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Client Questionnaire
Client Questionnaire
Client Questionnaire
Please check the appropriate box and include all necessary details and documentation.
Name
*
First
Last
Phone
*
Email
*
Enter Email
Confirm Email
Personal Information
Did your marital status change during the year?
*
Yes
No
If yes, please explain:
Did your address change from last year?
*
Yes
No
Can you be claimed as a dependent by another taxpayer?
*
Yes
No
Are you covered by a Group Health Coverage, or self-insured?
*
Yes
No
Did you change any bank accounts that have been used to direct deposit (or direct debit) funds from (or to) the IRS or other taxing authority during the tax year?
*
Yes
No
Dependent Information
Were there any changes in dependents from the prior year?
*
Yes
No
If yes, please explain:
Do you have any children under age 19 or a full-time student under age 24 with unearned income in excess of $1,900?
*
Yes
No
Do you have dependents who must file a tax return?
*
Yes
No
Did you provide over half the support for any other person(s) during the year?
*
Yes
No
Did you pay for child care while you worked or looked for work?
*
Yes
No
Did you pay any expenses related to the adoption of a child during the year?
*
Yes
No
If you are divorced or separated with child(ren), do you have a divorce decree or other form of separation agreement which establishes custodial responsibilities?
*
Yes
No
Purchases, Sales and Debt Information
Did you start a new business or purchase rental property during the year?
*
Yes
No
Did you acquire a new or additional interest in a partnership or S corporation?
*
Yes
No
Did you sell, exchange, or purchase any real estate during the year?
*
Yes
No
Did you purchase or sell a principal residence during the year?
*
Yes
No
Did you foreclose or abandon a principal residence or real property during the year?
*
Yes
No
Did you acquire or dispose of any stock during the year?
*
Yes
No
Did you take out a home equity loan this year?
*
Yes
No
Did you refinance a principal residence or second home this year?
*
Yes
No
Did you sell an existing business, rental, or other property this year?
*
Yes
No
Did you incur any non-business bad debts this year?
*
Yes
No
Did you have any debts canceled or forgiven this year?
*
Yes
No
Did you purchase a new hybrid, alternative motor, or electric motor energy efficient vehicle this year?
*
Yes
No
Did you pay any student loan interest this year?
*
Yes
No
Income Information
Did you have any foreign income or pay any foreign taxes during the year?
*
Yes
No
Did you receive any income from property sold prior to this year?
*
Yes
No
Did you receive any lump-sum payments from a pension, profit sharing or 401(k) plan?
*
Yes
No
Did you make any withdrawals from or contributions to an IRA, Roth, Keogh, SIMPLE, SEP, 401k, or other qualified retirement plan?
*
Yes
No
Did you make any withdrawals from an education savings or 529 Plan account?
*
Yes
No
Did you receive any distributions from a Health savings account (HSA), Archer MSA, or Medicare Advantage MSA this year?
*
Yes
No
Did you receive any Social Security benefits during the year?
*
Yes
No
Did you receive any unemployment benefits during the year?
*
Yes
No
Did you receive any disability income during the year?
*
Yes
No
Did you receive tip income not reported to your employer this year?
*
Yes
No
Did any of your life insurance policies mature, or did you surrender any policies?
*
Yes
No
Did you cash any Series EE or I U.S. Savings bonds issued after 1989?
*
Yes
No
Itemized Deduction Information
Did you incur a casualty or theft loss during the year?
*
Yes
No
Did you pay out-of-pocket medical expenses (Co-pays, prescription drugs, etc.)?
*
Yes
No
Do you have evidence to substantiate charitable contributions?
*
Yes
No
Did you make any noncash charitable contributions (clothes, furniture, etc.)?
*
Yes
No
Did you donate a vehicle or boat during the year? If yes, attach Form 1098-C.
*
Yes
No
Upload File
Did you have an expense account or allowance during the year?
*
Yes
No
Did you use your car on the job, for other than commuting?
*
Yes
No
Did you work out of town for part of the year?
*
Yes
No
Did you have any expenses related to seeking a new job during the year?
*
Yes
No
Did you make any major purchases during the year (cars, boats, etc.)?
*
Yes
No
Did you make any out-of-state purchases (by telephone, internet, mail, in person) that the seller did not collect state sales or use tax?
*
Yes
No
Miscellaneous Information
Did you make gifts of more than $13,000 to any individual?
*
Yes
No
Did you have any educational expenses during the year?
*
Yes
No
Did you make any contributions to an education savings or 529 Plan account?
*
Yes
No
Did you make any contributions to a Health savings account (HSA) or Archer MSA?
*
Yes
No
Did you pay long-term health care premiums for yourself or your family?
*
Yes
No
Did you pay any COBRA health care coverage continuation premiums?
*
Yes
No
If you are a business owner, did you pay health insurance premiums for your employees this year?
*
Yes
No
Did you utilize an area of your home for business purposes?
*
Yes
No
Did you engage in any bartering transactions?
*
Yes
No
Are you an active participant in a pension or retirement plan?
*
Yes
No
Did you retire or change jobs this year?
*
Yes
No
Did you incur moving costs because of a job change?
*
Yes
No
Did you, your spouse, or your dependents attend a post-secondary school during the year, or plan to attend one in the coming year?
*
Yes
No
Did you pay any individual as a household employee during the year?
*
Yes
No
Did you make energy efficient improvements to your main home this year?
*
Yes
No
Were you a grantor or transferor for a foreign trust, or do you have an interest in or a signature or other authority over a bank account, securities account, or other financial account in a foreign country?
*
Yes
No
Did you receive correspondence from the State or the Internal Revenue Service?
*
Yes
No
If yes, please explain:
Do you want to designate $3 to the Presidential Election Campaign Fund? If you check yes, it will not change your tax or reduce your refund.
*
Yes
No
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