Skip to content
Schedule an Appointment Today
Home
About
Services
Business Planning
Bookkeeping
Tax Preparation
Payroll
Sales and Excise Tax Management
Budgeting
Consulting Services
Financial Statements
Radio Recap
Blog
Resources
Securely Share Your Files / Documents
Download & Print New Tax Client Form
Download & Print New Business Client Form
Fill Out New Tax Client Form Online
Fill Out New Business Client Form Online
Contact
Book An Appointment
Navigation Menu
Navigation Menu
Home
About
Services
Business Planning
Bookkeeping
Tax Preparation
Payroll
Sales and Excise Tax Management
Budgeting
Consulting Services
Financial Statements
Radio Recap
Blog
Resources
Securely Share Your Files / Documents
Download & Print New Tax Client Form
Download & Print New Business Client Form
Fill Out New Tax Client Form Online
Fill Out New Business Client Form Online
Contact
Book An Appointment
Schedule an Appointment Today
New Tax Client Form
Name
First
Last
Social
Phone
Employer
Spouse Name
First
Last
Social
Phone
Employer
Address
Street Address
Address Line 2
City
State / Province / Region
ZIP / Postal Code
Dependents:
Name
Social Security #
Date of Birth
Name
Social Security #
Date of Birth
Name
Social Security #
Date of Birth
Name
Social Security #
Date of Birth
Income:
Company
Select One
W2
1099
K1
Select One
Self
Spouse
Company
Select One
W2
1099
K1
Select One
Self
Spouse
Company
Select One
W2
1099
K1
Select One
Self
Spouse
Tax Return Questionnaire
Taxpayer Name:
First
Last
Taxpayer Address:
Street Address
Address Line 2
City
State / Province / Region
ZIP / Postal Code
Occupation
Phone Number
Email Address
Spouse Name
First
Last
Spouse Address
Street Address
Address Line 2
City
State / Province / Region
ZIP / Postal Code
Spouse Occupation:
Spouse Phone Number
Spouse Email Address
Filing Status:
Single
Married
Head of Household
Qualifying Widow
If you would like your tax refund (if any) deposited directly into your bank:
Account Type:
Checking
Savings
Account Number:
Bank Routing Number:
If we have not previously prepared your return, please provide a copy of your previous tax return and driver's license.
Dependents
Name
First
Last
Income over $2200?
Yes
No
Date of Birth
Relationship
Months Lived in Home
Name
First
Last
Income over $2200?
Yes
No
Date of Birth
Relationship
Months Lived in Home
Name
First
Last
Income over $2200?
Yes
No
Date of Birth
Relationship
Months Lived in Home
Virtual Currency: Did you receive, sell, send, exchange, or otherwise acquire any financial interest in any virtual currency?
Yes
No
Health Insurance Coverage: Did you have health care coverage with a government marketplace?
Yes
No
If yes, please provide form 1095-A issued by marketplace.
Income
1. Wages & Salaries - Include W-2's
Name of Payer
Please select one
Taxpayer
Spouse
Name of Payer
Please select one
Taxpayer
Spouse
Name of Payer
Please select one
Taxpayer
Spouse
Name of Payer
Please select one
Taxpayer
Spouse
Name of Payer
Please select one
Taxpayer
Spouse
2. Interest / Dividend Income - Include 1099's
Name of Payer
Please select one
Taxpayer
Spouse
Name of Payer
Please select one
Taxpayer
Spouse
Name of Payer
Please select one
Taxpayer
Spouse
Name of Payer
Please select one
Taxpayer
Spouse
3. Capital Gain & Losses
Name of Payer
Please select one
Taxpayer
Spouse
Name of Payer
Please select one
Taxpayer
Spouse
Name of Payer
Please select one
Taxpayer
Spouse
Name of Payer
Please select one
Taxpayer
Spouse
4. Other Gains & Losses
Name of Payer
Please select one
Taxpayer
Spouse
Name of Payer
Please select one
Taxpayer
Spouse
Name of Payer
Please select one
Taxpayer
Spouse
Name of Payer
Please select one
Taxpayer
Spouse
5. Pensions, IRA Distributions, Annuitites, and Rollovers - Include 1099 K
Name of Payer
Please select one
Taxpayer
Spouse
Name of Payer
Please select one
Taxpayer
Spouse
Name of Payer
Please select one
Taxpayer
Spouse
Name of Payer
Please select one
Taxpayer
Spouse
6. Rents/ Royalties, Partnerships, S Corporations, Estates, Trusts
Rents/ Royalties, Partnerships, S Corporations, Estates, Trusts
7. Unemployment Compensation Received - Include 1099 G
Name of Payer
Please select one
Taxpayer
Spouse
Name of Payer
Please select one
Taxpayer
Spouse
Name of Payer
Please select one
Taxpayer
Spouse
Name of Payer
Please select one
Taxpayer
Spouse
8. Social Security Benefits Received
Social Security Benefits Received
9. Other Income
Description
Please select one
Taxpayer
Spouse
Description
Please select one
Taxpayer
Spouse
Description
Please select one
Taxpayer
Spouse
Description
Please select one
Taxpayer
Spouse
Credits
Child & Dependent Care
Number of Qualifying Individuals
Name, address, and Identification Number of each Provider:
Name
Address
Id Number
Amount Paid
Add
Remove
If payments were made to an individual, were the services performed in your home?
Yes
No
If yes, have reports been filed?
Yes
No
Special Needs Child
Yes
No
Adoption Expenses
Tuition & Fees Paid for higher education
Foreign Tax Credits (attach details)
Estimated Tax Payments
Federal
Amount
State
Amount
Add
Remove
Other Payments (Child Tax Credit Received)
Date
Amount
Date
Amount
Add
Remove
Other payments or credits - attach schedule & explain
Third Stimulus: enter the amount from IRS notice 1444-C, Your Economic Impact Payment (if any)
Itemized Deductions:
Medical & Dental - Amount
1. Out of pocket costs for prescription medicines, drugs, insulin, doctors, dentists, nurses, and medical and dental insurance premiums (including Medicare B) paid (reduce any insurance reimbursements)
2. Transportation and loding incurred to obtain medical care
3. Other - Hearing aids, eyeglasses, medical devices, etc.
Adjustments to Income
1. Your IRA deduction amount
Maximize?
Yes
No
2. Spouse's IRA deduction amount
Maximize?
Yes
No
Keogh SEP deduction amount
Maximize?
Yes
No
4. Penalty for early withdrawal of savings amount
5. Alimony paid?
6. Self-employed health insurance premiums amount
Did anyone in your family receive a scholarship of any kind?
Yes
No
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)
Add
Remove
List
Dispositions:
Description
Date of disposition
Amount realized
Add
Remove
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.)
Yes
No
Did you sell your primary residence?
Yes
No
Did you change your state residency?
Yes
No
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:
Previous Address:
Distance:
Date of Move:
Cost of Move:
Describe:
For the Year: (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)?
Yes
No
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?
Yes
No
Did you exercise any stock options?
Yes
No
Did you purchase, sell, or own any bonds you paid more or less than the face amount?
Yes
No
Did you sustance any non-business bad debts?
Yes
No
Did you or your spouse make any gifts in excess of $15,000 to any one donee?
Yes
No
Were you the recipient of, or did you make a "below market" or interest-free" loan?
Yes
No
Do you have a child under the age of 18 as of Dec 31, who has earned an income (interest, dividends, etc.) of more than $1,100?
Yes
No
Did you lease a car in which you used for business purposes?
Yes
No
- 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, (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:
Residence
Commercial
Location Address
Street Address
Address Line 2
City
State / Province / Region
ZIP / Postal Code
If Vacation Home:
Number of days rented
Number of days used personally
Property is owned by:
Taxpayer
Spouse
Joint
Percentage Ownership
Did you live in part of the rental property?
Yes
No
If yes, what percentage did you occupy as a tenant?
Did you rent this property to a relative?
Yes
No
If yes, relation?
Fill out only if you don't have a Profit & Loss Statement:
Rental Income Amount
Royalties Received Amount
Expenses and Amount
1. Advertising
2. Association Dues
3. Auto Miles Driven
4. Travel
5. Cleaning &. Maintenance
6. Commissions
7. Insurance
8. Legal & Professional Fees
9. Allocated Tax Preparation Fees
10. Licenses and permits
11. Management Fees
12. Mortgage interest (form 1098)
13. Other interest
14. Repairs
15. Supplies
16. Property Taxes
17. Utilities
Other (description)
18a
18b.
18c.
18d.
18e.
18f.
18g.
18h.
18i.
18j.
18k.
18l.
Depreciation:
Property
Date Acquired
Cost or Other Basis
Depreciation Method
Prior Depreciation
Add
Remove
Business Income and Expenses (Sole Proprietorship)
Principle business or professional:
Business name:
Employer ID Number
Business Address
Street Address
Address Line 2
City
State / Province / Region
ZIP / Postal Code
Business Ownership:
Taxpayer
Spouse
Accounting Method:
Cash
Accural
Inventory Method:
Cost
Lower cost or market
Other
N/A
Did you materially participate in the business?
Yes
No
Check if this is the first year of the business
Fill out only if you don't have a Profit & Loss Statement: Income - Amount
1. Gross receipts or sales amount
2. Returns and allowances
3. Other Income
Cost of Goods Sold - Amount
1. Beginning of year inventory
2. Purchases
3. Cost of items used personally
4. Cost of labor
5. Materials and supplies
6. Other costs
7. End of year inventory
Expenses - Amount
1. Advertising
2. Bad debt (N/A cash benefits)
3. Commissions and fees
4. Employee benefits
Health Insurance
6. Other Insurnace
7. Mortgage interest
8. Other Interest
9. Legal and accounting fees
10. Allocation of tax preparation fees
11. Office expense
12. Pension and profit-sharing plans
13. Rent, vehicles
14. Rent, equipment
15. Rent, building
16. Repairs and maintenance, building
17. Repairs and maintenance, equipment
18. Repairs and maintenance, vehicles
19. Supplies
20. Payroll taxes
21. Other taxes
22. Licenses
23. Travel
24. Meals & entertainment
25. Utilites
26. Wages
27. Mangement fees
28.Consulting expenses
29. Payroll service
30. Employee vehicle expense
31. Employee mileage reimbursement
32. Client gifts (limited to $25 each)
33. Education and seminars
34. Other (Description)
35.
36.
37.
38.
39.
40.
Depreciation (Sole proprietorship)
Property
Date Acquired
Cost or Other Basis
Depreciation Method
Prior Depreciation
Add
Remove
Farm Income and Expense
Primary Product
Employer ID Number
Accounting Method
Cash
Accrual
check if you are materially participated in farm operations:
Taxpayer
Spouse
Fill out only if you don't have a Profit & Loss Statement: Farm Income - Amount
1. Sales of livestock and other resale items
2. Cost of above
3. Sales of livestock, produce, etc. you raised
4. Cooperative distributions(1099-PATR)
5. Cooperative distributions, taxable portion
6. Agricultural program payments
7. Agricultural program, taxable portion
8. Commodity Credit Corporation Loans
9. Crop insurance loans
10. Custom hire
11. Other:
Expenses - Amount
1. Car and truck expenses
2. Chemicals
3. Conservation expense
4. Custom hire (machine work)
5. Employee benefit programs
6. Employee health insurance
7. Feed purchased
8. Fertilizers and lime
9. Freight and trucking
10. Gasoline, fuel, oil
11. Other insurance
12. Mortgage interest
13. Other interest
14. Labor hired
15. Legal & Professional fees
17. Pension and profit share plans
16. Allocated tax preparation fees
18. Vehicle Rental
19. Machinery & Equipment rental
20. Land Rental
21. Repairs and maintenance
22. Seeds & plants purchased
23. Storage & warehousing
24. Supplies purchased
25. Payroll Taxes
26. Other Taxes
27. Utilites
28. Vet, breeding & Medicine
29. Other
30. Other
31. Other
32. Other
Depreciation (Farm)
Property
Date Acquired
Cost or Other Basis
Depreciation Method
Prior Depreciation
Add
Remove
Business Use of Home
Do you use any part of your home regularly and exclusively for business?
Yes
No
Estimated percentage of time spent in home office?
Description of work done in home office.
Description of work done outside of home office.
Total area of home?
Total area of home used regularly for business?
Home Insurnace
Direct Costs (benefit only business portion of home)
Indirect costs (Other)
Repairs and maintenance
Direct Costs (benefit only business portion of home)
Indirect costs (Other)
Utilities
Direct Costs (benefit only business portion of home)
Indirect costs (Other)
Rent
Direct Costs (benefit only business portion of home)
Indirect costs (Other)
Other
Direct Costs (benefit only business portion of home)
Indirect costs (Other)
Daycare Facility
Days used as a daycare facility
Prior year carry over of unallowed losses
Cost of home improvement and prior depreciation
Depreciation of home, improvement, furniture, and equipment
Daycare Facility
Property
Date Acquired
Cost or Other Basis
Depreciation Method
Prior Depreciation
Add
Remove
Household Employees (Nanny Tax)
Employee Identification Number:
Did you pay a household employee at least $2300 this year?
Yes
No
If yes, please provide the following:
Name
First
Last
Wages paid
Federal Income tax withheld
Social Security tax withheld
Medicare tax withheld
State income tax withheld
Has a W-2 been filed?
Yes
No
If not, do you want us to prepare one for you?
Yes
No
Have the necessary state employment returns been filed?
Yes
No
If not, do you want us to prepare them for you?
Yes
No
Was the household employee under 18 years of age and a student?
Yes
No
Additional Tax Information or Questions:
67350
Ask Jennifer a question for the KOTA Radio Segment
Ask her here