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.

1.) Did we do your taxes last year? (If no please provide a copy of last year's return.) YesNo
2.) Did you receive your full refund last year? YesNo
3.) Did you receive a letter of any type from the IRS or any state last year? YesNo
4.) 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
5.) 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
6.) Has your marital status or filing status changed during 2023? YesNo
7.) Marital status MarriedSingleDivorcedSeparatedWidower
If you selected "Separated", provide the date of separation
8.) Did you receive any unemployment compensation in 2023? (if yes provide 1099-G) YesNo
9.) Have you put any money INTO or taken any money OUT OF any Tax deferred account during 2023? (Such as IRA's, 401K's, Pension, Annuities, 529 plan, HSA, MSA) YesNo
10.) Have you paid any daycare expenses in 2023 for a child under age 13 or a disabled spouse or other disabled dependent? YesNo
11.) Have you, your spouse or your dependents taken any college or tech school courses in 2023? (You must provide the 1098-T from the educational institution) YesNo
12.) Have you paid interest on any student loans in 2023? YesNo
13.) Have you bought, sold, or had your Home foreclosed on in 2023? YesNo
14.) Have you had any Cancellation of Debt in 2023? (Such as credit cards, auto loans, forgiveness of debt, repossession, etc) YesNo
15.) Have you made any Energy Efficiency improvements to your personal residence in 2023? (Such as Solar, Geothermal, Window, Doors, HVAC, Gas Hot Water Heater) YesNo
16.) 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
17.) Did you sell stock, timber, real estate, or any Digital assets in 2023? YesNo
18.) Did you receive Social Security benefits in 2023? (if yes please provide your 1099-SSA form) YesNo
19.) Did you receive any lottery winnings, jury duty pay or alimony in 2023? YesNo
20.) Do you or your spouse have any Foreign Bank Accounts or Trusts? YesNo
21.) At any time during 2023, did you receive (as a reward, award, or payment) or sell, exchange, gift, or dispose of any DIGITAL ASSETS? (If so, please provide documentation.)(EX: Bitcoin, Dogecoin, Ethereum, or through brokers such as Robinhood, Coinbase, Cash App, PayPal, etc., they should issue you a year end statement) YesNo
22.) For the year 2023 did you have health insurance for you and your family with the Affordable Care Act also known as Healthcare.gov (1095-A Form is required) YesNo
23.) If you would like DIRECT DEPOSIT of any refunds?(If so, please provide your direct deposit routing number and account number information WITH your tax documents.) 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.