Accounting & Tax Service Please leave this field empty. Primary Name (First, MI, Last) Date of Birth Occupation Spouse Name (First, MI, Last) Date of Birth Occupation Information Mailing Address/Street Address City State Zip Daytime Phone Evening Phone Cell Phone Email Address Please bring Social Security Cards for both you and your spouse, your Picture ID and all tax information documents to your appointment. Questions Please answer all questions. Did we do your taxes last year? (If no please provide a copy of last year's return.) YesNo Did you receive your full refund last year? YesNo Did you receive a letter of any type from the IRS or any state last year? YesNo Have you ever been denied Earned Income Tax Credit or had a child disallowed as a dependent on your tax return by the IRS (IF YES PLEASE EXPLAIN) YesNo Explain Are you claiming any dependents on your tax return? (If so you must provide a copy of their social security card and birth certificate, additional documents may be required to qualify for Earned Income Tax Credit.) YesNo Has your marital status or filing status changed during 2018? YesNo Marital status MarriedSingleDivorcedSeparatedWidower If you selected "Separated", provide the date of separation Did you receive any unemployment compensation in 2018? (if yes provide 1099-G) YesNo Have you put any money into or taken any money out of any Tax deferred account during 2018? (Such as IRA's, 401K's, Pension, Annuities, 529 plan, HSA, MSA) YesNo Have you paid any daycare expenses in 2018 for a child under age 13 or a disabled spouse or other disabled dependent? YesNo Have you, your spouse or your dependents taken any college or tech school courses in 2018? (You must provide the 1098-T from the educational institution) YesNo Have you paid interest on any student loans in 2018? YesNo Have you bought, sold, or had your Home foreclosed on in 2018? YesNo Have you had any Cancellation of Debt in 2018? (Such as credit cards, auto loans, forgiveness of debt, repossession, etc) YesNo Have you made any SOLAR or GEOTHERMAL improvements to your personal residence? YesNo Did you make any out of state purchases (by phone, internet, mail order, etc) that the seller did not collect state sales or use tax on? (ex: Amazon, Ebay, etc) YesNo Did you sell stock, timber, real estate, or any other assets in 2018? (if yes please provide your 1099-SSA form) YesNo Did you receive Social Security benefits in 2018? (if yes please provide your 1099-SSA form) YesNo Did you receive any lottery winnings, jury duty pay or alimony in 2018? YesNo Did you have a casualty loss due to Hurricane damage from 2015 to present? YesNo For the year 2018 did you have health insurance for you and your family? (Thru either Individual Policy, Employer, Government Agency (Medicaid or State) or Health Care Market Place.) YesNo Please note in the section below any other items you would like to discuss with your tax preparer: Date you would prefer to visit MorningAfternoonLate Afternoon Our fees are based on the size, complication and forms on your tax return. These fees cannot be accurately determined until the completion of the return. However, if price is a concern, please ask the preparer for a cost estimate prior to the start of your return. The estimate will be within 10% of the final fee. Once the return is started you will be responsible for the fee.