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2022 Income Tax Intake Form

  • Primary Taxpayer Information

    Please Note that you can "Save and Continue" this form later by using the link at the bottom of the page next to the "Submit" button.
  • Please set a 4-6 digit passcode that we can use to identify you. Please keep this passcode confidential.
  • Please Answer the Following

  • Drop files here or
  • Spouse

  • Personal Information

  • Household

  • Please add one person per line. Press the "+" to add another line.
    First NameLast Name 
  • Dependent 1

  • Disabled is defined as they are on a disability program.
  • You must provide official documentation PRIOR to electronically submitting a return. Examples of documentation may include, but not be limited to, the following: Disability Letter from Doctor (will be verified), Notice from Social Security Administration, Immobility Card with Photo ID, etc.
    Drop files here or
  • Drop files here or
  • Who are the Biological Parents?

  • Dependent 2

  • Disabled is defined as they are on a disability program.
  • You must provide official documentation PRIOR to electronically submitting a return. Examples of documentation may include, but not be limited to, the following: Disability Letter from Doctor (will be verified), Notice from Social Security Administration, Immobility Card with Photo ID, etc.
    Drop files here or
  • Drop files here or
  • Who are the Biological Parents?

  • Dependent 3

  • Disabled is defined as they are on a disability program.
  • You must provide official documentation PRIOR to electronically submitting a return. Examples of documentation may include, but not be limited to, the following: Disability Letter from Doctor (will be verified), Notice from Social Security Administration, Immobility Card with Photo ID, etc.
    Drop files here or
  • Drop files here or
  • Who are the Biological Parents?

  • Dependent 4

  • Disabled is defined as they are on a disability program.
  • You must provide official documentation PRIOR to electronically submitting a return. Examples of documentation may include, but not be limited to, the following: Disability Letter from Doctor (will be verified), Notice from Social Security Administration, Immobility Card with Photo ID, etc.
    Drop files here or
  • Drop files here or
  • Who are the Biological Parents?

  • Dependent 5

  • Disabled is defined as they are on a disability program.
  • You must provide official documentation PRIOR to electronically submitting a return. Examples of documentation may include, but not be limited to, the following: Disability Letter from Doctor (will be verified), Notice from Social Security Administration, Immobility Card with Photo ID, etc.
    Drop files here or
  • Drop files here or
  • Who are the Biological Parents?

  • Dependent 6

  • Disabled is defined as they are on a disability program.
  • You must provide official documentation PRIOR to electronically submitting a return. Examples of documentation may include, but not be limited to, the following: Disability Letter from Doctor (will be verified), Notice from Social Security Administration, Immobility Card with Photo ID, etc.
    Drop files here or
  • Drop files here or
  • Who are the Biological Parents?

  • Dependent 7

  • Disabled is defined as they are on a disability program.
  • You must provide official documentation PRIOR to electronically submitting a return. Examples of documentation may include, but not be limited to, the following: Disability Letter from Doctor (will be verified), Notice from Social Security Administration, Immobility Card with Photo ID, etc.
    Drop files here or
  • Drop files here or
  • Who are the Biological Parents?

  • Dependent 8

  • Disabled is defined as they are on a disability program.
  • You must provide official documentation PRIOR to electronically submitting a return. Examples of documentation may include, but not be limited to, the following: Disability Letter from Doctor (will be verified), Notice from Social Security Administration, Immobility Card with Photo ID, etc.
    Drop files here or
  • Drop files here or
  • Who are the Biological Parents?

  • Dependent 9

  • Disabled is defined as they are on a disability program.
  • You must provide official documentation PRIOR to electronically submitting a return. Examples of documentation may include, but not be limited to, the following: Disability Letter from Doctor (will be verified), Notice from Social Security Administration, Immobility Card with Photo ID, etc.
    Drop files here or
  • Drop files here or
  • Who are the Biological Parents?

  • Document Uploads

  • Please enter your tax payer information above before uploading documents.
  • You have not submitted a completed form. Please complete the entire intake form once before uploading additional documents.
  • Please upload your driver’s license, any birth certificates, W-2s, 1099s, mortgage statements, proof of residency, etc.
    Drop files here or
  • Accuracy Acknowledgment

  • I attest that the above information is accurate and true to the best of my knowledge. I understand that if any of the above information provided is not true, I can be held personally liable for all fees associated with filling my federal and state income tax return fees electronically. I have also attested to the accuracy of the information denoted by my consent above.
  • Disclosures - “All” Situations

    Consent is sought for use of tax return information under any circumstance. 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. 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. 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.
  • Please note the above consent is for preparation of your income tax returns. Internal Revenue Service requires additional consent to disclose tax return information beyond preparation. If you will need this information provided from Chronicles of Numbers, LLC to another party, you are required to complete additional disclosures. Examples where additional disclosures will be needed are for mortgages, vehicle loans, etc.
  • PRIVACY STATEMENT

    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 General for Tax Administration (TIGTA) by telephone at 1-800-366-4484, or by email at complaints@tigta.treas.gov. PRIVACY STATEMENT Your privacy is very important to us at Chronicles of Numbers, LLC. We are providing this statement to inform you about the types of information we collect from you, and how we may disclose or use that information in connection with the services we provide. This Privacy Statement describes the privacy practices of our company as required by law. During the course of providing our services to you, we may offer you various other services that may be of interest to you based on our determination of your needs through analysis of your data. Your use of the services we offer constitutes consent to our disclosure of tax information to the service providers. If at any time you wish to limit your receipt of promotional offers based upon information you provide, you may call us at (318) 424-6532.
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