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Self-Employed Intake Form (1099 / Stated Income)

This form helps us collect the information needed to prepare your self-employed tax return accurately. Upload copies of documents only. If unsure, write “Not Sure.”

1) Your Information
2) Which Form(s) Did You Receive?
Stated income means income earned but not documented by a tax form.
3) Questionnaire

Yes No

Yes No

Yes No
4) Business Information

Yes No
5) Income & Expenses

Yes No
Examples: supplies, advertising, phone/internet, rent, equipment, software, insurance, meals, travel, training.
6) Vehicle Use (If Applicable)

Yes No
7) Required Next Forms
Taxpayer Signature
IRS Self-Employed Disclaimer:
This form is for tax preparation intake purposes only and is not an official IRS form. Self-employment income may be subject to income tax and self-employment tax. Submission of this form does not guarantee any refund, acceptance, or outcome by the IRS or any state taxing authority.