Messner & Fox, LLC - Due Diligence Questionnaire

Due Diligence Questionnaire
The United States Tax Code requires that taxpayers receiving certain tax credits or reductions to meet and comply with certain reporting requirements, known as Due Diligence. Failure to do so can result in significant penalties to the taxpayers, their spouse, and their preparer. To make this process easier, Messner & Fox, LLC has reviewed the tax code and compiled the below questionnaire to collect the information necessary to comply with this requirement. We appreciate your cooperation as we ensure compliance.
Full Name:*

First NameLast Name
Last 4 of SSN:*
Are you married?*

NoYesYes, But Living ApartWidowed
When did you last live together?
Have you ever been disallowed a tax credit in the past?*

NoYes
If so, please explain.
Did you live outside the US any this year?*

NoYes
If so, please explain.
Will you be listing any dependents?*

NoYes
Are any of your dependents married?

NoYes
If your dependents have different last names, why?
If you are under 18, explain how your dependent was cared for until you were old enough to support.
List anybody else who could possible claim your dependent.

List others in your household not included on your return:

List any supplemental, non-taxable income you received:

Due Diligence - Education
Were you, your spouse, or any dependents in college or continuing education?*

NoYes
Name of school?
Did the student attend at least half time?

NoYes
What degree is the student seeking?
How many years has the student attended higher education?
Did the student receive a tuition statement from the school?

NoYes
Other books/materials costs not included in tuition?
How much did the student earn while in school?
How many years have you claimed the American Opportunity Tax Credit?
Has the student been convicted of any drug related felonies?

NoYes
Please provide a statement form Financial Affairs of Bursar, if available.

Due Diligence - Single Parent / Head of Household
You stated that you are either married or do not have children. You have nothing to complete in this section.
You indicated that are you listing dependents and are not married. Please complete the following questions as you may qualify as Head of Household (single guardian paying more than 50% of household costs).
What is the name of the other parent(s)?
Where are the other parent(s) living?
Why is the other parent(s) not claiming?
What is the other parent(s) approx income?
Do you have legal full custody of the dependent?

NoYes
Do you have legal joint custody of the dependent?

NoYes
How long did the dependent live in your home this year?
How long did the dependent live with the other parent(s) this year?
Do you have a signed Form 8332 (Release of Claim)?

NoYes
Who babysits while you work?
Your Monthly Income
Include all sources (wages, child support, other)

(Do not include money received under public assistance/welfare/foodstamps in the amount your contributed, but include all costs paid with public assistance in the total cost. This means, if your rent is $500 and you only pay $200 and $300 is subsidized by public housing, you list $200 in the first column and $500 in the second.)

Due Diligence - Authorization
Taxpayer (or spouse) has provided all answers to the above questions to be true and correct to the best of the their knowledge. Taxpayer has been informed that cliaming a dependent for EITC/CTC/AOTC/HOH or other credit or tax deduction can result in an audit, fines and penalties if information provided to prepare is incorrect.
Taxpayer or Spouse Signature:*

Clear
(Please note that the date and time of this submission will be automatically recorded.)
Should be Empty:

Due Diligence Questionnaire