Online Tax Questionnaire


Name (First, MI, Last)
Date of Birth


Name (First, MI, Last)
Date of Birth


Mailing Address/Street Address
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.


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
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 2019? YesNo
Marital status MarriedSingleDivorcedSeparatedWidower
If you selected "Separated", provide the date of separation
Did you receive any unemployment compensation in 2019? (if yes provide 1099-G) YesNo
Have you put any money INTO or taken any money OUT OF any Tax deferred account during 2019? (Such as IRA's, 401K's, Pension, Annuities, 529 plan, HSA, MSA) YesNo
Have you paid any daycare expenses in 2019 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 2019? (You must provide the 1098-T from the educational institution) YesNo
Have you paid interest on any student loans in 2019? YesNo
Have you bought, sold, or had your Home foreclosed on in 2019? YesNo
Have you had any Cancellation of Debt in 2019? (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 2019? (if yes please provide your 1099-SSA form) YesNo
Did you receive Social Security benefits in 2019? (if yes please provide your 1099-SSA form) YesNo
Did you receive any lottery winnings, jury duty pay or alimony in 2019? YesNo
Did you have any Virtual Currency (Bitcoin, Litecoin, Ethereum, etc.) or any Foreign Bank Accounts or Trusts? YesNo
Did you have a casualty loss due to Hurricane damage from 2015 to present? YesNo
For the year 2019 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 (1095-A required).) 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.

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