Client Tax Questionnaire

Page 1

Tax Firm Name

Are you a new or existing client?*

Do you have a copy of your prior year tax return?*

Yes No

Were you previously issued an Identity Protection PIN (IP PIN) by the IRS?*

Yes No

Taxpayer Name*

First Name

Last Name

Taxpayer Date of Birth*

Taxpayer Occupation*

Phone Number*

Email*

Address*

Street Address

City

State / Province

ZIP / Postal Code

Can another taxpayer claim you as a dependent on their tax return?*

Yes No

Will you be filing a tax return with your spouse?*

Yes No

Did the taxpayer work in 2021?*

Yes No

Taxpayer Photo*

Max 10 MB per file

Taxpayer Income Documents

Max 10 MB per file

Page 2

Spouse Name

First Name

Last Name

Spouse Date of Birth

Spouse Occupation

Spouse Phone Number

Spouse Email

Were you previously issued an Identity Protection PIN (IP PIN) by the IRS?

Yes No

Can another taxpayer claim you as a dependent on their tax return?

Yes No

Did the spouse work in 2021?

Yes No

Spouse Photo Identification

Max 10 MB per file

Spouse Income Documents

Max 10 MB per file

Page 3

Do you have any dependents you will claim on your 2021 tax return?*

Yes No

Have you ever been disallowed for EITC/AOTC/CTC? ACTC?*

Yes No

How many dependents will you claim on your 2021 tax return?*

1 2 3 4 or more

Was dependent (1) claimed on your tax return last year?*

Yes No

Can anyone else claim dependent (1) on their 2021 tax return?*

Yes No

Dependent (1) Name*

First Name

Last Name

Dependent (1) Date of Birth*

How many months did dependent (1) live in your household in 2021?*

Relationship*

Is dependent (1) your biological child?*

Yes No

Was dependent (2) claimed on your tax return last year?

Yes No

Can anyone else claim dependent (2) on their 2021 tax return?

Yes No

Dependent (2) Name

First Name

Last Name

Dependent (2) Date of Birth

How many months did dependent (2) live in your household in 2021?

Relationship

Is dependent (2) your biological child?

Yes No

Was dependent (3) claimed on your tax return last year?

Yes No

Can anyone else claim dependent (3) on their 2021 tax return?

Yes No

Dependent (3) Name

First Name

Last Name

Dependent (3) Date of Birth

How many months did dependent (3) live in your household in 2021?

Relationship

Is dependent (3) your biological child?

Yes No

If you have four or more dependents or qualifying children, please list their name(s), date of birth, and relationship to the taxpayer.*

Page 4

Did you pay any child care expenses for any dependents listed above?*

Yes No

Upload Child Care Receipts

Max 10 MB per file

Did you, your spouse, or any dependents attend college in 2021?*

Yes No

Name of person that attended college in 2023

First Name

Last Name

Did the student attend college at least half time?

Yes No

Upload Form 1098-T from College

Max 10 MB per file

Additional Person?

Yes No

Name of person that attended college in 2021

First Name

Last Name

Did the student attend college at least half time?

Yes No

Upload Form 1098-T from College

Max 10 MB per file

Did you, your spouse or dependents receive health insurance through the Marketplace in 2021 and receive Form 1095-A?*

Yes No

Upload Form 1095-A Health Insurance Marketplace Statement*

Max 10 MB per file

Did you or your spouse receive unemployment benefits in 2021?*

Yes No

Upload Form 1099-G received for Unemployment Benefits*

Max 10 MB per file

Page 5

Do you rent or own your current residence?*

Rent Own Other

Did you make any home improvements in 2021?*

Yes No

If you own your home, have you received form 1098 from your mortgage lender?*

Yes No

Upload Form 1098 from mortgage lender

Max 10 MB per file

Did you or your spouse make payments on your student loans in 2021?*

Yes No

Upload Form 1098-E Student Loan Interest Statement

Max 10 MB per file

Did you or your spouse pay any medical or dental expenses in 2021? (This does not include insurance premiums)*

Yes No

Do you or your spouse own a rental property?*

Yes No

Did you or your spouse have any gambling winnings in 2021?*

Yes No

Upload Form W-2G from gambling winnings

Max 10 MB per file

Did you or your spouse receive social security benefits in 2023?*

Yes No

Did you make any charitable contributions in 2023?*

Yes No

Did you purchase a vehicle in 2023?*

Yes No

Did you or your spouse withdraw money from your 401k in 2023?*

Yes No

Did you receive any earnings from interest or dividends in 2023?*

Yes No

Upload Forms 1099-DIV and 1099-INT for dividends and interest earned

Max 10 MB per file

Are you self-employed?*

Yes No

Do you or your spouse owe debt to any Government Agency; such as IRS, Student Loans, Child Support etc?*

Yes No

Which Government Agency do you owe?*

Do you plan to purchase a home within the next one or two years?

Yes No

Do you currently have life insurance for you, your spouse and/or dependents?

Yes No

Are you interested in a FREE life insurance quote?

Yes No

Would you like your tax refund direct deposited into your bank account? If so, please complete bank information below:

Yes No

Bank Name*

Routing Number

Account Number*

Account Type*

Would you like to receive a text message when your refund is funded?

Yes No

Select your cell phone provider*

How did you hear about us?*

Taxpayer Signature*

Sign here

Spouse Signature*

Sign here

Additional Tax Year (If Applicable)

Taxpayer Signature*

Sign here

Spouse Signature*

Sign here

Additional Tax Year (If Applicable)

Taxpayer Signature*

Sign here

Spouse Signature*

Sign here

Additional Tax Year (If Applicable)

Taxpayer Signature*

Sign here

Spouse Signature*

Sign here

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