2021 Client Questionnaire

2021 Individual Questionnaire
It is extremely important that you thoroughly complete this questionnaire and return it to us as it is designed to identify potentional tax savings and to create a complete and accurate tax return.

Submit your supporting documents, completed Tax Questionnaire and signed Engagement Letter in one of the following ways:
- Upload your documents electronically through our secure portal, SafeSend. You can find the link in our email signatures or on our website under ‘client drop box’ in the top menu.
- Fax to 970-223-6509.
- Mail/Deliver to 1044 West Drake Road, Suite 201, Fort Collins, CO 80526
  - We have a drop box outside our office doors that is available Monday- Friday 8am-5pm.

Did you make any estimated tax payments in 2021 (in addition to withholding from your wages)?

Yes No
If yes, click on the arrow below to provide information regarding your estimated tax payments.

If you have comments on any item, please leave them in the comments section at the bottom of the page.

Estimated Tax Payments
IRS Payments
1st Quarter Amount Paid:
1st Quarter Date Paid:

Month Day Year
Date
2nd Quarter Amount Paid:
2nd Quarter Date Paid:

Month Day Year
Date
3rd Quarter Amount Paid:
3rd Quarter Date Paid:

Month Day Year
Date
4th Quarter Amount Paid:
4th Quarter Date Paid:

Month Day Year
Date
State Payments

State Payments
How many different states did you pay estimated tax payments to for 2021?

0 1 2 3

State #1
To which state did you pay estimated taxes?
1st Quarter Amount Paid:
1st Quarter Date Paid:

Month Day Year
Date
2nd Quarter Amount Paid:
2nd Quarter Date Paid:

Month Day Year
Date
3rd Quarter Amount Paid:
3rd Quarter Date Paid:

Month Day Year
Date
4th Quarter Amount Paid:
4th Quarter Date Paid:

Month Day Year
Date

State #2
To which state did you pay estimated taxes?
1st Quarter Amount Paid:
1st Quarter Date Paid:

Month Day Year
Date
2nd Quarter Amount Paid:
2nd Quarter Date Paid:

Month Day Year
Date
3rd Quarter Amount Paid:
3rd Quarter Date Paid:

Month Day Year
Date
4th Quarter Amount Paid:
4th Quarter Date Paid:

Month Day Year
Date

State #3
To which state did you pay estimated taxes?
1st Quarter Amount Paid:
1st Quarter Date Paid:

Month Day Year
Date
2nd Quarter Amount Paid:
2nd Quarter Date Paid:

Month Day Year
Date
3rd Quarter Amount Paid:
3rd Quarter Date Paid:

Month Day Year
Date
4th Quarter Amount Paid:
4th Quarter Date Paid:

Month Day Year
Date
Comments:

Did you pay for any child care so you and your spouse if married could work, look for work, or attend school, for any child under the age of 13?

Yes No
If yes, click on the arrow below to provide information regarding your child care.

If you have comments on any item, please leave them in the comments section at the bottom of the page.

Child Care
How many different child care providers did you pay in 2021?

1 2 3

Child Care Provider #1
Name of Business/ Care Provider:
Address:

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Tax Identification Number (social security number or federal identification number). If you do not provide this, you cannot take this credit.
Amounts paid to child care provider PER DEPENDENT:

Child Care Provider #2
Name of Business/ Care Provider:
Address:

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Tax Identification Number (social security number or federal identification number). If you do not provide this, you cannot take this credit.
Amounts paid to child care provider PER DEPENDENT:

Child Care Provider #3
Name of Business/ Care Provider:
Address:

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Tax Identification Number (social security number or federal identification number). If you do not provide this, you cannot take this credit.
Amounts paid to child care provider PER DEPENDENT:
Comments:

Did anyone attend college during 2021?

Yes No
If yes, include all Forms 1098-T and click on the arrow below to provide information regarding your education.

If you have comments on any item, please leave them in the comments section at the bottom of the page.

Education
Did the student receive scholarships or grants?

Yes No
If yes, please indicate amounts received (if not provided on Form 1098-T)
Did the student or taxpayers receive any distributions from a qualified tuition program (529 plan, Coverdell, etc.)? If so, please provide Form 1099-Q.

Yes No
Did you pay for any required course materials (books and supplies) in 2021 that were not reflected on the Form 1098-T? If so, provide a summary of these.

Yes No
If yes, please indicate the amount that was NOT purchased from that educational institution.
Comments:

Did you make any contributions to an education savings account in 2021?

Yes No
If yes, click on the arrow below to provide information regarding your education savings account. If you have comments on any item, please leave them in the comments section at the bottom of the page.

Education Savings
Did you make contributions to any Colorado 529 tuition savings plan? If so, provide the 2021 year-end statement for your Colorado 529 tuition savings plan account(s). Keep in mind the only types of plans that qualify for the Colorado deduction are administered by CollegeInvest, which include: Direct Portfolio College Savings Plan, Scholars Choice College Savings Program, Smart Choice College Savings Plan, and Stable Value Plus College Savings Plan.

Yes No
If you are not a Colorado resident and you made contributions to a 529 tuition savings plan, please check yes and provide us with your year-end statement.

Yes No
Comments:

Did you purchase rental property during 2021 that is not reported on a separate tax return (please do not include details that you already provided for a separate LLC or partnership tax return)?

Yes No
If yes, click on the arrow below to provide information regarding your rental property purchase. If you have comments on any item, please leave them in the comments section at the bottom of the page.

Purchase of Rental Property
Please provide copies of the purchase closing statement of any real property purchased in 2021. Also, provide copies of any refinancing settlement statements if you refinanced the property after purchase.

NOTE: There are certain items included in a rental property purchase that can be depreciated over a shorter period of time than the building. Although this step is OPTIONAL, by identifying the value at purchase of these items below we can maximize the current year tax deductions for your property.

Please provide the value at purchase of the following items in the rental property purchased:
Refrigerator:
Stove:
Oven:
Dishwasher:
Microwave:
Washer:
Dryer:
Flooring - Tacked Down Carpet:
Window Coverings:
Hot Water Heater:
Furnace:
Air Conditioner:
Roof:
Landscaping:
Other (please describe):
Comments:

Do you have a home office? Answer no to the following question if your home office is for your job with a W-2 employer/business that you do not own. Also answer no if your business files a separate income tax return (such as Form 1120S or 1065).

Yes No
If yes, click on the arrow below to provide information regarding your home office. If you have comments on any item, please leave them in the comments section at the bottom of the page.

Home Office
If the taxpayer or spouse has a qualified home office, please complete the following (include the total amount of each expense; we will calculate the home office portion). If you do not know what qualifies, please ask us.
Square footage of the space used solely for business:
Total square footage of your home:
Is this a new home office in 2021?

Yes No
Purchase price of home:
Cost of major improvements:
Date home office first used:

Month Day Year
Date
If you would prefer to use the IRS standard home office deduction of $5/square foot (maximum of $1,500), please indicate below and do NOT complete the Home Office Details.
I want to use the standard home office deduction

Yes No

Home Office Details:
2021 Mortgage Interest Paid:
2021 Mortgage Insurance Paid (not the same as property insurance):
2021 Property Taxes Paid:
2021 Rent Paid (if you do not own the home):
2021 Utilities Paid (Electric, Gas, Water, Sewer, Trash):
2021 Property Insurance Costs Paid:
2021 Maintenance Expenses Paid:
2021 Repairs Paid:
2021 HOA Fees Paid:
2021 Capital Improvements and/or Appliances (include description, date in service, and amount):
2021 Other Home Expenses (please describe):
Comments:

When you are confident that you have completed this form in its entirety, click the submit button.

A copy of this 2021 individual questionnaire should be emailed to you from Jotform. If you do not receive a copy, please let us know and we can email a copy to you. Be sure to check your spam or junk folders.
Should be Empty:

2021 Individual Questionnaire

Contact Information

If you have comments regarding any of the questions below, please leave them in the comments section at the bottom of this page.

If you have comments regarding any of the items below, please leave them in the comments section at the bottom of this page.

If you have comments regarding any of the items below, please leave them in the comments section at the bottom of this page.

IRS Payments

State Payments

When you are confident that you have completed this form in its entirety, click the submit button.