2020 Online Client Tax packet
Form 1040
General Information
Todays Date
*
-
Month
-
Day
Year
Date
Client Status
*
New Client
Returning Client
Filing Status
*
Married Filing Jointly
Married Filing Seperatly
Single
Head of Household
Qualifying Widow(er)
Date of Spouse's death
-
Month
-
Day
Year
Date
Pres. Campaign Fund
Please Select
Yes
No
Dependent of another
Please Select
Yes
No
Taxpayer Name
*
First Name
Middle Name
Last Name
Suffix
Spouse Name
First Name
Middle Name
Last Name
Suffix
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Taxpayer Social Security #
*
Spouse Social Security #
Taxpayer DL#
*
Spouse DL#
Taxpayer Occupation
*
Spouse Occupation
Taxpayer DOB
*
-
Month
-
Day
Year
Date
Spouse DOB
-
Month
-
Day
Year
Date
Taxpayer phone #
*
Please enter a valid phone number.
Spouse phone #
Please enter a valid phone number.
Taxpayer Email
example@example.com
Spouse Email
example@example.com
Is the Taxpayer:
Blind
Disabled
Is the Spouse
Blind
Disabled
Dependents (Children & Others)
1st Dependent's Name
First Name
Middle Name
Last Name
Suffix
1st Dependent's SS#
1st Dependent's DOB
-
Month
-
Day
Year
Date
Months lived with you
Please Select
1 Month
2 Months
3 Months
4 Months
5 Months
6 Months
7 Months
8 Months
9 Months
10 Months
11 Months
12 Months
Relation
Please Select
Daughter
Son
Parent
Grandchild
Grandparent
Foster child
Niece
Nephew
Other
None
Is 1st Dependent a full time student?
Yes
No
Is 1st Dependent Disabled?
Yes
No
2nd Dependent's Name
First Name
Middle Name
Last Name
Suffix
2nd Dependent's SS#
2nd Dependent's DOB
-
Month
-
Day
Year
Date
Months lived with you
Please Select
1 Month
2 Months
3 Months
4 Months
5 Months
6 Months
7 Months
8 Months
9 Months
10 Months
11 Months
12 Months
Relation
Please Select
Daughter
Son
Parent
Grandchild
Grandparent
Foster child
Niece
Nephew
Other
None
Is 2nd Dependent a full time student?
Yes
No
Is 2nd Dependent Disabled?
Yes
No
3rd Dependent's Name
First Name
Middle Name
Last Name
Suffix
3rd Dependent's SS#
3rd Dependent's DOB
-
Month
-
Day
Year
Date
Months lived with you
Please Select
1 Month
2 Months
3 Months
4 Months
5 Months
6 Months
7 Months
8 Months
9 Months
10 Months
11 Months
12 Months
Relation
Please Select
Daughter
Son
Parent
Grandchild
Grandparent
Foster child
Niece
Nephew
Other
None
Is 3rd Dependent a full time student?
Yes
No
Is 3rd Dependent Disabled?
Yes
No
4th Dependent's Name
First Name
Middle Name
Last Name
Suffix
4th Dependent's SS#
4th Dependent's DOB
-
Month
-
Day
Year
Date
Months lived with you
Please Select
1 Month
2 Months
3 Months
4 Months
5 Months
6 Months
7 Months
8 Months
9 Months
10 Months
11 Months
12 Months
Relation
Please Select
Daughter
Son
Parent
Grandchild
Grandparent
Foster child
Niece
Nephew
Other
None
Is 4th Dependent a full time student?
Yes
No
Is 4th Dependent Disabled?
Yes
No
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Tax Questionnaire
Please select all that apply
I am self employed, or received hobby income?
I received income from raising crops or animals?
I received rent form real estate or other property?
I received income from one or more of the following: gravel, timber, minerals, oil, gas, copyrights, patents.
I withdrew or wrote checks from a mutual fund
I have a foreign bank account or business
I provide a home for or help support someone not listed in dependent section above
I received correspondence from the IRS or State Department for taxation
I had one or more change in my immediate family: birth of child, death, marriage, divorce, adoption
I gave a gift of more than $15,000 to one or more people
I have had one or more of the following: canceled debt, forgiven debt or refinanced a debt
I went through bankruptcy proceedings
I paid interest on a student loan for one or more of the following: myself, my spouse, a dependent.
I paid expenses to attend classes beyond high school for one or more of the following: myself, my spouse or a dependent
I have children under the age of 19 or 19 to 23 years year old student(s) with unearned income of more than $950.00
I purchased a new alternative technology or electric vehicle
I installed one or more of the following energy properties to my residence: solar water heater, generator, fuel cells
I owned $50,000 or more in foreign financial assets
If a new client please upload last years tax return here
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Income Information
Please complete for all income received
Wage Income - Form W-2
*
I received one or more Form W2(s) from my employer(s)
My spouse received one or more W2(s) from their employer(s)
No W2(s) received
Please attach all W2(s)
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Interest Income- Form 1099-INT & Broker statements
*
I received one or more Form 1099 -INT(s) or broker statement(s)
My spouse received one or more 1099 -INT(s) or broker statement(s)
No 1099 -INT or broker statement(s) received
Please attach all 1099-INT & Broker statements
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Dividend Income - Form 1099-DIV from Mutual Funds & Stocks
*
I received one or more Form 1099-DIV(s)
My spouse received one or more Form 1099-DIV(s)
No 1099- DIV(s) received
Please attach all 1099-DIV(s)
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Partnership, Trust & Estate Income - Form K-1
*
I received one or more Form K-1(s) from a partnership, limited partnership, S-corporation, trust or estate.
My spouse received one or more Form K-1(s) from a partnership, limited partnership, S-corporation, trust or estate.
No Form K-1(s) from a partnership, limited partnership, S-corporation, trust or estate.
Please attach all K-1(s)
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K-1 upload
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Property Sold - 1099-S & closing statements
Personal residence
Vacation Home
Land
Other
Please attach all 1099-S & Closing statements & include dates of original purchase.
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Pension & Annuity Income - Form 1099-R
*
I received one or more form 1099-R(s) for pension/annuity
my spouse received one or more form 1099-R(s) for pension/annuity
No form 1099-R received for pension/annuity
Please attach all 1099-R(s)
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I.R.A (Individual Retirement Account) Contributions for tax year
Roth IRA
Date
Amount
Tax payer
Yes
No
Spouse
Yes
No
Amounts withdrawn
Plan Trustee
Reason for withdrawal
Reinvested?
1
Yes
No
2
Yes
No
3
Yes
No
4
Yes
No
Please attach IRA 1099-R
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IRA 1099-R/ 5498 Upload
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Social Security & Railroad benefits
*
I received one or more form SSA 1099(s) or RRB 1099(s)
My spouse received one or more form SSA 1099(s) or RRB 1099(s)
No form SSA 1099(s) or RRB 1099(s) received
Please attach all SSA 1099 & RRB 1099
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Investments Sold - Stocks, bonds, Mutual funds, Gold, Silver, Partnership Interest
Investment
Date Accuired
Date Sold
Cost
Sale Price
1
2
3
4
Please attach 1099-B & conformation slips
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Other Income
Received
Amount
Comments
Scholarship (grants)
Child Support
Unemployment compensation (repaid)
Cash Prizes, bonuses, awards
Gambling, lottery winnings
Unreported tips
Director/Executor's fee
Commissions
Jury Duty
Workers Compensation
Disability Income
Veterans Pension
Payments from prior installment sale
Prior repayment of 1st time homebuyers credit
State Income Tax refund
Other (list type in comment section)
Other (list type in comment section)
Please attach any Other Income forms here
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additional income forms upload
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Please attach additional documents here
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Expense Information
Please complete for expenses paid
Medical/Dental Expenses
Amount Paid
Medical Insurance premiums (paid by you)
Prescription drugs
Insulin
Glasses and Contacts
Hearing Aids & Batteries
Braces
Medical equipment & Supplies
Nursling Care
Medical Therapy
Hospital
Doctor/Dental/Orthodontist
Long Term Care
Mileage (number of miles driven for medical reasons)
Taxes Paid
Amount Paid
Real property Tax
Personal Property Tax
Other Property Tax
Charitable Contributions
Name of Charity
Type
Amount
1
Cash
Non-Cash
2
Cash
Non-Cash
3
Cash
Non-Cash
Interest Expense
Amount Paid
Mortgage Interest Paid
Interest Paid to individual for your home (include amortization schedule & Name, address & SS of individual)
Investment Interest
Premiums paid or accrued for qualified mortgage insurance
Please attach 1098 & other applicable documents for Interest expenses
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Health Insurance
*
I/my family had health insurance through Market Place during the tax year
I/my have other health insurance during the tax year
I/my do not have health insurance during the tax year
Please attach form 1095A (if you/family had Market Place insurance during the tax year)
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Child & Other dependent care expenses
Name of Care provider
Address
SS or Employer ID
Amount Paid
1
2
3
Estimated Taxes paid
Date Paid
Amount Paid
Quarter 1 Payment
Quarter 2 Payment
Quarter 3 Payment
Quarter 4 Payment
Additional Payment
Additional Payment
Education Expenses
Name Of Student
Name of School
Full Time Student
Amount of expenses not paid to institution
1098 -T received
1
Yes
No
2
Yes
No
3
Yes
No
4
Yes
No
Please attach Form 1098-T
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Other Deductions
Amount Paid
Student Interest
Health Savings Account contributions
Archer Medical Savings Account contibutions
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Self Employment
Please complete for each sole prop business if you have any self employment income if none please go to the next page
Self Employment - General Information
Name of Business/profession
Payments made that require filing form(s) 1099?
Minister, Clergy or religious worker?
1
Yes
No
Yes
No
2
Yes
No
Yes
No
3
Yes
No
Yes
No
If payments were made that require the filing of forms 1099 please select one of the following:
I have filed the required 1099's myslef
I will need the required 1099's filed as an added service. I understand that there will be an additional charge of $50.00 per form needed.
Please attach the 1099 information needed for each form. (Name, address, social security number and amount for each from needed)
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1099 information upload
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Self Employment - Income Information
Business 1 amount
Business 2 amount
Business 3 amount
Gross receipts and Sales
Other Income
Please attach 1099(s) received, or other income receipts/statements
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Self employment - Costs of Goods Sold
Business 1 amount
Business 2 amount
Business 3 amount
Beginning Inventory
Cost of Purchases
Cost of Labor
Cost of Materials
Other Costs
Ending Inventory
Please attach a breakdown or spreadsheet of all Costs Of Goods Sold
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Self employment Expenses
Business 1 amount
Business 2 amount
Business 3 amount
Advertising
Commission/fees
Contract Labor
Insurance other than health
Interest -other
Legal & Professional fees
Office Expenses
Pension/Profit sharing
Rent-Machinery
Business Rent-Other
Business Repairs & Maintenance
Supplies
Business Taxes/Licenses
Business Travel
Business Meals
Business Utilities
Business phone
Business Uniforms
Business wages paid to employees
Business wages paid to Officers
Other
Please attach a Breakdown or spreadsheet of all expenses for each business
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Self Employment - Asset(s) Purchased
Description
Date placed in service
Cost
purchased New/Used
Business
1
New
Used
Business 1
Business 2
Business 3
2
New
Used
Business 1
Business 2
Business 3
3
New
Used
Business 1
Business 2
Business 3
4
New
Used
Business 1
Business 2
Business 3
5
New
Used
Business 1
Business 2
Business 3
6
New
Used
Business 1
Business 2
Business 3
7
New
Used
Business 1
Business 2
Business 3
8
New
Used
Business 1
Business 2
Business 3
9
New
Used
Business 1
Business 2
Business 3
10
New
Used
Business 1
Business 2
Business 3
Self Employment - Asset(s) Sold
Description
Date sold
Sale Price
Business
1
Business 1
Business 2
Business 3
2
Business 1
Business 2
Business 3
3
Business 1
Business 2
Business 3
4
Business 1
Business 2
Business 3
5
Business 1
Business 2
Business 3
6
Business 1
Business 2
Business 3
Please attach Asset documents
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Rental, Royalty and Pass-through Income
Please complete if you have any Rental, Royalty or pass-through income if none please go to the next page
Self Employment - General Information
Property Description
Address of property
Payments made that require filing form 1099
Type
1
Yes
No
Rental
Royalty
Pass-through
2
Yes
No
Rental
Royalty
Pass-through
3
Yes
No
Rental
Royalty
Pass-through
4
Yes
No
Rental
Royalty
Pass-through
5
Yes
No
Rental
Royalty
Pass-through
If payments were made that require the filing of forms 1099 please select one of the following:
I have filed the required 1099's myslef
I will need the required 1099's filed as an added service. I understand that there will be an additional charge of $50.00 per form needed.
Please attach the 1099 information needed for each form. (Name, address, social security number and amount for each from needed)
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Income
Amount
Property 1
Property 2
Property 3
Property 4
Property 5
Please attach 1099(s) received for rent, royalties or pass-through income
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Please attach spreadsheet or breakdown of all expenses for each Property
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Farms
Please complete if you have farm income, if none go to next page
Farm General information
Description/ Name
Payments made that require filing form 1099
Farm 1
Yes
No
Farm 2
Yes
No
Farm 3
Yes
No
If payments were made that require the filing of forms 1099 please select one of the following:
I have filed the required 1099's myslef
I will need the required 1099's filed as an added service. I understand that there will be an additional charge of $50.00 per form needed.
Please attach the 1099 information needed for each form. (Name, address, social security number and amount for each from needed)
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Farm Income
Sales of livestock & other amounts
Sales of products raised for cash
Other
Farm 1
Farm 2
Farm 3
File Upload
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Please attach a breakdown or spreadsheet of all expenses for each farm
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Business Account Information
Please complete if you need a Business tax return filed in addition to your individual tax return, if none go to next page
Business Name
Business FEIN
Business Type
LLC
S Corp
Corp
Estate
Trust
Have we filed this business tax return for you in prior years?
Yes
No
Will we need to prepare any 1099's for this business?
Please Select
Payments made to anyone over the amount of $600.00, except those who file taxes as a corporation, will need to be issued a form 1099
Please attach the 1099 information needed for each form. (Name, address, social security number/EIN and amount for each from needed)
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I understand that a tax organizer or a breakdown of all business income, receipts and expenses is required for completion of my business tax return.
Yes
If you are an existing client with us would you like a tax organizer sent to you?
Yes, please send me a custom tax organizer for my business, I will complete and attach any necessary forms and documentation for completion of my return
No, I do not want a tax organizer and I will provide/attach a breakdown of my business income, receipts and expenses below.
If you are a new client or are an existing client and choosing to upload a breakdown of all business income, receipts and expenses and necessary forms such as 1099's, payroll forms, etc. please do so here.
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Check out
To the best of my knowledge the information enclosed in this client tax organizer is correct and includes all income, deductions and other information necessary for the preparation of my 2020 tax return for which I have adequate records.
*
Clear
Bank Information
In the event of a federal refund, I request that the refund be direct deposited to the account below. If no account information is provided a refund will be requested and issued in the form of a check.
Bank Name
Account Type:
Checking
Savings
Account Number :
Routing Number:
Upon completion of my tax return, I give Catherine L Ozment CPA PLLC permission to use the above listed bank account to pay for the preparation of my tax return, along with any audit protection plans I have selected. I understand that if I choose not to give permission for the direct payment via ACH, my return will not be filed until payment is received in full for services rendered.
*
Yes I give permission for the direct payment via ACH, and will complete the Direct Payment Authorization form.
No I do not give permission for the direct payment via ACH.
Deposit Acknowledgement Outlined in our updated fee schedule, effective July 1, 2018, our tax return prices begin at $350 (Personal) and $490 (Business). These prices could increase depending on the complexity of the return. By acknowledging you have read and understand on the fillable form you agree to pay a deposit of $150 for Personal returns, and $250 for Business returns. The deposit is due upon submitting your tax packet/documents. This means that unless prior arrangements have been made through our office, the down payment is required to be paid in full before we will begin to work on your return. Furthermore, the remaining balance will need to be paid in its entirety once services have been completed. Your return will not be filed, nor will it be released to you, until we have received payment in full.
*
I acknowledge I have read and understand the fee schedule and the requirement of deposit
Audit Protection Plans: Please add the following plan to my 2020 tax invoice
*
$29.00 Basic Audit Protection Plan for 2020 tax year
$59.00 Core Audit Protection Plan for 2020 tax year
$99.00 Premium Audit Protection Plan for 2020 tax year
None
Are you any of the following:
*
Military active duty or veteran
1st responder
Over the age of 65
None
Tax Deposit Amount Due:
*
Individual Tax return deposit $150.00
Business Tax return deposit $250.00
Once we receive your online tax form we will call you to collect your deposit payment. Please include a reachable phone number you would like us to call to collect the deposit amount. I understand my information will not be fully accepted and entered for processing until my deposit is paid
*
phone number.
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