Intake Form

Freedom Tax Service - Income Tax Information Sheet

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FREEDOM TAX SERVICE OF AMERICA

Income Tax Information Sheet

Branch:

Preparer Name/PTIN:

Referred by:

Taxpayer

First Name *

Last Name *

SSN *

D.O.B. *

Occupation *

Phone # *

Address *

Email *

Spouse

First Name

Last Name

SSN

D.O.B.

Occupation

Phone #

Address

Filing Status *

Single Married Filing Jointly Married Filing Separate Head of Household Widower

Dependents

Dependent 1

Name

D.O.B

SSN

REL

Refund Options & Bank Information

Refund Options:
Direct Deposit Debit Card Cashier Check Mail

Routine #

Acc #

Bank Name

Documents

Click here to upload Tax Documents

Accepted: PDF, DOCX, JPG, PNG, WEBP

I attest that the information in this income tax information sheet is true and correct to the best of my knowledge.

Signature *

Date *

Security Verification

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