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 informationNo

General Questions
What is your filing status?*

SingleMarried filing jointlyMarried filing separatelyHead 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?*

YesNo

General Questions
Please enter your new address.*

General Questions
Are you a new client?*

YesNo

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

YesNo, if not, you are not allowed a tax deduction

IRA's
Have you, or will you contribute to an IRA for 2022? If yes, please provide Form 5498. Please note if you're single and your income is over $78,000 ($129,000 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.*

YesNo
Did you convert funds from a traditional IRA to a Roth IRA in 2022? If yes, please provide your form 1099-R(s).*

YesNo

IRA's
How much did you or will you contribute to an IRA for 2022?*
What is the approximate date of the contribution you have made or will make before April 15, 2023?*

MonthDayYear
Date
How much did your spouse contribute or how much will your spouse contribute to an IRA for 2022?
What is the approximate date of the contribution your spouse made or will make before April 15, 2023?

MonthDayYear
Date

IRA's
Do you have any amounts left in a traditional IRA or SEP on 12-31-2022?*

Yes - Please provide documentation showing the amount on 12-31-22.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.*

YesNo
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.*

YesNo

Foreign Questions
At any time during 2022, 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?*

YesNo

Foreign Questions
Was the account balance over $10,000 at any point in 2022?*

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 2022, did you receive a distribution from, or were you the grantor of, or transferor to, a foreign trust?*

YesNo

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

Digital Assets
At any time during 2022, did you receive digital currency as a reward, award or payment for property or services?*

YesNo

Digital Assets
Please provide all relevant information

Digital Assets
At any time during 2022, did you sell, exchange, gift, or otherwise dispose of a digital asset or a financial interest in a digital asset?*

YesNo

Digital Assets
Please provide all relevant information

Gifts to Individuals
Did you make any gifts to individuals in excess of $16,000 per person ($32,000 for joint gifts)?*

YesNo

Gifts to Individuals
Name of the person who received the gift.*
Relationship to the person who received the gift (i.e., son, daughter, grandchild)*
Address of the person receiving the gift.*
Date of the gift.*

MonthDayYear
Date
Amount of the gift.*

Dependent Questions
Do you have any children who qualify as your dependent?*

YesNo

Dependents
Do you have any other relatives that qualify as your dependents?*

YesNo

State Questions
Where did you live in 2022?*

Full year Arizona residentFull year Florida residentFull year Minnesota residentFull year resident of another statePart 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.*

YesNo
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.*

YesNo

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-ENo

Minnesota
What was the total amount of loans you originally borrowed?*
What were your total loan payments in 2022 (principal and interest)?*
What was the total amount of loans your spouse originally borrowed?
What were your spouses total loan payments in 2022 (principal and interest)?

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

YesNo

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?*

YesNo

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.*

YesNo
Click the links for 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.*

YesNo

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.*

MonthDayYear
Date
Date residency ended in State 1*

MonthDayYear
Date
Name of State 2.*
Date residency began in State 2.*

MonthDayYear
Date
Date residency ended in State 2.*

MonthDayYear
Date
Name of State 3.
Date residency began in State 3.

MonthDayYear
Date
Date residency ended in State 3.

MonthDayYear
Date

2023 Information
Other than your Mayo salary, do you expect any changes in your tax situation for 2023?*
Should be Empty:

General Questions

General Questions

General Questions

General Questions

General Questions

General Questions

Contributions to Charitable Organizations

IRA's

IRA's

IRA's

Home Deductions

Foreign Questions

Foreign Questions

Foreign Questions

Foreign Questions

Digital Assets

Digital Assets

Digital Assets

Digital Assets

Gifts to Individuals

Gifts to Individuals

Dependent Questions

Dependent Questions

Dependents

Dependent Questions

Head of Household

State Questions

Minnesota

Minnesota

Minnesota

Minnesota

Minnesota

Minnesota

Minnesota

Minnesota

Arizona

Arizona

Arizona

Arizona

Florida

Florida

Residency

Residency

2023 Information