DTS BUSINESS RETURN Intake Form

Select EntityDOMESTIC ENTITYFOREIGN ENTITY

BUSINESS NAME

STATE AND DATE INCORPORATED OR ORGANIZED

BUSINESS ADDRESS0 / 500

Phone Number / Fax0 / 500

TYPE OF ENTITY *SOLE PROPRIETOR SCORPPARTNERSHIP SCORPPARTNERSHIP NON SCORPNON PROFIT CORPORATION

EIN NUMBER:

IF THE COMPANY ELECTED TO BE TAXED AS AN S CORP
WHAT DATE DID THE IRS APPROVE THE ELECTION?

Date:

If Diverse Tax Service, LLC did not prepare your monthly book keeping, please be sure to provide documentation of all income and expenses. This may be an income and expense
statement or profit and loss report from your bookkeeper.

OWNER(S) / PARTNERS *0 / 500

TITLE & OWNERSHIP % ADDRESS *0 / 500

SSN/ITIN *0 / 500

PLEASE BE SURE TO ENTER ALL INFORMATION AND SIGN PAGE #2. LIST ALL DOCUMENTS THAT YOU SUBMIT ON PAGE #3

UPLOAD THE PRIOR YEAR’S BUSINESS RETURN (1120S or 1065) *

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UPLOAD A COPY OF EIN LETTER OF APPROVAL TO PROVE ENTITY TYPE *

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UPLOAD A COPY OF THE BUSINESS LICENSE WITH THE STATE *

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UPLOAD COPY OF THE ARTICLE OF INCORPORATION

No file chosen

ATTESTATION: I attest that all the above information is correct and was provided voluntary. In addition, none of the above information was by any fashion, shape, or form aided by any of Diverse Tax Service, LLC preparer. Therefore, I agree to release Diverse Tax Service, LLC of any liability that may incur from the above information.

Responsible Party’s Signature:

Date:

Responsible Party’s Printed Name & Position:

Preparer’s Signature:

Date:

Printed Name & Position: S. Michelle Ross, Tax Firm Owner, Diverse Tax Service, LLC

DTS BUSINESS RETURN Intake Form

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