Lashunda Philpotts's Account

2024 Client Intake Form

+1 706-518-4699

Full Name of the Person Who Referred You

Are you already working with a Lashunda Philpotts's Account Tax Professional?

Yes

No

Select Lashunda Philpotts's Account Team Member

Basic Information

Full Legal Name

Date of Birth

Social Security Number:

Your Email *

Current Cell Phone Number

Current Home Number

Address

Current Address

City

State

Country

Postal code

What SCHOOL DISTRICT did you live in as of December 31 2024

What COUNTY did you live and work in as of December 31, 2024

Can someone else claim you as a Dependent?

Yes

No

Will you be filing more than one STATE return?

Yes

No

Please list the State(s) you will be filing in/for

Have you been a victim of identity theft and been given an identity theft protection PIN by the IRS?

Yes

No

Enter your six digit identity protection PIN number

Did you file your 2023 tax return?

Yes

No

Was your tax return completely “Offset” (taken and you did not receive) last year?

Yes

No

Are you listed on your 2023 tax return as Disabled?

Yes

No

Please describe the nature of your Disability 

Were you enrolled at least part time in an accredited College, Trade School or University in 2024?

Yes

No

Name of accredited College, Trade School or University 2024

Have they already issued your 1098-T or 1098-E?

Yes

No

Are you Married or Single?

Married

Single

Do you and your Spouse file Jointly?

Yes

No

Spouse Full Legal Name

Spouse Birth Date

Spouse Cell Phone

Spouse Current Occupation

Has your spouse been a victim of Identity Theft and been given an Identity Theft Protection PIN by the IRS?

Yes

No

Enter your spouse’s Six Digit Protection PIN number

Was your spouse enrolled at least part time in an Accredited College, Trade School or University 2024?

Yes

No

Name of spouse's Accredited College, University or Trade School

Have they already issued a 1098-T or 1098-E 

Yes

No

Has your spouse ever been listed on a Tax Return as Disabled?

Yes

No

Please describe the nature of the Disability

Has your Spouse ever been convicted of a felony?

Yes

No

Dependants

Are you claiming any Dependent(s) that you have provided more than half of the support for in 2024?

Yes

No

Do you have joint custody of any of your Dependents?

Yes

No

Are you claiming a child who IS NOT your own son or daughter?

Yes

Will you claim the CHILD CARE DEDUCTION for this tax year for any Dependent?

Yes

No

Are you claiming a child who is under the age of 13?

Yes

No

Did you provide MORE THAN HALF the support for these dependents?

Yes

No

Were any of your Dependants enrolled at least part time in an accredited College, Trade School or University 2024?

Yes

No

Dependent #1 Date of Birth

Dependent #1 Social Security Number

Dependent #1 Address

Dependent #1 How long did dependent live in your home during 2024?

Dependent #1 Relationship to Taxpayer

Dependent #1 Full Legal Names of Biological Parents

Dependent #1 Will this dependent be claimed for Child Care Deduction?

Yes

No

Dependent #1 Amount Spent on Childcare 

Dependent #1 Was this Dependent enrolled at least part time in an accredited College, Trade School or University in 2024?

Yes

No

Dependant #1 Enter the Name of the Accredited College Trade School or University

Dependant #1 Has this Dependent been issued a 1098-T or 1098-E  for 2024?

Yes

No

Dependent #2 Date of Birth

Dependent #2 Social Security Number

Dependent #2 Address

Dependent #2 How long did dependent live in your home during 2024?

Dependent #2 Relationship to Taxpayer

Dependent #2 Full Legal Names of Biological Parents

Dependent #2 Will this dependent be claimed for Child Care Deduction?

Yes

No

Dependent #2 Amount Spent on Childcare 

Dependent #3 Full Legal Name:

Dependent #3 Date of Birth

Dependent #3 Social Security Number

Dependent #3 Address

Dependent #3 How long did dependent live in your home during 2024?

Dependent #3 Relationship to Taxpayer

Dependent #3 Full Legal Names of Biological Parents

Dependent #3 Will this dependent be claimed for Child Care Deduction?

Yes

No

Dependent #3 Amount Spent on Childcare 

Dependent #4 Full Legal Name:

Dependent #4 Date of Birth

Dependent #4 Social Security Number

Dependent #4 Address

Dependent #4 How long did dependent live in your home during 2024?

Dependent #4 Relationship to Taxpayer

Dependent #4 Full Legal Names of Biological Parents

Dependent #4 Will this dependent be claimed for Child Care Deduction?

Yes

No

Dependent #4 Amount Spent on Childcare 

Dependent #5 Date of Birth

Dependent #5 Social Security Number

Dependent #5 Address

Dependent #5 How long did dependent live in your home during 2024?

Dependent #5 Relationship to Taxpayer

Dependent #5 Full Legal Names of Biological Parents

Dependent #5 Will this dependent be claimed for Child Care Deduction?

Yes

No

Dependent #5 Amount Spent on Childcare 

Dependent #6 Full Legal Name:

Dependent #6 Date of Birth

Dependent #6 Social Security Number

Dependent #6 Address

Dependent #6 How long did dependent live in your home during 2024?

Dependent #6 Relationship to Taxpayer

Dependent #6 Full Legal Names of Biological Parents

Dependent #6 Will this dependent be claimed for Child Care Deduction?

Yes

No

Dependent #6 Amount Spent on Childcare 

Dependent #7 Full Legal Name:

Dependent #7 Date of Birth

Dependent #7 Social Security Number

Dependent #7 Address

Dependent #7 How long did dependent live in your home during 2024?

Dependent #7 Relationship to Taxpayer

Dependent #7 Full Legal Names of Biological Parents

Dependent #7 Will this dependent be claimed for Child Care Deduction?

Yes

No

Dependent #7 Amount Spent on Childcare 

Dependent #8 Full Legal Name:

Dependent #8 Date of Birth

Dependent #8 Social Security Number

Dependent #8 Address

Dependent #8 How long did dependent live in your home during 2024?

Dependent #8 Relationship to Taxpayer

Dependent #8 Full Legal Names of Biological Parents

Dependent #8 Will this dependent be claimed for Child Care Deduction?

Yes

No

Dependent #8 Amount Spent on Childcare 

Income

Did you receive ANY supplemental non-taxable income such as child support, Food stamps, Medicaid / Medicare, TANF, Social Security or Disability?  

Yes

No

If "Yes" enter the amount received for any that pertain to you

Child Support
Food Stamps
Medicaid
Medicare
TANF
Social Security
Disability
Other

Did you receive any gambling winnings in 2024?

Yes

No

Please enter the type of gambling winnings and amount won:

Have you received your 1099-G or W2-G?

Yes

No

Did you withdraw from your 401k in 2024?

Yes

No

Have you received your 1099-R

Yes

No

Did you receive unemployment in 2024?

Yes

No

Did you receive your 1099-G

Yes

No

Did you buy or sell any stocks or crypto currency in 2024?

Yes

No

Have you received your tax forms (eg. 1099B etc.)?

Yes

No

Were you an Uber, or any other “Rideshare” driver in 2024?

Yes

No

Have you received your 1099-K, 1099-NEC or both?

Yes

No

Have you received your Annual Summary, Tax summary or Both ?

Yes

No

Were you an Independent Contractor for any companies like DoorDash, Instacart, etc?

Yes

No

Have you received your 1099-K, 1099-NEC or both 2024?

Yes

No

Have you received your Annual Summary, Tax Summary or Both?

Yes

No

Expenses

Are you a Homeowner?

Yes

No

Did you purchase your home in 2024?

Yes

No

Have you received your tax documents?

Yes

No

Did you make any Energy Improvements in 2024?

yes

No

Please list each improvement you made and the amount paid for each

Did you pay upkeep & repair expenses in 2024?

yes

No

Please list repair expense you made and the amount paid for each

Did you pay for Property Insurance in 2024?

yes

No

Enter amount paid for Property Insurance in 2024

Did you rent in 2024

yes

No

Enter your monthly Rental Amount and number of months that you paid

Did you pay for renters insurance in 2024? 

yes

No

Enter your monthly Insurance Payment Amount and number of months that you paid in 2024

Did you purchase a NEW ELECTRIC VEHICLE in 2024?

yes

No

Enter Make, Model and Amount?

Did you pay taxes on any personal property in 2024?

yes

No

Enter Amount Paid

Did you have any large MEDICALor DENTAL expenses in 2024?

yes

No

Enter the type of procedure/ surgery etc. and amount you paid

Did you donate personal property (not money) to any charity's in 2024?

yes

No

Please list the Name of the Charity, Contribution Purpose and Amount(s)

Banking

Do you want your refund Deposited Directly to your bank account?

Yes

No

Attach a scanned voided check

Name of Bank:

Routing Number:

Account Number:

Banking Information Certification

I certify that I am the account owner or have authority to access this account. I further acknowledge that I am responsible for incorrect information, mistyping or any other issues resulting from my error and to hold Lashunda Philpotts's Account harmless if any issues shall arise due to the same

Authorization and Consent for Disclosure of Tax Return Information

CONSENT AND DISCLOSURE OF TAX RETURN INFORMATION. Federal law requires this consent form be provided to you (“you” refers to each taxpayer, if more than one). This authorizes Lashunda Philpotts's Account to review your information for the purposes of preparing, assisting to prepare, and/or file an income tax return for the tax year as referenced above. Further, 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. 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. In order to process your return, we may disclose your tax return information to trusted partners of Lashunda Philpotts's Account for the purpose of tax preparation, compliance, funding, and advances. For your convenience, we have entered into agreements with a bank to provide qualifying taxpayers with the opportunity to apply for a (bank product) Refund Transfer (RT), or Electronic Refund Check or Electronic Refund Deposit. To determine whether these products may be available to you, we will need to use your tax return information by analyzing it and calculating the amount of your anticipated refund. By signing below, you authorize us to disclose to your tax return information. By signing below, you (including each of you if there is more than one taxpayer) authorize us to use the information you provided to us during the preparation of your tax return to determine whether to present you with opportunity to apply for bank product (described above) and services and to support the compliance with the Internal Revenue Code and due diligence requirements.

Taxpayers Signature

Clear

Spouse's Signature

Clear

Referrals

We continue to grow our business through loyal customers like you. Please look in your cell phone and provide us with at least three (3) names and phone numbers of people needing tax preparation assistance, so they can get back the MAXIMUM amount of money they are legally entitled to!

Referral#1 Full Name

Referral#1 Mobile Number

Referral#2 Full Name

Referral#2 Mobile Number

Referral#3 Full Name

Referral#3 Mobile Number