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FLINT CPA, P.C.
Which states did you live in?
Address
*
Have you (or your spouse, if married) been a victim of tax related identity theft or been issued an Identity Protection PIN?
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Yes
No
Occupation
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Name:
*
Other Information you may want to explain about your situation
Spouse's Occupation
Where you referred by a client? If so, who referred you?
Are you a full-time student, blind, or permanently disabled?
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Yes
No
Income
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Wages (W-2)
Self-Employment Income (1099-NEC, 1099- MISC, 1099-K)
Income from the sale of Stocks, Bonds, or Real Estate (Form 1099B, Form 1099-S, Consolidated 1099s from Brokerage Firms)
Interest or Dividends (1099-INT, 1099-DIV)
Pensions, Annuities, or IRAs (Form 1099R)
Social Security Benefits (Form SSA-1099)
Income from Rental Property (Including Form 1099-K, Form 1099-MISC, AirBnb statements, Management Firm statements, or payments not reported on any IRS form)
Cash or check payments not reported on an IRS form
Scholarships or Tuition Paid (W-2, 1098-T)
Refund of State or Local Income Taxes (1099-G)
Disability Income, such as from insurance or workers compensation plans (1099R, W-2)
Unemployment Compensation (1099-G)
Alimony Income or Separate Maintenance Payments
Income from a Partnership, S-Corporation, Estate, or Trust (Schedule K-1)
Income from the sale of digital assets
Income from royalties
Foreign Income
Income from gambling/lottery winnings, prizes/awards
Phone
*
Did you live in any other state besides Texas in the previous year?
*
Yes
No
What is your gross income (combined if married)
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$10,000 - $50,000
$51,001 - $100,000
$100,001 - $200,000
$200,001 - $350,000
$400,000 +
New Client Application
If married what is your spouse's name?
Expenses
*
College or Post Secondary Tuition Expenses (1098-T, 1099-Q)
Student Loan Interest (1098-E)
Mortgage Interest (1098)
Real Estate or Personal Property Taxes (might be reported on 1098)
Charitable Contributions
Childcare Expenses
Large Medical and Dental Expenses (including health care premiums)
Long term care and Accelerated Death Benefits (1099-LTC)
Expenses related to self-employment income
Expenses related to any other income
Contributions to a retirement account
Alimony or separate maintenance payments
Contributed to a 529 Plan Investment Account
Other expenses we may have not listed
Spouse's Email Address
Do you have any dependents?
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No
1 dependent
2 dependents
3 dependents
4 dependents
More than 5
What is your current status?
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Married
Single
Divorced
Head of Household
Email
*
Thank you for contacting us! We will reach out to you within 48-72 hours.
Life Events
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Bought or Sold a Home (whether or not reported on Form 1099-S)
Bought or Sold a Business
Had Debt Cancelled by a Lender (1099-A, 1099-C)
Had a Health Savings Account (5498-SA, 1099-SA, W-2 with code W in Box 12)
Had Health Insurance Coverage through the Marketplace (1095-A)
Purchased and Installed Energy Efficient Home Improvements
Made Estimated Tax Payments
Applied Last Year's Refund to This Year's Tax
Filed a Tax Return Containing a Capital Loss Carryover
Had Any Tax Credits Disallowed
Bought or Sold Bitcoin or any other Virtual Currency
Had the Earned Income Credit, Child Tax Credit, or American Opportunity Credit disallowed in any prior tax year?
Received any correspondence from the IRS
Inherit anything in the previous year
Are you a US Citizen or permanent resident?
*
Yes
No
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