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New Tax Client Form
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Spouse Name
Address

Dependents:

Income:

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Tax Return Questionnaire - 2021 Tax Year

Taxpayer Name:
Taxpayer Address:
Spouse Name
Spouse Address
Filing Status:

If you would like your tax refund (if any) deposited directly into your bank:

Account Type:

If we have not previously prepared your return, please provide a copy of your 2020 tax returns and driver's licenses.

Dependents

Name
Income over $2200?
Name
Income over $2200?
Name
Income over $2200?
Virtual Currency: At any time during 2021, did you receive, sell, send, exchange, or otherwise acquire any financial interest in any virtual currency?
Health Insurance Coverage: Did you have health care coverage with a government marketplace during 2021?
If yes, please provide form 1095-A issued by marketplace.

Income

1. Wages & Salaries - Include W-2's

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2. Interest / Dividend Income - Include 1099's

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3. Capital Gain & Losses

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4. Other Gains & Losses

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5. Pensions, IRA Distributions, Annuitites, and Rollovers - Include 1099 K

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6. Rents/ Royalties, Partnerships, S Corporations, Estates, Trusts

7. Unemployment Compensation Received - Include 1099 G

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8. Social Security Benefits Received

9. Other Income

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Credits

Child & Dependent Care

Name, address, and Identification Number of each Provider:
Name
Address
Id Number
Amount Paid
 
If payments were made to an individual, were the services performed in your home?
If yes, have reports been filed?
Special Needs Child

Adoption Expenses

2021 Estimated Tax Payments
Federal
Amount
State
Amount
 
Other Payments (Child Tax Credit Received)
Date
Amount
Date
Amount
 

Itemized Deductions:

Medical & Dental - Amount

Adjustments to Income

Maximize?
Maximize?
Maximize?
Did anyone in your family receive a scholarship of any kind during 2021?
If, yes please supply details.
If you have added or disposed of any fixed assets used in trade or business or rental or farm activities, please provide the following:
Addition:
Description:
Date Acquired
Cost
Trade In (if any)
 
List
Dispositions:
Description
Date of disposition
Amount realized
 
Did you settle any notices or settle any tax examinations concerning your prior tax year's returns? (if yes, please provide copy of notes, settlement reports, etc.)
Did you sell your primary residence during 2021
Did you change your state residency during 2021?
If yes, and you were a member of the armed forces on active duty who moved because of a permanent change of station, please provide the following:

For the Year 2021: (provide details for any "yes" responses)

Did your principal residence (and second residence, if any) loan(s) exceed the fair makred value of the residence(s)?
Do you have a balance borrowed against a home (equity line of credit) in excess of $100,000, or total mortgage indebtedness in excess of $750,000?
Did you exercise any stock options?
Did you purchase, sell, or own any bonds you paid more or less than the face amount?
Did you sustance any non-business bad debts?
Did you or your spouse make any gifts in excess of $15,000 to any one donee?
Were you the recipient of, or did you make a "below market" or interest-free" loan?
Do you have a child under the age of 18 as of Dec 31, 2021 who has earned an income (interest, dividends, etc.) of more than $1,100?
Did you lease a car in which you used for business purposes?
- If "yes", provide (1) fair market value or capitalized cost of the car on the 1st day of the lease or rental agreement, (2) term of the lease, (3) number of payments made, (4) number of days the car was leased in 2021, (5) percentage of business use, (6) business or work the car was used in, (7) amount of expenses reported by you to your employer on Form W2.

Rental and Royalty Income and Expense

Property Type:
Location Address
If Vacation Home:
Number of days rented
Number of days used personally
Property is owned by:
Did you live in part of the rental property?
Did you rent this property to a relative?

Fill out only if you don't have a Profit & Loss Statement:

Expenses and Amount

Depreciation:
Property
Date Acquired
Cost or Other Basis
Depreciation Method
Prior Depreciation
 

Business Income and Expenses (Sole Proprietorship)

Business Address
Business Ownership:
Accounting Method:
Inventory Method:
Did you materially participate in the business?
Check if this is the first year of the business

Fill out only if you don't have a Profit & Loss Statement: Income - Amount

Cost of Goods Sold - Amount

Expenses - Amount

Depreciation (Sole proprietorship)
Property
Date Acquired
Cost or Other Basis
Depreciation Method
Prior Depreciation
 

Farm Income and Expense

Accounting Method
check if you are materially participated in farm operations:

Fill out only if you don't have a Profit & Loss Statement: Farm Income - Amount

Expenses - Amount

Depreciation (Farm)
Property
Date Acquired
Cost or Other Basis
Depreciation Method
Prior Depreciation
 

Business Use of Home

Do you use any part of your home regularly and exclusively for business?

Daycare Facility

Daycare Facility
Property
Date Acquired
Cost or Other Basis
Depreciation Method
Prior Depreciation
 

Household Employees (Nanny Tax)

Did you pay a household employee at least $2300 this year?
If yes, please provide the following:
Name
Has a W-2 been filed?
If not, do you want us to prepare one for you?
Have the necessary state employment returns been filed?
If not, do you want us to prepare them for you?
Was the household employee under 18 years of age and a student?