Tax Payer Questionnaire

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Start by filling out this short questionnaire.

TAX YEAR & DATE
Tax Year*
Today's Date*
MM slash DD slash YYYY
CLIENT INFORMATION
Primary Taxpayer Full Name*
First Last
(From Social Security Card - This person will be listed first on the tax return)
Has your name changed (past year)?*
- YES
- NO
Taxpayer Former Name
If yes, please list former name
First Last
Social Security Number
Date of Birth*
MM slash DD slash YYYY
Occupation*
Drivers License Number*
Issue Date*
MM slash DD slash YYYY
Expiration Date*
MM slash DD slash YYYY
Email Address*
Currently serving in the military?*
- YES
- NO
Donate $3 to the Pres. Campaign Fund?
- YES
- NO
Marital Status*
- Single
- Married
- Separated
- Divorced
- Widowed
Can you be claimed as a dependent on someone else's tax return?*
- YES
- NO
Date of Spouse's Death*
MM slash DD slash YYYY
Date of Separation*
MM slash DD slash YYYY
Spouse's SSN #
Spouse Full Name*
First Last
(from Social Security Card)
Has name changed (past year)?*
- YES
- NO
Social Security Number
Date of Birth*
MM slash DD slash YYYY
Occupation*
Drivers License Number*
Issue Date*
MM slash DD slash YYYY
Expiration Date*
MM slash DD slash YYYY
Email Address*
Are you currently serving in the military on Active Duty?*
- YES
- NO
Do you want $3 to go to the Presidential Campaign Fund?*
- YES
- NO
Mailing Address*
Street Address City State ZIP Code
Physical Street Address (if different)
Street Address City State ZIP Code
Daytime Phone
Evening Phone
Evening Phone
How did you hear about us?
If "friend", Friends name
Want to receive our newsletter?
- YES
DEPENDENTS
Would you like to claim a dependent?*
- YES
- NO
Dependent Name
First Last
Dependent Social Security Number
Relationship
Months in Home (this year)
Date of Birth
MM slash DD slash YYYY
Full Time Student
Would you like to claim another dependent?*
- YES
- NO
Dependent Name
First Last
Dependent Social Security Number
Relationship
Months in Home (this year)
Date of Birth
MM slash DD slash YYYY
Full Time Student
Would you like to claim third dependent?*
- YES
- NO
Dependent Name
First Last
Dependent Social Security Number
Relationship
Months in Home (this year)
Full Time Student
Date of Birth
MM slash DD slash YYYY
Months in Home (this year)
Would you like to claim fourth dependent?*
- YES
- NO
Dependent Name
First Last
Dependent Social Security Number
Relationship
Full Time Student
Date of Birth
MM slash DD slash YYYY
DID YOU OR YOUR SPOUSE LAST YEAR...
Live in any other state?*
- YES
- NO
Work in any other state?*
- YES
- NO
If yes, list the states & dates:
City/County of Residence or Workplace
School District
Check all that apply
- Receive wages, salaries, or any other employer compensation?
- Receive W-2 forms from ALL employers you worked for last year?
- Receive unemployment compensation?
- Receive alimony?
- Receive Social Security Income?
- Pay daycare expenses? (Name, address and SSN (or EIN) of provider is required)
- Receive winnings from gambling? (lottery, race track, casinos, raffles, etc.)
- Receive any miscellaneous income? (prizes, awards, jury duty, etc.) Amount and description are required
- Pay interest on student loans?
- Receive a state tax refund?
- Pay real estate taxes?
- Have a Home Mortgage?
- Have medical expenses or pay for health insurance?
- Contribute to charity, church, etc?
- Receive pension, annuity, ROTH, IRA or retirement income?
- Receive interest on savings, cash, US bonds, stock dividends?
- Sell stock, mutual fund, or other securities?
- Receive any 1099s (e.g. 1099-A, 1099-C, 1099-Misc)?
- Own your own business or work as self-employed?
- Use a portion of your home exclusively for business?
- Sell your home?  Sell any other property? (equipment, land, etc.)
- Make estimated tax payments?
- Own rental property or convert rental property to personal use?
- Pay alimony?
- Contribute to a ROTH IRA
- Contribute to a Traditional IRA
- Contribute to a SEP
- Contribute to a Keogh
- Contribute to a Simple Retirement Plan
- Have a Health Savings Account (HSA)?
- Have out-of-pocket expenses, use personal vehicle on the job, etc?
- Have a loss from casualty? (fire, theft, natural disaster, etc.)
- Have a job-related move?
- Pay college tuition expenses?
- Was the Earned Income Credit ever disallowed for you?
- Do you currently have health insurance coverage?
- Are you receiving health insurance coverage through an ACA Marketplace?
- Take a distribution from any retirement account?
- Are you enrolled as a part time student?
- Are you enrolled as a full time student?
- Receive royalties?
- Operate a farm?
- Receive installment payments on property sold?
- Have an interest in a partnership, S-corporation, estate or trust?
- Have income as a minister?
- Receive housing allowance?
REQUIRED CHECKLIST
Copy of Previous Year’s Tax Return*
Max. file size: 256 MB.
Copy of Voided Check for Refunds*
Max. file size: 256 MB.
Copy of Taxpayer’s Driver’s License/State ID*
Max. file size: 256 MB.
Copy of Spouse's Driver’s License/State ID
Max. file size: 256 MB.
Client’s Signature
Email
This field is for validation purposes and should be left unchanged.

Let's Get Started!

Start by filling out this short questionnaire.

TAX YEAR & DATE

CLIENT INFORMATION

DEPENDENTS

DID YOU OR YOUR SPOUSE LAST YEAR...

REQUIRED CHECKLIST

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