Lopez & Associates, LLC - New Tax Clients

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Email*

First Name*

Last Name*

Primary Phone*

Do you need Business Services?

Yes, I want to start a new business

Yes, I already have a business

No, I do not have a business, OR I don't need help with my business

Company Name*

Are you representing a company? If yes, complete this field with your official Company Name. If you are not representing a company, then please enable the switch below labeled "I'm not representing a Company".

Did you change your address in the last year?*

Yes

No

What is your new address?*

Update if you moved in the last year

Did you change jobs or occupation since last year?*

Yes

No

Occupation*

Did your filing status change since last year?*

Yes

No

Civil Status for Tax Filing*

Single

Married Filing Jointly

Married Filing Separately

Head of Household

Qualifying Widow(er)

Unsure

Spouse Full Name*

Spouse date of birth*

Spouse Address*

Did your dependent information change since last year?*

Yes

No

Unsure

How many dependents do you have?*

Dependent Details*

What types of income do you typically receive?*

W-2 Income

Self-employment Income

Real Estate

Interests/Dividends

Unemployment Benefits

Social Security

Alimony

Foreign Income

Other Income

Please Specify*

Did you change your health insurance provider or situation in the last year?*

Yes

No

What type of health insurance do you have?*

Marketplace Purchased (1095-A)

Medicaid (1095-B)

Employer Provided Health Insurance (1095-C)

Medicare (SSA-1099)

Private/Other

Do you make contributions to a retirement plan such as a pension, 401K, IRA?*

Yes

No

Did you pay for any daycare expenses?*

Yes

No

Provide us detail of provider and expenses*

Do you own or rent your home?*

Own

Rent

Did you have any qualified energy improving expenses on your main home or investment property?*

Yes

No

Did you pay for any interest or mortgage points not provided to you in a form 1098?*

Yes

No

Did you sell your home?*

Yes

No

Was this a primary home or an investment home?*

Private Home

Investment Home

Did you sell any vehicles, large equipment, or cryptocurrency that you used for more than a year?*

Yes

No

Are you a student or are you paying for student expenses?*

Student

Paying for Student Expenses

Not a Student

Have you used the American Opportunity Credit in the past?*

Yes

No

If so, how many years?*

What education level are you enrolled in?*

Were you required to purchase supplies or materials from the school in addition to the tuition?*

Yes

On

How much in technology or book material purchases were you required to obtain from the school?*

Did you donate to Charity?*

Yes

No

Which charity did you donate to?*

Please provide details of items and/or money donated and its value*

Are you or your spouse an active member of the armed forces?*

Yes

No

What is your domiciled state?*

Did you receive income from sources outside of your assigned duties while living in the state?*

Yes

No

Did you have any moving expenses while an active member for an assigned duty?*

Yes

No

How much moving expenses did you receive?*

Did you have any medical, dental, or vision costs?*

Yes

No

Were these costs reimbursed OR part of an HSA plan?*

Yes

No

Consent*

By submitting this form, I hereby consent to the processing of my personal data which I voluntarily provide below in this consent. I also declare that I am at least 16 years old or have the consent by the person who has parental responsibility for me.

Yes

New Tax Clients

Hello 👋🏽!

Ready to get your taxes done?

PLEASE UPLOAD THE FOLLOWING

PERSONAL INFORMATION

DEPENDENT(S)

INCOME

HEALTH INSURANCE

DAYCARE EXPENSES

HOMEOWNERSHIP & HOUSING EXPENSES

ASSET SALES

MILITARY SERVICE & RELATED EXPENSES

MEDICAL EXPENSES AND REIMBURSEMENTS