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TAX PREPARING
Business Owners Policy

Tax Preparation

Tax Intake/Interview

Part I - Your Personal Information

* Indicates required field

1. Your first name *

M.I. *

Last Name *

Phone Number *

Are you a U.S. citizen? *

Yes No

2. Your spouse's first name *

M.I. *

Last Name *

Phone Number *

Is your spouse a U.S. citizen? *

Yes No

3. Mailing Address *

Apt # *

City *

State *

Zip *

4. Date of Birth *

5. Job Title *

6. Last year, were you:

a. Full-time student *

Yes No

b. Permanently Disabled *

Yes No

c. Legally Blind *

Yes No

7. Your spouse's Date of Birth *

8. Your spouse's job title *

9. Last year, was your spouse

a. Full-time student *

Yes No

b. Permanently Disabled *

Yes No

c. Legally Blind *

Yes No

10. Can anyone claim you or your spouse on their tax return? *

Yes No Unsure

11. Have you or your spouse:

a. Been a victim of identity theft? *

Yes No

b. Adopted a child? *

Yes No

Part II - Marital Status and Household Information

1. As of December 31, 2017, were you *

2. List the names below of:

everyone who lived with you last year (other than your spouse)
anyone you supported but did not live with you last year

a. Name *

b. Name *

c. Name *

DOB *

DOB *

DOB *

Relationship *

Relationship *

Relationship *

Part III - Income - Last Year, Did you (or Your Spouse) Receive *

1. Wages or Salary? (Form W-2) 2. Tip Income? 3. Scholarships? (Forms W-2, 1098-T) 4. Interest/Dividends from: checkings/savings accounts, bonds, CDs, brokerage? (Forms 1099-INT, 1099-DIV) 5. Refund of state/local income taxes? (Form 1099-G) 6. Alimony income or seprate maintenance payments? 7. Self-Employment income? (Form 1099-MISC, cash) 8. Cash/check payments for any work performed not reported on Forms W-2 or 1099? 9. Income (or loss) from the sale of Stocks, Bonds or Real Estate? (including your home) 10. Disability income? )such as payments from insurance, or workers compensation) 11. Payments from Pensions, Annuities, and/or IRA? (Form 1099-R) 12. Unemployment Compensation? (Form 1099G) 13. Social Security or Railroad Retirement Benefits? 14. Income (or loss) from Rental Property? 15. Other income? (gambling, lottery, prizes, awards, jury duty, etc.)

Check appropriate box for each section.

Submit

Contact Us

(281) 232-5207
2600 S Loop West Suite 475H
Houston, TX 77054
Click Here to Email Us

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Contact Us

Lifeway Insurance Brokers
2600 S Loop West Suite 475H
Houston, TX 77054
(281) 232-5207
Click Here to Email Us

Houston, TX

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Home
Get A Quote
Our Products
Client Service
About Us
- Client Testimonials
Contact
TAX PREPARING
Business Owners Policy