Individual Taxpayer Organizer
Name
First Name
Last Name
Name
First Name
Last Name
Email
example@example.com
Email
example@example.com
IP PIN
IP PIN
Occupation
Occupation
Date of birth
-
Month
-
Day
Year
Date
Date of birth
-
Month
-
Day
Year
Date
Driver’s LicenseNo.
Driver’s License No.
Issue Date
-
Month
-
Day
Year
Date
Issue Date
-
Month
-
Day
Year
Date
Exp. Date
-
Month
-
Day
Year
Date
Exp. Date
-
Month
-
Day
Year
Date
State
State
Phone Number
Please enter a valid phone number.
Phone Number
Please enter a valid phone number.
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Are you new to our firm?
Yes
No
If you moved during 2021, enter your previous address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Marital status at 12/31/21:
Single
Married
Separated
Widow(er)
Registered Domestic Partnership (RDP)
Unsure
Date of move
-
Month
-
Day
Year
Date
Were you divorced or separated during the year?
Yes
No
Were there any deaths in the family?
Yes
No
Have you received any notice from the IRS or state revenue department within the past year?
No
Yes
Dependent children
IP PIN
Date of birth
Months lived in home in 2021
Relationship to taxpayer
College student?
Names of dependent children
Names of dependent children
Names of dependent children
Names of dependent children
Did any of the children have unearned income above $1,100 for the year?
Yes
No
Do any of the children have a disability?
Yes
No
Is it anticipated that a different taxpayer will seek to claim a child listed above as their dependent for tax year 2021?
Yes
No
Dependent children
IP PIN
Date of birth
Months lived in home in 2021
Relationship to taxpayer
Income
Names of dependent children
Names of dependent children
Questions — All Taxpayers
Lifestyle & Taxes
Are either you or your spouse legally blind?
Yes
No
Unsure
Did you pay or receive alimony in 2021?
Yes
No
Unsure
Paid/Received
Date of divorce or separation
-
Month
-
Day
Year
Date
Did you purchase health insurance through a public exchange?
Yes
No
Unsure
Will there be any significant changes in income or deductions next year, such as retirement?
Yes
No
Unsure
Did you pay anyone for domestic services in your home?
Yes
No
Unsure
Did you purchase a new energy-efficient car, truck, or van?
Yes
No
Unsure
Are you involved in bankruptcy, foreclosure, repossession, or had any debt (including credit cards) cancelled?
Yes
No
Unsure
Are you a member of the military?
Yes
No
Unsure
State of residency
Were you a citizen of or lived in a foreign country?
Yes
No
Unsure
Foreign country
Do you own or have financial interest in a foreign bank or financial account? Balance exceeds $50,000
Yes
No
Unsure
Did you receive any economic impact payments (stimulus payments) during 2021? If yes, provide the amount(s) and dates received
Yes
No
Unsure
dates received.
Children & Education
Were any children born or adopted in 2021? (Provide statement for other expenses.)
Yes
No
Unsure
Did you receive any advance Child Tax Credit payment?
Yes
No
Unsure
Were any children attending college?
Yes
No
Unsure
Year in college
Type a question
Tuition $
Student loan interest $
Books $
Paid by you:
Paid by student:
Did you pay any tuition for a private school for a dependent or take classes yourself?
Yes
No
Unsure
Amount paid $
Name and address of school
Student
Student
Did you pay for child or dependent care so you could work or go to school? (add statement if needed)
Yes
No
Unsure
Type a question
Amount paid $
Name and address of provider
Student
Student
Do you have any children who have unearned income of $1,100 or more?
Yes
No
Unsure
Did you make any contributions to a 529 plan in 2021?
Yes
No
Unsure
Investments
Did you, or will you, contribute any money to an IRA for 2021?
Yes
No
Unsure
Amount
Traditional IRA
Roth IRA
Did you roll over any amounts from a retirement account in 2021?
Yes
No
Unsure
Did you sell or transfer any stock or sell rental or investment property?
Yes
No
Unsure
Did you receive any income from an installment sale?
Yes
No
Unsure
Did you have any investments become worthless or were you a victim of investment theft in 2021?
Yes
No
Unsure
Were you granted, or did you exercise, any employee stock options during 2021?
Yes
No
Unsure
Did you receive, sell, send, exchange, or otherwise dispose of any financial interest in any virtual currency?
Yes
No
Unsure
Deductions
Did you, or do you plan to, contribute money before April 18, 2022 to an HSA for 2021? If yes, provide details.
Yes
No
Unsure
Did you pay any interest on a loan for a boat or RV that has living quarters? If yes, provide details
Yes
No
Unsure
Did you pay sales taxes on a major purchase in 2021, such as a vehicle, boat, or home?
Yes
No
Unsure
Did you make any charitable contributions in 2021? If yes, provide details
Yes
No
Unsure
Business
Did you work from a home office or use your car for business?
Yes
No
Unsure
Did you receive income from a sharing/gig economy activity (e.g. Airbnb, Uber, etc.)?
Yes
No
Unsure
Do you own a business or an interest in a partnership, corporation, LLC, farming activities, or other venture?
Yes
No
Unsure
Home
Do you own a business or an interest in a partnership, corporation, LLC, farming activities, or other venture?
Yes
No
Unsure
If you sold a home, did you claim the First-Time Homebuyer Credit when it was purchased? If yes, provide details.
Yes
No
Unsure
Did you refinance a mortgage or take a home equity loan? If yes, provide closing statement.
Yes
No
Unsure
Did you use any mortgage loan proceeds for purposes other than to buy, build, or substantially improve your home?
Yes
No
Unsure
Did you make any new energy-efficient improvements to your home? If yes, provide details
Yes
No
Unsure
State Information
States of residence during 2021 and dates
School district
Do you rent or own your home?
Rent
Own
Rental Information
Amount paid in rent
By signing below you are attesting that the personal and financial information provided to DM Bookkeeping Services is true and accurate.
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