependent from youngest to oldest.
(First, M.I. Last)
 NameDate of BirthSSNRelationshipMonths in home
#1
#2
#3
#4

CHILD CARE INFORMATION

 Let us know if you have more than one provider
Provider's Name
Provider's Full Address
Provider's SSN/EIN
Amount Paid

INCOME

Select all of the forms that you have
 How may of the forms do you have?
W2 Forms
1099-Misc Forms
Lottery/Gambling Winnings
Received Unemployment
Social Security Income
Retirement Income
Interest/Dividends

DEDUCTIONS

Select all of the forms that you have
 How many of the forms do you have?
Educator Expenses
Student loan interest payments
Moving expenses
Early Withdrawal of Savings

PERSONAL DEDUCTIONS

Medical Deductions
 Enter the dollar amount
Medical insurance prem
Lab Fees
Prescriptions
Eyeglass/Braces/Crutches
Therapy sessions
Wheelchair/Hearing Aids
Medical Miles Driven
Taxes You Paid
 Enter the dollar amount
State/Local tax paid
Property Tax
Personal Tax
Other Tax
Interest You Paid
 Enter the dollar amount
Home Mortgage
Home Mortgage Points
Investment Interest
Charitable Contributions
 Enter the dollar amount
American Cancer Society
American Red Cross
Boy/Girl Scouts
Heart Association
Salvation Army
Other
Casualty Theft or Losses
 Enter the dollar amount
Fire
Flood
Natural Disaster
Job Expenses and Other Miscellaneous Deductions
 Enter the dollar amount
Union Dues
Tax preparation fees
Safe Deposit Fees
Uniform Maintenance

BANKING INFORMATION

 Be sure this info is correct.
Routing #
Account #
 Select One
Checking
Savings

ARE YOU INTERESTED IN HAVING YOUR TAX PREPARATION FEES DEDUCTED FROM YOUR REFUND?

I would like my tax preparation fees to be deducted from my refund.

SIGNATURE

I have reviewed the information given to you on this form and to the best of my knowledge it is true, correct and complete. I have maintained the underlying records required by law to support this information. I authorized Sweet Pea Bookkeeping Services to prepare my taxes based on the information and retain this form with the appropriate documents that I supply.
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