Smartaxx, LLC Attestation Client Form

Thank you for choosing Smartaxx! We have over 26 years of experience and we are excited to offer you great customer service.

*Please review the form in it's entirety before filling it out so that you are aware of the documents we are asking for. This will save you time. Thank you.

Client Status *

Returning Client

New Client

How did you hear about us?

Recommended by friend/family

Google

Facebook

Instagram

Who recommended you?

CLIENT INFORMATION

First Name *

Middle Initial

Last Name *

Suffix

Date of Birth *

MM/DD/YYYY

Filing Status *

Single

Head of Household

Married Filing Joint

Married Filing Seperate *If spouse has filed with same option and added you to their return

Social Security Number *

Email *

Phone *

Cell Phone Provider *

AT&T
Boost Mobile
Cricket
Metro PCS
Spectrum
Sprint
T-Mobile
TracPhone
US Mobile
Verizon
Other
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Secondary Phone Number *

Address *

City *

State *

Postal code *

Occupation/Role *

Employment Status *

Self-Employed

Unemployed

Employed

Spouse First Name

S. Initial

Spouse Last Name

Spouse Suffix

Spouse Social Security Number

Spouse Date of Birth

MM-DD-YYYY

Spouse Occupation/Role

Spouse Phone #

111-11-1111

Spouse Email Address

Need to add dependents? *

Yes

Dependent #1 First & Last Name

Dependent #1 Date of Birth

Relationship to you

Dependent #1 Social Security Number

Add Dependent #2?

Yes

Dependent #2 First & Last Name

Dependent #2 Date of Birth

Relationship to you

Dependent #2 Social Security Number

Do you need to add Dependent #3?

Yes

Dependent #3 First & Last Name

Dependent #3 Date of Birth

Relationship to you

Dependent #3 Social Security Number

Add Dependent #4?

Yes

Dependent #4 First & Last Name

Dependent #4 Date of Birth

Relationship to you

Dependent #4 Social Security Number

Who would you like to prepare your return? *

Any Professional Preparer
Akera Christian
Angel Williams
Breonna Jordan
Carla Clark
Charnita Horton
Christie Harris
Destinee Guthrie
Jason Horton
Joann Horton
Kentoria Carlisle
LaShunda Hires
Shelby Collins
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TAX INFORMATION

Please Note: If you pulled from or had distribution from your 401k or retirement, please include the 1099R form.

Which year(s) do you want to file taxes for? *

i.e 2022,2023,2024

Did you attend college last year? *

Yes

Did you pull out of retirement? *

Yes

(This does not include borrowing)

Did you receive unemployment? *

Yes

Do you owe any debt that could possibly affect your refund? If so, please explain.

The IRS implemented ID.Me in 2022. This is to protect all taxpayers identity. Do you have an ID.Me account with the IRS? If no, after submitting this form, please visit IRS.gov to set up your ID.Me account. Upon completion, please send us your Identification Protection (IP) PIN to add to your return. *

Yes
No
Not yet, I will create one.
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What is your IP PIN number?

Do you own a business? *

Yes

How long have you owned your business?

Brief description of business

Where do you conduct business?

What services do you perform?

How much do you charge?

Approximately how many clients do you have?

How often do you provide services for each client?

What type of items do you need to operate?

How often are they replenished?

Do you travel for business?

Yes

How do you keep track of mileage?

When and where do you have to travel for business?

Can you provide any documentation to substantiate your business?

i.e., Business Cards, Business Stationery, Receipts or receipt book (with company header), Business/Occupational License (if required), Other tax returns (sales/excise, employment, etc.), Advertisements (newspaper, flier, yellow pages, etc.), other

Who maintains the business records?

Do you maintain separate banking accounts for personal and business transactions?

Yes

How do you differentiate between personal and business transactions and monetary assets?

Please provide Income & Expense records (totals):

Please include any Accounting records, Paid invoices/receipts, Computer Records, Car/truck expenses, Logbooks, Ledgers, Business bank accounts, Other

Please attach your License or ID

File types: PDF, PNG, GIF, DOCX/DOC, JPG/JPEF, XLS/CSV

Social Security Card

Social Security Cards for Dependents

W2 Info, Check stub, or 1099 Contractor

Mortage Info

Student 1098t

Utility Bill

Childcare Documents

Receipts, Tag Info, Medical Info, Etc.

Birth Certificate for Dependents

Please attach important unemployment payout off your portal or mailed to you

Please attach a selfie of yourself

Are you missing or waiting on any of the following documents? *

1099s

1098 Interest

1098t School

No Missing Files

Other

Financial Institution

Name of Bank

Type of Account

Checking

Savings

Account #

Routing #

Please give us 2 people you would recommend to Smartaxx, to earn $25 each when they file. Please provide contact information.

First & Last Name | Phone Number | Email Address

ACKNOWLEDGEMENT

Federal law requires this consent form be provided to you. Unless authorized by law, we cannot use, without your consent, your tax return information for purposes other than the preparation and filing of your tax return. If you consent to the use of your tax return information, Federal law may not protect your tax return information from further use or distribution. You are not required to complete this form. If we obtain your signature on this form by conditioning our services on your consent, your consent will not be valid. If you agree to the disclosure of your tax return information, your consent is valid for the amount of time that you specify. If you do not specify the duration of your consent, your consent is valid for one year.
Duration of consent: Calendar year 2022 through Calendar year 2025
Pursuant to I (we), ______________________ authorize to use any and all tax return information, forms, schedules, documents and attachments for the purpose of offering a tax audit assistance, support and representation service, provided by Audit Maintenance Pro, L.L.C. If you believe your tax return information has been disclosed or used improperly in a manner unauthorized by law or without your permission, you may contact the Treasury Inspector.

Client Signature: *

Clear