Mindful Pro Software - Tax Intake Form

Tax Filing Year

Date Form Being Completed

Do You Have A Promo or Discount Code

(Optional) Please provide the name of the person who referred you or provide the place where you saw our business

How will you provide documents

*E-mail Documents

*Upload To This Form

*Upload To My Client Portal

Primary Taxpayer Email*

Primary Taxpayer First Name*

Primary Taxpayer Middle Name

Primary Taxpayer Last Name*

Taxpayer's SSN -The IRS requires your Social Security Number for e-filing

Primary Taxpayer's Date Of Birth

Primary Taxpayer's Occupation

Taxpayer's Phone Number

Tax Filing Status

Primary Taxpayer - Please Check Any That Apply

Taxpayer can be claimed as a dependent on someone else's return

Taxpayer was over age 18 and a full-time student at an eligible educational institution

Taxpayer is blind

Taxpayer is deceased

Taxpayer has received, sold, sent, exchanged, or otherwise acquired financial interest in virtual currency during the current tax year

Taxpayer prefers to receive written communications from the IRS in a language other than English

Taxpayer prefers to receive written communications from the IRS in an accessible format

Do You Have A Spouse

Address Line 1

City

ZIP / Postal Code

State / Province

What County do you stay in

Do you Rent or Own at your current address

Does Tax Payer, Spouse or Any Dependents get an IP (Identity Protection) Pin letter from the IRS every year

Did you or anyone listed on this return work in different states this tax season

Have you or anyone listed on this return ever been audited by the IRS

I am also claiming a deceased Spouse, Child or Relative

How Many Dependents Will You Be Claiming

Do you have Student Loans in Forbearance or Deferment

Are You Currently Paying Student Loans

Did you pay child and dependent care costs

Did you make cash charitable contributions

Did you make solar, wind, geothermal or fuel cell energy efficiency improvements to your primary residence

Did you purchase an energy-efficient or other new vehicle

Did you acquire, use, dispose of, or hold any type of virtual currency/cryptocurrency (such as bitcoin)

Do you have a business

Did you have to pay out of pocket for any insurance through the Market Place

Did you have health insurance coverage for all 12 months of the tax year for which we are preparing tax returns (please note that coverage for just one day of a month is considered coverage for the entire month)

What type of Tax Documents are you providing - You will be uploading these documents in the next section

Marketplace Insurance (Forms 1095-A)

Did you receive wages (Forms W-2)

Did you receive interest or dividend income (Forms 1099-INT or 1099-DIV)

Did you rollover retirement funds or receive a retirement distribution (Forms 1099)

Did you receive social security benefits (Forms SSA-1099)

Did you receive unemployment benefits (Forms 1099-G)

Did you sell stocks, bonds, cryptocurrency/digital assets (such as bitcoin), or other investment property? (Forms 1099-B)

Did you buy or sell real estate (Closing disclosure, formerly known as the HUD-1, and/or Forms 1099-S)

Did you have any debts cancelled or forgiven (Forms 1099-C)

Did you receive a distribution from an Education Savings Account or a Qualified Tuition Program (Forms 1099-Q)

Did you receive any distributions from a Health Savings Account (HSA) (Forms 1099-SA)

Did you have any foreign income, pay any foreign taxes not reflected on a provided Form 1099 or file any foreign information reporting or tax forms

Did you receive any disability income

Did you pay mortgage interest (Forms 1098)

Did you pay interest on a home equity line of credit (Forms 1098)

Upload ID/DL (Unexpired)

Drop Files

File(s) Uploaded Successfully

Upload Completed

Upload ALL Tax Documents

Drop Files

File(s) Uploaded Successfully

Upload Completed

Upload 1098T, Receipts or School Schedule

Drop Files

File(s) Uploaded Successfully

Upload Completed

IF CLAIMING HOH please upload a copy of utility bill

Drop Files

File(s) Uploaded Successfully

Upload Completed

Will you want any of the following Bank Products (Choose All That Apply ) ** Please note all bank products must go through an approval process and will require a written authorization Form 7216 Bank Consent to Disclosure of Tax Return Information

No Bank Products

Tax Refund Advances

Deduction of Tax Preparation from your Refund

How would you like your refund to be deposited when ready

Name of Bank

Is this account:

Address To Mail Check

Account Number

Routing Number

Please Upload a Voided Check or Letter from Bank

Drop Files

File(s) Uploaded Successfully

Upload Completed

Prepaid Card - Account Number

Prepaid Card- Routing Number

Cardholder Name*

Credit Card Number*

Expiration Date (Month)*

Expiration Date (Year)*

CVV/CVC Code*

Billing Street Address*

Billing City*

Billing State*

Billing Zip Code

Credit Card Authorization

Credit Card Authorization Form

Engagement Letter

Review & Sign- Engagement Letter

Consent To Use Of Tax Return Information

Review & Sign- Consent To Use Of Tax Return Information

Consent To File Tax Return Electronically

Review & Sign- Consent To File Tax Return Electronically

Consent For Payment

Review & Sign- Consent For Payment