Client Intake 2019 Client Intake Form (#2) Complete only applicable fields. Please skip sections if we already have your info from prior tax filings. *** New Clients—Please provide us a copy of your prior year tax returns and depreciation schedules. ***FILING STATUS Single Married Filing Joint Married Filing Single Head of Household Qualifying WidowerADDRESSAddress Line 1 Address Line 2 City State Zip Code TAXPAYERFirst Name Middle Name Last Name Social Security Number Email Occupation Mark if Legally Blind Mark if Legally BlindMark if Dependent of Another Mark if Dependent of AnotherDate of Birth Date of Death Work/Daytime Phone Home/Evening Phone SPOUSEFirst Name Middle Name Last Name Social Security Number Email Occupation Mark if Legally Blind Mark if Legally BlindMark if Dependent of Another Mark if Dependent of AnotherDate of Birth Date of Death Work/Daytime Phone Home/Evening Phone DEPENDENTSFirst, Middle, Last Name First, Middle, Last Name First, Middle, Last Name First, Middle, Last Name Date of Birth Date of Birth Date of Birth Date of Birth Social Security Number Social Security Number Social Security Number Social Security Number Relationship Relationship Relationship Relationship EMPLOYMENT & RETIREMENT INFORMATIONA.) Are You Employed? Yes NoB.) Are You Unemployed? Yes NoC.) Are you contributing to a 401k, 403b or other pre-tax account? Yes NoD.) Have you ever opened any form of pretax account in the past? Yes NoE.) Have you considered a ROTH conversion of pretax accounts? Yes NoF.) Would you like a ROTH conversion tax "WHAT IF" prepared with your return? Yes NoSTATE & OTHERA.) Are you requesting state return(s)? Yes NoIf yes, what State(s)? B.) Are you requesting local, school, RITA or county return(s)? Yes NoPlease specify PreviousNextTax Client Income and Expense Questions Please Provide Us Your Form 1095(s) In Order to Complete The Health Insurance Mandate Tax Forms.Please Let Us Know if You: Had More Than $10,000 in a Foreign Bank Account at Any Point During 2018 Had Non-Cash Foreign Assets Exceeding $50,000 in Value at Any Point During 2018 Invested in Bitcoin or any other Cryptocurrencies in 2018 or prior years The below checklist provides basic information. There very well could be more information needed to be supplied. For situations that are beyond the information provided below, please make sure detailed notes are provided to assist the preparer in determining the proper way to account for the situation. Missing information will delay the processing of the return.BASIC QUESTIONS Please check the box to the left for any of the following that apply. If not leave blank. If checked, please provide a brief explanation below if the information will assist the preparer in any way. (Note: Please check for you AND your spouse) 1. Did your marital status change from the prior year? 2. Did you change your address from last year? 3. Any change in your dependents from last year? 4. Did you have children under 19 (or 24 if a full time student) who had more than $2,100 in unearned income? 5. Are all your dependents either US Residents or Citizens? 6. Did you pay any adoption expenses? 7. Did you provide over half the support for someone you aren't claiming as a dependent? 8. Are you being claimed or eligible to be claimed as a dependent of someone else's return? 9. Were either you or your spouse in the military or National Guard? 10. Did you purchase or sell your primary residence? Or did you refinance your primary residence? 11. Have you been notified by the IRS of changes to a previously submitted tax return? Or have you received any other IRS or State Notices? 12. Did you make any gifts over $15,000 to any individuals?Comments/Description: INCOMEPlease check any of the following that you and/or your spouse received. 1. W-2 Income 2. Interest and/or Dividends 3. Tax Exempt Interest and/or Dividends 4. Taxable refunds, credits or offsets? (including prior year State refunds) 5. Alimony 6. Business income (Self Employment Income). If "yes" please fill a Schedule C Worksheet and provide financials. 7. Stock Sales (Capital Gains)- (MAKE SURE ALL BASIS INFO IS PROVIDED). 8. Capital Loss Carryforward from prior yearAmount of Capital Loss Carryforward from prior year: 9. Any other Assets Sold or any other Gains or Losses 10. Rental Real Estate Income (If "yes" please fill out a Schedule E Worksheet) 11. Passive Activity Loss Carryforward from prior yearAmount of Passive Activity Loss Carryforward from prior year: 12. K-1's (1120S, 1065, 1041) 13. Unemployment 14. Social Security Income 15. Other IncomePlease list Other Income: 16. Foreign Income 17. IRA or Pension Distributions A.) Are any of these Rollovers? (Should not be taxed) B.) Are any of these ROTH conversions? (taxable)More info about these distributions: ADJUSTMENTS TO INCOMEPlease check any of the following that apply to you and/or your spouse: 1. Educator Expenses (Teaching Expenses) 2. Health Savings Account Deductions 3. Moving Expenses 4. Contributions to SEP, SIMPLE and other Qualified Plans 5. Self Employed Health Insurance 6. Alimony 7. IRA Contributions 8. Student Loan Information 9. Tuition and Fees Deduction (you or your dependents)TAX AND CREDITSFor the following, please check any of the following that apply: 1. Itemized Deductions (* If "yes" please fill out Schedule A Worksheet) 2. Child and Dependent Care Expenses 3. First Time/Long Time Homebuyer 4. Energy Efficiency Related Upgrades/Repairs 5. Oil & Gas Investment credits 6. Other tax shelters or creditsESTIMATED PAYMENTS (Please fill in if Estimates were made or refunds from a prior year were applied.)$ Federal $ Federal $ Federal $ Federal $ Federal $ Federal $ Federal $ Federal Date Date Date Date Date Date Date Date Quarter Quarter Quarter Quarter Quarter Quarter Quarter Quarter E-FILE / FILING INFO - REFUND / PMT INFO1. How do you want any refund sent to you? (Must choose one.) Direct Deposit (takes a few days) Applied to Next Year's Return Paper Check in the Mail (could take several weeks)2. Any taxes due will be paid by check along with Voucher provided by tax preparer. It is the taxpayer's responsibility to mail payments before tax due dates.PreviousNextSpecial Information for the Tax PreparerIs there something "unique" that the preparer should pay special attention to or know? If yes, please explain. Tax Client Home Office Deduction Info Fill out completely or mark "N/A". Do not leave blank.Date home was first used for Business: Square Footage of Area Used for Home Business Total Square Footage of the Home Deduction Expenses (Current Year)Casualty Losses Deductible Mortgage Interest Real Estate Taxes Insurance Rent Repairs and Maintenance Utilities Other (please specify type and amount):Other #1: Type Other #1: Amount Other #2: Type Other #2: Amount Other #3: Type Other #3: Amount Other #4: Type Other #4: Amount DepreciationDo you have depreciable assets? Yes NoIf yes, please provide a detailed depreciation schedule below.Asset #1 Date Aquired Asset #1 Description of Item/Property Asset #1 Cost Basis or Purchase Price Asset #2 Date Aquired Asset #2 Description of Item/Property Asset #2 Cost Basis or Purchase Price Asset #3 Date Aquired Asset #3 Description of Item/Property Asset #3 Cost Basis or Purchase Price Asset #4 Date Aquired Asset #4 Description of Item/Property Asset #4 Cost Basis or Purchase Price PreviousNextAdditional Forms If you are not required to submit a Schedule A, Schedule C, or Schedule E, you may skip this section and proceed to the Next.Check here if you need to fill out a Schedule A Schedule AFill out COMPLETELY or mark "N/A". DO NOT leave blank. Include any back-up documents. Medical Expenses (Current Year)Medical & Dental Expenses Medical Insurance Premiums Paid (other than Social Security Medicare payments) Long Term Care Premiums Prescription Drugs and Medications Medical Miles Driven Tax Expenses - LIMITED TO $10,000 (Current Year)State and Local Income Taxes Paid (other than those on W-2s, 1099s, etc.) Last year Income Taxes Paid Real Estate Taxes Personal Property Taxes Other Taxes (please specify) Qualified New Vehicle Taxes Additional State or Local/Taxes Interest Expense (Current Year)Home Mortgage Interest reported on Form 109 Home Mortgage Interest paid to others Refinancing Points Paid in 2018 Investment Interest (other than K-1) Contributions (Current Year)Cash Contributions (note: Please provide a detailed list for donations over $500) Non Cash Contributions (note: Please provide a detailed list for donations over $500) Volunteer Mileage Driven Casualty & Theft Losses If you had any casualty or theft losses during the year, please provide detail below, including date, description, amount of casualty or loss, any insurance reimbursement & basis in the property.Check here if you need to fill out a Schedule C Schedule CFill out COMPLETELY or mark "N/A". DO NOT leave blank. Use a separate Worksheet for EACH Schedule C.** Please Note: If possible, it is preferred a Trial Balance, P&L and Balance Sheet be provided by the client. They may be uploaded in the Client Portal. Business Info (Required for all)Business Owner Taxpayer SpouseAddress of BusinessAddress Line 1 Address Line 2 City State Zip Code Country Select CountryAfghanistanAland IslandsAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelauBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Saint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBritish Virgin IslandsBruneiBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos (Keeling) IslandsColombiaComorosCongo (Brazzaville)Congo (Kinshasa)Cook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyIvory CoastJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKosovoKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacao S.A.R., ChinaMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth KoreaNorthern Mariana IslandsNorwayOmanPakistanPalestinian TerritoryPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarReunionRomaniaRussiaRwandaSão Tomé and PríncipeSaint BarthélemySaint HelenaSaint Kitts and NevisSaint LuciaSaint Martin (Dutch part)Saint Martin (French part)Saint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia/Sandwich IslandsSouth KoreaSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwazilandSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUgandaUkraineUnited Arab EmiratesUnited Kingdom (UK)United States (US)United States (US) Minor Outlying IslandsUnited States (US) Virgin IslandsUruguayUzbekistanVanuatuVaticanVenezuelaVietnamWallis and FutunaWestern SaharaYemenZambiaZimbabweName of Business EIN Number (if any) For the Business Code box below, click here for a reference of available codes accepted by the IRS. Use the code that best describes your business.Business Code Accounting Method Cash Accrual Other(Please specify Other accounting method) Date Business Started Did you materially participate in the business? Yes NoGeneral Questions (Required for all)Are you claiming use of a home office? (If yes, please upload a Home Office Deduction Worksheet) Yes NoDo you have depreciable assets? (If yes, please upload a detailed depreciation schedule) Yes NoVehicle InformationYear/Make/Model: Date Placed in Service: Total Miles Driven: Business Miles: Commuting Miles: Self Insured Health Insurance Deduction? Yes NoIf yes, how much did you pay? Income QuestionsWill you upload, or have you uploaded, your P&L or Income Statement in the Client Portal? Yes NoTotal Sales Other Income Cost of Goods Sold (Required if no P&L or Trial Balance Available)Beginning Inventory Purchases Cost of Labor Materials and Supplies Ending Inventory General Expenses (Required if no P&L or Trial Balance Available)Advertising Auto Expenses (other than mileage) Commissions Contract Labor Depletion Depreciation (Need Sched) Employee Benefit Programs Insurance (Other than Health) Interest a.) Mortgage Interest a.) Other Interest Legal & Professional Office Expense Pension & Profit Sharing Plans Rent or Lease a.) Vehicles, Machinery b.) Other Repairs & Maintenance Supplies Taxes & Licenses Travel Meals (Total) Utilities Wages Other (please specify) Other (please specify) Other (please specify) Other (please specify) Check here if you need to fill out a Schedule E Schedule EFill out COMPLETELY or mark "N/A". DO NOT leave blank. If you have multiple properties, you will need to upload separate worksheets for EACH property in the Client Portal.Property Owner Taxpayer JointProperty Description AddressAddress Line 1 Address Line 2 City State Zip Code General Questions: Active Participant Property was used for personal use by you or your family for more than 14 days (or 10% of the total rented days).Enter the number of days for personal use: Enter the number of days rented: Do you have depreciable assets? Yes NoIncome (current year):Rents Received: Royalties: Property Expenses (current year):Advertising Cleaning/Maintenance Commissions Insurance Legal and Other Professional Management Fees Qualified Mortgage Interest Other Interest Repairs Supplies Real Estate Taxes Other Taxes Utilities Other (please specify) Other (please specify) Other (please specify) Other (please specify) Assets Depreciation (please provide detailed schedule). New assets placed in service this year:1. Description 1. Date Placed in Service 1. Purchase Amount 2. Description 2. Date Placed in Service 2. Purchase Amount 3. Description 3. Date Placed in Service 3. Purchase Amount 4. Description 4. Date Placed in Service 4. Purchase Amount 5. Description 5. Date Placed in Service 5. Purchase Amount PreviousNextTwo Forms of ID Required For ALL ReturnsTaxpayer First Name Last Name Taxpayer Social Security Number Photo ID #1 — Required Choose File One Other Form of ID — Required Choose File Spouse First Name Last Name Spouse Social Security Number Photo ID #1 — Required Choose File One Other Form of ID — Required Choose File Upload image of voided check here if Direct Deposit wanted Choose File By my signature below, I hereby authorize the use of this identification above to electronically file my federal tax return according to IRS Publication 1345.Taxpayer Signature Sign Here Date Spouse Signature Sign Here Previous Submit Form
