Due Diligence Questionnaire Instructions

You are being supplied with this questionnaire because you have claimed one of these credits in the past or you have indicated that you will be claiming one of them this year. The questionnaire is designed to assist us in qualifying you for some valuable refundable tax credits. While the questions may seem to be alittle intrusive at times, they are questions that we are required to ask under the Due Diligence Requirements of the new Tax Laws. Failure to follow due diligence requirements can result in penalties of approximately $560.00 or more per credit claimed on your tax return. Please complete them in as much detail as possible. Not all questions will apply to all taxpayers. If they do not apply to you please answer them as NA (not applicable) so that we will know that you read the question and didn't just missit.

Abbreviations used on the Questionnaire:

CTC = Child Tax Credit ACTC = Additional Child Tax Credit

EITC= Earned Income Tax Credit (Low Income Households) AOTC= American Opportunity Tax Credit (College Credit) ODC = Other Dependent Credit

FOR NEW and/or existing CLIENTS with Dependents: Please remember to submit copies of social security cards, and proof of residency (possibly birth certificates, school records or medical records showing the dependents name and YOUR address, as all these documents will be needed in the event of an audit, failure to provide such, if an audit was to occur, can result in loss of future refunds, and including but not limited to monetary penalties. FORTAXPAYERSCLAIMINGCOLLEGETAXCREDITS: caseremember to submitcopies of the Form 1098T that you received from the college AND/OR a copy of the Financial/Account statement from the college showing the Spring and/or Fall semester charges and payments. The Credit applies to all payments made in cash or via student loans to tuition, fees and related expenses. IT does NOT apply to Room and Board or travel expenses. (FAFSA Student Loan Records are acceptable)

FOR TAXPAYERS CLAIMING HEAD OF HOUSEHOLD FILING STATUS: It is important to complete both the dependent questions and the Household Expense worksheet on page 3. If you are divorced or legally separated (by the courts) please remember to include a copy of the divorce decree and/or separation agreement. [NOTE: If the divorce is NOT final or you and your spouse lived together AT ANY TIME in the last 6 months of the tax year, you CANNOT claim Head of Household filing status]

IF you have any questions about the questionnaire, please do not hesitate to ask us. We will be glad to assist you.

To be Completed by All Taxpayers with Dependents:

7.Explain why the dependent(s) have different last names than the taxpayer_

aHow long did the child live in your home during this axyear? b.How long did your child/children live in the other parent's home during this taxyear? c.How much income did the other parent have during this tax year? d.Do you have a signed Form 83322

10. Did anyone else live in the home that provides financial support for your child/dependent(s)? aIf yes, who lives there and how much do they pay

aIf the taxpayer was under the age of 18. explain circumstances and who/how the child was cared for until the taxpayer was old enough to support and care for his/her child/dependent:

15. Can anyone else claim your dependent(s) as a dependent on their tax return?

18. Do you receive any other type of supplemental. non-taxable income such as child support. welfare benefits. social security, etc.?

22. Who are the biological parents?

25. Do you receive any financial aid for this child such as WIC. Medicaid. SNAP. listed on your health insurance policy. housing assistance.

26. Are you listed as the guardian for this dependent(s) on school records, medical records, daycare records, or place of worship records?

PLEASE PROVIDE THE FINANCIAL/ACCOUNT STATEMENT OF ACCOUNT HISTORY &/OR A 1098T FORM FROM THE COLLEGE

32. If your dependent is over the age of 18 and disabled, what is the nature of the disability?

CAN YOU, THE TAXPAYER, PROVIDESCHOOL/MEDICAL/DAYCARE/PLACE OF WORSHIP/BIRTH CERTIFICATES UPON

Married Filing Joint: Married Filing Separately: Head of Household:

Reason(s) as to why the above named relative is not claiming the child on the above-named relative's tax return:

Head of Household can ONLY be claimed by taxpayers with a Qualified Dependent AND who are:

1. Single and paying more than 1/2 cost of keeping up a home (complete worksheet below), OR

2. Married but did not live with your spouse AT ANY TIME in the last 6 months of the year OR

3. Divorced or LEGALLY separated (Attach copy of Decree or Separation Agreement)

(wages, child support, other income)

Do not count money received under public assistance/welfare/food stamps in the amount you paid.

Taxpayer has provided all answers to the above questions to be true and correct to the best of the taxpayer's knowledge. Taxpayer has been informed that claiming a dependent for EITC/CTC/AOTC/HOU or other can result in an audit, fines and penalties if information provided to preparer is incorrect.