Tax Questionnaire

Tax Questionnaire
Name*

First NameLast Name
Occupation
Email*
example@example.com
Birth Date*

MonthDayYear
Date
Spouse Name

First NameLast Name
Occupation
Spouse Email
example@example.com
Spouse Birth Date

MonthDayYear
Date
Dependent Names (first, initial, and last)
Dependents name:   First Name   Last Name
Dependents date of birth:    Date
Relationship:
Did dependent live with you?:
# of months lived in your home:   Type a label
Dependents name:   First Name   Last Name
Dependents date of birth:    Date
Relationship:
Did dependent live with you?:
# of months lived in your home:   Type a label
Did your filing status change in 2022?*

YesNo
Will the address on your 2022 Federal return be different from the one shown on your 2021 return? If YES, Enter the new address below.*

YesNo
New Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Were you notified by the Internal Revenue Service or any other tax authority of changes to a prior year tax return? (If YES, please enclose report notifying you of the change(s).)*

YesNo
Did you, your spouse or a dependent enroll in health insurance through the marketplace/exchange?*

YesNo
Are you aware of any changes to your income, deductions, and credits reported on a prior year return?*

YesNo
Did you sell and/or purchase principal residence in 2022?*

YesNo
Did you receive any insurance or other reimbursements form a prior year medical, casualty, or theft loss deduction?*

YesNo
Do you have any dependent children under 18 who received unearned income (interest, dividends, investment income) of over $1,900?*

YesNo
If YES, and if your child qualifies, do you elect to report your child's interest and dividends in your income tax return?*

YesNo
Did you or your spouse receive stock from an employer's stock bonus plan (do not include amounts reported on Form W-2)?*

YesNo
Did you buy or sell any bonds during the year? (If YES, please provide a copy of the brokers report.)*

YesNo
Did you start a new business in 2022?*

YesNo
Did you receive payments from a pension or profit-sharing plan?*

YesNo
Did you sell business or personal property(ies) on the installment method, OR did you receive payments from an installment sale? (If YES, please provide details)*

YesNo
Did you surrender any U.S. savings bonds during 2022?*

YesNo
Did you use the proceeds from series EE U.S. savings bonds purchased after 1989 to pay for higher education expenses?*

YesNo
Did you receive tip income NOT reported to your employer?*

YesNo
Did you receive any tax-exempt interest?*

YesNo
Did you obtain a loan and use the proceeds for an investment?*

YesNo
If employed, are your covered under a pension, profit-sharing, stock bonus or other retirement plan?*

YesNo
Did you receive a total distribution from an IRA or other qualified plan that was partially or totally rolled over into another IRA or qualified plan within 60 days of the distribution?*

YesNo
Did you rollover any amount from a Traditional IRA to a Roth IRA during 2021 or 2022?*

YesNo
Did you receive any disability payments this year?*

YesNo
If either you or your spouse are self-employed, are either of you covered under an employer's health plan at another job?*

YesNo
Did you have foreign income or pay any foreign taxes in 2022?*

YesNo
Did you sell property or equipment on installment in 2022?*

YesNo
Did you have any business-related educational expenses?*

YesNo
Did you make gifts of more than $16,000 to any individual?*

YesNo
Did you make gifts to a trust?*

YesNo
Did you suffer an uninsured casualty or theft loss on a non-business property?*

YesNo
Did your employer pay premiums on life insurance in excess of $50,000 where the proceeds are paid to beneficiaries named by you?*

YesNo
Did you receive any income not included in the Tax Organizer?*

YesNo
Did you pay any qualifying education expenses for yourself or any dependents?*

YesNo
Did you make any online purchases for which you did not pay state sales tax?*

YesNo
If so, enter the amount of purchases here. blank
Notes:
Should be Empty:

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