Client Questionnaire

First and last name of the person completing this questionnaire. *
What is your email address? *
For purposes of depositing a potential refund, has there been a change in your bank account information since last year? *

Yes - please include a voided check with your information No

General Questions
What is your filing status? *

Single Married filing jointly Married filing separately Head of household – generally you must be unmarried at the end of the year and provide housing and support to a dependent. Please see below.
Please click here for more information

Head of Household

General Questions
Has your address changed since last year? *

Yes No

General Questions
Please enter your new address. *

General Questions
Are you a new client? *

Yes No

General Questions
Please list your driver's license number. Many states are now requiring this information in order to electronically file. *
Please list the expiration date of your driver's license. *
Please list your spouse's (if applicable) driver's license number.
Please list the expiration date of your spouse's driver's license.

Contributions to Charitable Organizations
For the tax year 2021, you are allowed to take a deduction for at least some of your charitable contributions whether you can itemize your deductions or not. Did you make any charitable contributions? *

Yes - Please list in your organizer all charitable contributions No

Contributions to Charitable Organizations
Do you have an acknowledgment letter/receipt for each donation exceeding a single donation of $250 or more? *

Yes No

IRA's
Have you, or will you contribute to an IRA for 2021? If yes, please provide Form 5498. Please note if you're single and your income is over $75,000 ($124,000 if filing jointly) you may NOT contribute to a deductible IRA but may contribute to a non-deductible IRA then convert it to a Roth IRA. *

Yes No
Did you convert funds from a traditional IRA to a Roth IRA in 2021? If yes, please provide your form 1099-R(s). *

Yes No

IRA's
How much did you or will you contribute to an IRA for 2021? *
What is the approximate date of the contribution you have made or will make before April 15, 2022? *

Month Day Year
Date
How much did your spouse contribute or how much will your spouse contribute to an IRA for 2021?
What is the approximate date of the contribution your spouse made or will make before April 15, 2022?

Month Day Year
Date

IRA's
Do you have any amounts left in a traditional IRA or SEP on 12-31-2021? *

Yes - Please provide documentation showing the amount on 12-31-21. No

Home Deductions
Did you purchase or sell a home used as your principal home or second home? If so, please provide a copy of your "Closing Disclosure" statement(s) for each transaction. Your "Closing Disclosure" statement(s) can be found in your loan closing documents. Please provide all five pages. Please see below. *

Yes No
Click here for an example

Closing Disclosure Example
Did you refinance your principal home or second home or take out a home equity loan? If so, please provide a copy of your "Closing Disclosure" statement(s) for each transaction. Your "Closing Disclosure" statement(s) can be found in your loan closing documents. Please provide all five pages. Please see above. *

Yes No

Foreign Questions
At any time during 2021, did you have a financial interest in or signature authority over a financial account (such as a bank account, securities account, or brokerage account) located in a foreign country? *

Yes No

Foreign Questions
Was the account balance over $10,000 at any point in 2021? *

Yes - Please provide a statement showing the name and address of the institution and the highest amount held in the account during the year. No

Foreign Questions
During 2021, did you receive a distribution from, or were you the grantor of, or transferor to, a foreign trust? *

Yes No

Foreign Questions
Please provide all relevant information about the foreign distribution. *

Virtual Currency
At any time during 2021, did you receive, sell, send, exchange, or otherwise acquire any financial interest in any virtual currency? *

Yes No

Virtual Currency
Did you acquire the cryptocurrency from mining? *

Yes - The value of the currency is taxable immediately, please provide all relevant information. No
Did you dispose of the cryptocurrency by cashing it on an exchange or using it to buy goods or services? *

Yes - Please provide the sales price and your basis of the currency. No

Gifts to Individuals
Did you make any gifts to individuals in excess of $15,000 per person ($30,000 for joint gifts)? *

Yes No

Gifts to Individuals
Name of the person who received the gift. *
Relationship to the person who received the gift (i.e., son, daughter, grandchild) *
What is their address? *
Date of the gift. *

Month Day Year
Date
Amount of the gift. *

Dependent Questions
Do you have any dependents? *

Yes No

State Questions
Where did you live in 2021? *

Full year Arizona resident Full year Florida resident Full year Minnesota resident Full year resident of another state Part year resident in multiple states

Minnesota
Did you have any K-12 education expenses? Please click the link below to see what expenses do and do not qualify. Please see below. *

Yes No
Click here for more information

Qualifying Education Expenses

Minnesota
Please list dependent 1's name, grade, and education expense amount. The deduction is limited to $1,625 for dependents K-6 and $2,500 for dependents 7-12. *
Please list dependent 2's name, grade, and education expense amount. The deduction is limited to $1,625 for dependents K-6 and $2,500 for dependents 7-12.
Please list dependent 3's name, grade, and education expense amount. The deduction is limited to $1,625 for dependents K-6 and $2,500 for dependents 7-12.
Please list dependent 4's name, grade, and education expense amount. The deduction is limited to $1,625 for dependents K-6 and $2,500 for dependents 7-12.

Minnesota
Did you make any contributions to a 529 College Savings Plan? Please note Minnesota allows any state 529 Plan contributions to be deductible. *

Yes No

Minnesota
Please list dependent 1's name, the financial institution holding the funds, the account number, the amount contributed and/or withdrawn from this account. *
Please list dependent 2's name, the financial institution holding the funds, the account number, the amount contributed and/or withdrawn from this account.
Please list dependent 3's name, the financial institution holding the funds, the account number, the amount contributed and/or withdrawn from this account.
Please list dependent 4's name, the financial institution holding the funds, the account number, the amount contributed and/or withdrawn from this account.

Minnesota
Did you and/or your spouse make total student loan payments (principal and interest) that exceeded approximately 10% of your income? If you are not sure, please answer "yes" and proceed to the next section of questions. *

Yes - Please provide form 1098-E No

Minnesota
What was the total amount of loans you originally borrowed? *
What were your total loan payments in 2021 (principal and interest)? *
What was the total amount of loans your spouse originally borrowed?
What were your spouses total loan payments in 2021 (principal and interest)?

Minnesota
Did you contribute to a Long-Term Care policy? *

Yes No

Minnesota
Please list the name of the company, policy number and the amount contributed for you. If you previously provided the name of the company and policy number, enter "on file" for this information. *
Please list the name of the company, policy number and the amount contributed for your spouse (if any). If you previously provided the name of the company and policy number, enter "on file" for this information.

Arizona
Did you contribute to a 529 College Savings Plan? *

Yes No

Arizona
Please list the total amount contributed to all 529 College Savings Plan. *

Arizona
Did you donate to an Arizona charity, public or private school that qualifies for the Arizona tax credit? Please see below. *

Yes No
Click the links more information. Hint: After opening the link, use Ctrl+F on your keyboard to bring up a search box and type the name of the school or charity to see if your donation qualifies.

Qualifying Charitable Organizations

Public School List

Private School Tuition

Arizona
Please list the code, name, amount and the date you contributed to the qualifying organization 1. Or please provide the forms that have this information on it to us. Arizona requires all of the information in order to claim it on your return. *
Please list the code, name, amount and the date you contributed to the qualifying organization 2. Or please provide the forms that have this information on it to us. Arizona requires all of the information in order to claim it on your return
Please list the code, name, amount and the date you contributed to the qualifying organization 3. Or please provide the forms that have this information on it to us. Arizona requires all of the information in order to claim it on your return
Please list the code, name, amount and the date you contributed to the qualifying organization 4. Or please provide the forms that have this information on it to us. Arizona requires all of the information in order to claim it on your return

Florida
Did you purchase a motor vehicle, aircraft, or boat? If so, you may be able to deduct the sales tax from that purchase. *

Yes No

Florida
Please list what you purchased and the sales tax amount. *

Residency
Please list the state you lived in. *

Residency
Name of State 1. *
Date residency began in State 1. *

Month Day Year
Date
Date residency ended in State 1 *

Month Day Year
Date
Name of State 2. *
Date residency began in State 2. *

Month Day Year
Date
Date residency ended in State 2. *

Month Day Year
Date
Name of State 3.
Date residency began in State 3.

Month Day Year
Date
Date residency ended in State 3.

Month Day Year
Date

2022 Information
Other than your Mayo salary, do you expect any changes in your tax situation for 2022? *
Should be Empty:

General Questions

General Questions

General Questions

General Questions

General Questions

General Questions

Contributions to Charitable Organizations

Contributions to Charitable Organizations

IRA's

IRA's

IRA's

Home Deductions

Foreign Questions

Foreign Questions

Foreign Questions

Foreign Questions

Virtual Currency

Virtual Currency

Gifts to Individuals

Gifts to Individuals

Dependent Questions

Dependent Questions

Head of Household

State Questions

Minnesota

Minnesota

Minnesota

Minnesota

Minnesota

Minnesota

Minnesota

Minnesota

Arizona

Arizona

Arizona

Arizona

Florida

Florida

Residency

Residency

2022 Information