Tax Preparation Questionnaire
Daytime Telephone #_______________________________
E-Mail Address__________________________________________
Name: ___________________________________________________________________________________________________________
Client PIN # 5 Random Digits or Philip Selects
T/P________________ Spouse_________________
Personal Information: YES / NO
1. Did your marital status change during the year? _____ _____
2. Will the address on your current returns be different a prior years returns? ____ ____
3. Did you retire or change jobs during the year? ____ ____
4. Were you notified by IRS or other taxing authority of any changes in prior year? ____ ____
5. Have you or your spouse been a victim of identity theft and have you contacted the IRS?____ ___
Income, General
1. Do you have any income from the following list; if yes how many?
Wages (W-2), ____ _____
Social Security Income (1099SSA), _____ _______
Interest Income (1099 Int), _____ ______
Dividends Income (1099 Div) ____ ____
Retirement Income (1099 R) _____ _____
Capital Gains (Brokerage Statement) ______ ______
Gambling Income (W2G) _____ ______
Government Payments (1099G) _____ ______
Miscellaneous Income (1099 Misc) ______ ______
2. Did you receive deferred retirement or severance compensation? ____ ____
3. Do you receive or pay alimony? ____ ____
4. Do you have income from self-employment? ____ ____
5. Do you have rental income? ____ ____
Dependents:
1. Were there any changes in dependents from prior years?____ ____
2. Did you pay for childcare while you worked or looked for work?____ ____
3. Do you have any children under age 24 with unearned income more than $2,100?____ ____
4. Are any of your dependents required to file a tax return?____ ____
Healthcare
1. Did you have healthcare coverage (health insurance) for you, your spouse and any dependents? If Yes, include all Forms 1095-A, 1095-B and 1095-C?____ ____
2. Did you or your spouse have any transactions pertaining to a health savings account (HSA) or (MSA)? If you received a distribution from an HSA or MSA, include all Forms 1099-SA. ____ ____
3. Did you or your spouse receive any distributions from long-term care insurance contracts? If Yes, include Form 1099-LTC. ____ ____
4. Did you or your spouse lose your job because of foreign competition and pay for your own health insurance? ____ ____
Purchase Sales and Debts:
1. Did you sell exchange or purchase any real estate (Including Home) during the tax year? (Closing statement required) (Form 1099) ____ ____
2. Did you sell an existing business, rental property, farm or any existing interest in a Partnership or S-Corporation during the tax year ____ ____
3. Did you sell or convert any stocks, bonds, options or mutual funds? (1099B Required) ____ ____
4. Did you engage in any put or call transactions or did you close any short sales during the tax year?____ ____
5. Did you sell any securities not reported on Form 1099B? ____ ____
6. Did you receive any grants of stock options from your employer, exercise any stock options granted to you or dispose of any stock acquired under a qualified employee stock purchase plan? ____ ____
7. Did you have any debts canceled, forgiven, or refinanced during the year? ____ ____
Itemized Deductions:
1. Did you contribute property other than cash to charity with a FMV more than $5000? ____ ____
2. Do you have receipts for your charitable contributions? ____ ____
3. Did you make any large purchases such as motor vehicle or boat? ____ ____
4. Did you pay real estate or personal property taxes? _____ _____
4. Did you incur any large medical bills (more than 7% of your income) during the year? (Including long term care)? ____ ____
5. Did you pay any Student Loan Interest for yourself, spouse or your dependent during the year? ____ ____
6. Did you pay home mortgage on Equity Loan Interest? (Form 1098)(indicate # of form 1098) ____ ____
7. Did you refinance home mortgage, home equity or other loans? ____ ____
8. Do all of your Mortgages Exceed 1 million dollars? ____ ____
9. Did you incur any casualty or theft losses during the year? ____ ____
IRA/ROTH IRA’S/ Educational IRA’s:
1. Did you contribute to any IRA’s, including ROTH IRA or convert to a Roth IRA? ____ ____
2. Did you receive a distribution from an IRA or qualified retirement plan during the tax year? (Form 1099-R) ____ ____
3. In 2010 did you or your spouse convert an IRA into a Roth IRA during the tax year? ____ ____
4. Did you or your spouse turn age 70 ½ during the year and have money in an IRA or other retirement account
without taking any distribution? ____ ____
Miscellaneous:
1. Did you or your dependents incur any post-secondary education expenses such as tuition? (Form 1098-T) ____ ____
2. If you deduct business use of vehicle, do you maintain a log? ____ ____
3. Did you make gifts of more than $15,000 to any individual? ____ ____
4. Did you pay an individual for domestic services performed in your home, greater than $1,900? ____ ____
5. Did you receive unreported tip income of $20 or more in any month, not reported to employer? ____ ____
6. Have you received a punitive damage award? ____ ____
7. Did you purchase a new alternative technology vehicle, including plug-in electric? ____ ____
8. Did you install any energy equipment in you residence in 2019 (Solar, Wind, Windows, Heat Pump) etc _____ _____
9. Were you displaced or did you suffer casualty losses as a result of Federally Declared Disaster? ____ ____
10. Did you or your spouse claim a homebuyer credit for a home purchased in 2008? ____ ____
Sharing Economy: (If yes, provide documentation)
1. Did you engage in any bartering transaction? ____ ____
2. Did you engage or incur expenses associated with car sharing (e.g., Lyft,or Uber)?
If yes, attach Form 1099-MISC and Form 1099-K ____ ____
3. Did you receive income or incur expenses associated with freelancing (e.g., Upwork or TaskRabbit)?
If yes attach Form 1099-K ____ ____
4. Did you receive or incur expenses associated with a short-term rental (e.g., Airbnb or HomeAway) ____ ____
5. Did you receive income or incur expenses associated with crowdfunding (e.g., Kickstarter or Indiegogo)
If yes, attach Form 1099-K. ____ ____
. Did you receive income or incur expenses associated with fashion sharing (e.g., Poshmark) _____ ____
Foreign Income and Taxes:
1. Were you or your spouse a grantor or transferor for a foreign trust, have an interest in or a signature or other authority over a bank account, securities account, or other financial account in a foreign country? ____ ____
2. Do you or your spouse own any foreign financial assets? ____ ____
3. Did the aggregate value of foreign accounts exceed $10,000 at any time during the year? _____ _____
4. Did you have any foreign income or pay foreign taxes? ____ ____
5. Did you perform any work outside of the US? ____ ____
MASSACHUSETTS ONLY
1. Total purchases outside of MA during the year, subject to Mass. Sales/Use Tax ___________
2. Rental Deduction information:
Name of Landlord: ____________________________ Rent Paid $___________
3. MA Health Care Insurance Form MA-1099HC REQUIRED ____ ____
4. Fast Lane cost if more than $150 in 2018 or MBTA Commuter pass. ____ ____
5. Do you have MBTA Pass for dependent student?____ ____
7. Did you do Lead paint removal? ______ ______