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Welcome to ORIGIN Tax solutions

Where integrity meets expertise — and every return finds its true value.

client intake form

WHO WE ARE

At Origin Support Group Tax Specialists, we believe taxes don’t have to be overwhelming. Our team combines professional expertise with personal care to make the process simple, smooth, and stress-free. We take time to understand your unique situation, offer honest support, and help you make informed financial decisions—all year long.

OUR SERVICES

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Client Intake Form

PLEASE SELECT PREPARER OF YOUR CHOICE*

FILING STATUS*

PERSONAL INFORMATION

TAX PAYER*

FIRST NAME

LAST NAME*

SSN/ITIN*

OCCUPATION*

EMAIL*

US CITIZEN?*

Yes

No

LEGALLY BLIND?*

Yes

No

PERMANENTLY DISABLED?*

Yes

No

ARE YOU LEGALLY MARRIED?*

Yes

No

START DATE

Month

Day

Year

Multi-line address

Country/Region

Address

Address - line 2

City

Zip / Postal code

Phone*

GOVERNMENT ASSISTANCE?*

Yes

No

DEPENDENT INFORMATION

DO HAVE DEPENDENTS?*

Yes

No

ATTENDING COLLEGE?*

Yes

No

DOES ANYONE ATTEND DAYCARE/AFTERCARE*

Yes

No

EITC Questionnaire

Did you live with your spouse at any time during the year?*

Yes

No

Did you live with any other person who could be claimed as a dependent?*

Yes

No

Did you provide over half the cost of keeping up a home for yourself and a qualifying person?*

Yes

No

Did you have a child under age 19 (or under 24 if a full-time student) who lived with you for more than half the year?*

Yes

No

Did you have a child who lived with you and who you can claim as a dependent?*

Yes

No

DEPENDENT ANSWERS

Please respond according to the previous question.

If no, what is the reason for the absence?

Financial contribution

Is the adjusted gross income of the dependent less than $4,300?*

Yes

No

Number of months lived in household.(If Above Answer Is No Dependents, Please Enter The Number 0)*

Can you claim the dependent on your return? *

Yes

No

Self Employment? *

Yes

No

Do you confirm that all the answers provided above are accurate, correct, and complete to the best of your knowledge?*

Yes

No

Bank Information

IRS refund method*

Check

Direct deposit

Fast Moneycard

ARE YOU A NEW CLIENT?*

Yes

No

DOCUMENT UPLOAD: (Upload all W2's, 1099's, Social Security Cards, Birth Certificates, Identification, Proof of medical insurance, Childcare Forms, and College 1098-T along with any supporting documents you may have here):

Additional notes

Little Elm Office

PMB 559

2701 Little Elm Pkwy Ste 100

Little Elm, TX 75068

Phone: 844-230-5505

L

Local 469.498.7400

Toll Free 844.230.5505

Virtual Fax 214.380.9327

info@originsupportgroup.com

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