Roadrunner Tax, LLC

Type of Client

New

Returning

Preferred Tax Preparer *

Last Name *

First Name *

Email *

Phone *

Date of birth *

Taxpayer SSN *

Taxpayer Occupation

Spouse Name

Spouse SSN

Spouse Date of Birth

Spouse Phone Number

Spouse Email

Spouse Occupation

Do you have any dependents to claim on your selected tax year return?

Yes

No

How many dependents will you claim on your selected tax year return?

1

2

3

4

Dependent 1 Name

Dependent 1 SSN

Dependent 1 Date of Birth

Dependent 1 Relationship to Taxpayer

Is Dependent 1 disabled?

Yes

No

Did you pay any childcare expenses for dependent 1?

Yes

No

Dependent 2 Name

Dependent 2 SSN

Dependent 2 Date of Birth

Dependent 2 Relationship to Taxpayer

Is Dependent 2 disabled?

Yes

No

Did you pay any childcare expenses for dependent 2?

Yes

No

Dependent 3 Name

Dependent 3 SSN

Dependent 3 Date of Birth

Dependent 3 Relationship to Taxpayer

Is Dependent 3 disabled?

Yes

No

Did you pay any childcare expenses for dependent 3?

Yes

No

Dependent 4 Name

Dependent 4 SSN

Dependent 4 Date of Birth

Dependent 4 Relationship to Taxpayer

Is Dependent 4 disabled?

Yes

No

Did you pay any childcare expenses for dependent 4?

Yes

No

Was the taxpayer, spouse, or any of the dependents issued a IP PIN by the IRS?

Yes

No

Please provide the 6 digit IP PIN provided by the IRS & the person who received one.

Did you, your spouse, or any dependents attend college for the selected tax year?

Yes

No

Name of person that attended college in the selected tax year?

Name of School

Did the student attend college at least half time?

Yes

No

Have you ever been disallowed for EITC/AOTC/CTC?ACTC?

Yes

No

Did you receive a federal/state refund last year?

Yes

No

Did you, your spouse or dependents receive health insurance through the Marketplace in the selected tax year and receive Form 1095-A?

Yes

No

Are you self-employed, own a full time or side business, or 1099 contractor ?

Yes

No

Name of Business

EIN Number

Business Address

Did you file this business on last year's tax return?

Yes

No

Gross Business Income for 2024

$

Expense Amount (USD) for 2024

Advertising
Travel
Rent/Lease
Meals
Supplies
Taxes
Wages
License
Office Supplies
Labor
Equipment
Utilities
Commission
Insurance
Legal Fees
Repairs
Vehicle Mileage
Miscellaneous

How would you like to receive your refund ?

Direct Deposit

Refund Check

Direct Deposit: Bank Name

Account Number

Routing Number

Signature *

Clear

Date *

Your Taxes,
OUR EXPERTISE
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TAX INTAKE FORM

Taxpayer's Information

Spouse Information

Dependents

Identity Protection PIN (IPPIN)

Childcare Expenses Information

College Students

Tax Return Questions

Schedule C Worksheet for Business

Refund Disbursement

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