Form 1040 Client Information Sheet - Tax Year 2022
*This form is REQUIRED to be filled out by ALL Clients
PERSONAL INFORMATION
***New Clients: Include a complete copy of your 2022 tax return***
Please specify how you would like to receive the following with either Mail (+$15 fee), Pick up, or Electronically (all New Clients)
FILING STATUS
Did you have a change in marital status during 2022
For Filing Status: Only select Head of Household if all of the following statements are true
Taxpayer lived apart from your spouse for the last half of the year (July-December).
Taxpayer was single or legally separated for the last half of the year (July-December).
Taxpayer has a qualifying child or dependent live with you for at least 6 months of the year.
Taxpayer provided more than half the cost of maintaining a home where you and a qualifying child or dependent.
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DEPENDENTS:
Please list all dependents that you will be claiming on your 2022 tax return on the following pages. Please attach additional sheets if necessary. Visit our website at www.belt-accounting.com for additional forms for more than two dependents. Note: If your dependent(s) have income and has prepared his or her own tax return, please include a copy of their tax return with your documents.
Dependent #1
Dependent's relationship to taxpayer / spouse
Please Select
Child
Stepchild
Foster Child
Sibling
Step brother / sister
Half-brother / sister
Parent
Other
How many months did dependent live with you during 2022?
If dependent did not live with you due to separation or divorce, please attached a completed Form 8332 signed by the custodial parent
Taxpayer released the claim for this dependency exemption to another taxpayer.
Taxpayer provided over 50% of dependent's support during 2022.
Dependent is married and filing a joint return with his/her spouse for 2022.
Dependent is a U.S. Citizen, U.S. National, or U.S. Resident Alien.
Dependent is NOT a U.S. Citizen, U.S. National, or U.S. Resident Alien.
There are other adults living in the household (other than taxpayer and/or spouse).
Dependent is totally and permanently disabled.
Did you pay any child/dependent care expenses for this dependent? If yes, please provide: Amount Paid SSN or EIN Provider's Name & Address
Did you pay any private school tuition (grades 5K-12) for this dependent? If yes, please provide: Amount Paid Student's Grade School EIN School Name & Address
Dependent is between the ages of 19-24, was he/she a full-time student for any part of five calendar months during 2022. *If yes, please attach Form 1098-T along with a detailed student account activity statement showing amounts billed and amounts paid in 2022.
Student completed the first 4 years of postsecondary education before 2022? What year of school is student currently in.
Student was enrolled in a program leading to a degree or certificate.
Student has a federal or state felony drug conviction.
Student received a distribution from an education savings account or qualified tuition program. *If yes, attach Form 1099-Q.
1099-Q was issued in Student's name and Social Security Number.
Dependent's gross income is less than $4,300.
Dependent has interest/dividend income in excess of $11,000, or total investment income in excess of $2,200. If yes, please provide documents.
Dependent has income and would like us to prepare dependent's tax return? Recommended Minimum fee $50.00. Additional forms billed at 30% discount.
In previous years, the following credits related to this dependent has been disallowed or reduced by the IRS: Child Tax Credit, Additional Child Tax Credit, Earned Income Tax Credit, or the American Opportunity Credit? If yes, please attach detailed explanation.
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DEPENDENTS:
Please list all dependents that you will be claiming on your 2022 tax return on the following pages. Please attach additional sheets if necessary. Visit our website at www.belt-accounting.com for additional forms for more than two dependents. Note: If your dependent(s) have income and has prepared his or her own tax return, please include a copy of their tax return with your documents.
Dependent #2
Dependent's relationship to taxpayer / spouse
Please Select
Child
Stepchild
Foster Child
Sibling
Step brother / sister
Half-brother / sister
Parent
Other
How many months did dependent live with you during 2022?
If dependent did not live with you due to separation or divorce, please attached a completed Form 8332 signed by the custodial parent
Taxpayer released the claim for this dependency exemption to another taxpayer.
Taxpayer provided over 50% of dependent's support during 2022.
Dependent is married and filing a joint return with his/her spouse for 2022.
Dependent is a U.S. Citizen, U.S. National, or U.S. Resident Alien.
Dependent is NOT a U.S. Citizen, U.S. National, or U.S. Resident Alien.
There are other adults living in the household (other than taxpayer and/or spouse).
Dependent is totally and permanently disabled.
Did you pay any child/dependent care expenses for this dependent? If yes, please provide: Amount Paid SSN or EIN Provider's Name & Address
Did you pay any private school tuition (grades 5K-12) for this dependent? If yes, please provide: Amount Paid Student's Grade School EIN School Name & Address
Dependent is between the ages of 19-24, was he/she a full-time student for any part of five calendar months during 2022. *If yes, please attach Form 1098-T along with a detailed student account activity statement showing amounts billed and amounts paid in 2022.
Student completed the first 4 years of postsecondary education before 2022? What year of school is student currently in.
Student was enrolled in a program leading to a degree or certificate.
Student has a federal or state felony drug conviction.
Student received a distribution from an education savings account or qualified tuition program. *If yes, attach Form 1099-Q.
1099-Q was issued in Student's name and Social Security Number.
Dependent's gross income is less than $4,300.
Dependent has interest/dividend income in excess of $11,000, or total investment income in excess of $2,200. If yes, please provide documents.
Dependent has income and would like us to prepare dependent's tax return? Recommended Minimum fee $50.00. Additional forms billed at 30% discount.
In previous years, the following credits related to this dependent has been disallowed or reduced by the IRS: Child Tax Credit, Additional Child Tax Credit, Earned Income Tax Credit, or the American Opportunity Credit? If yes, please attach detailed explanation.
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DEPENDENTS:
Please list all dependents that you will be claiming on your 2022 tax return on the following pages. Please attach additional sheets if necessary. Visit our website at www.belt-accounting.com for additional forms for more than two dependents. Note: If your dependent(s) have income and has prepared his or her own tax return, please include a copy of their tax return with your documents.
Dependent #3
Dependent's relationship to taxpayer / spouse
Please Select
Child
Stepchild
Foster Child
Sibling
Step brother / sister
Half-brother / sister
Parent
Other
How many months did dependent live with you during 2022?
If dependent did not live with you due to separation or divorce, please attached a completed Form 8332 signed by the custodial parent
Taxpayer released the claim for this dependency exemption to another taxpayer.
Taxpayer provided over 50% of dependent's support during 2022.
Dependent is married and filing a joint return with his/her spouse for 2022.
Dependent is a U.S. Citizen, U.S. National, or U.S. Resident Alien.
Dependent is NOT a U.S. Citizen, U.S. National, or U.S. Resident Alien.
There are other adults living in the household (other than taxpayer and/or spouse).
Dependent is totally and permanently disabled.
Did you pay any child/dependent care expenses for this dependent? If yes, please provide: Amount Paid SSN or EIN Provider's Name & Address
Did you pay any private school tuition (grades 5K-12) for this dependent? If yes, please provide: Amount Paid Student's Grade School EIN School Name & Address
Dependent is between the ages of 19-24, was he/she a full-time student for any part of five calendar months during 2022. *If yes, please attach Form 1098-T along with a detailed student account activity statement showing amounts billed and amounts paid in 2021.
Student completed the first 4 years of postsecondary education before 2022? What year of school is student currently in.
Student was enrolled in a program leading to a degree or certificate.
Student has a federal or state felony drug conviction.
Student received a distribution from an education savings account or qualified tuition program. *If yes, attach Form 1099-Q.
1099-Q was issued in Student's name and Social Security Number.
Dependent's gross income is less than $4,300.
Dependent has interest/dividend income in excess of $11,000, or total investment income in excess of $2,200. If yes, please provide documents.
Dependent has income and would like us to prepare dependent's tax return? Recommended Minimum fee $50.00. Additional forms billed at 30% discount.
In previous years, the following credits related to this dependent has been disallowed or reduced by the IRS: Child Tax Credit, Additional Child Tax Credit, Earned Income Tax Credit, or the American Opportunity Credit? If yes, please attach detailed explanation.
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INCOME
Taxpayer has income from wages (Form W-2). Attach forms
Taxpayer has interest (Form 1099-INT) and/or dividend (Form 1099-DIV) income. Attach forms.
Taxpayer has received a stimulus payment from the IRS in 2022.
Taxpayer or taxpayer's spouse has more than $10,000 in a foreign account at any time during the year.
Taxpayer has sold stocks, bonds, or mutual funds (Form 1099-B). Attach forms.
Taxpayer was granted or did you exercise any stock options (Forms 3921, 3922 or 1099-B). Attach forms.
Taxpayer has own business or received Form 1099-NEC. Attach forms and Schedule C Info Sheet.
Taxpayer has received any income from a farm or rental real estate.* Attach Schedule E Info Sheet
Taxpayer has received any alimony.
Taxpayer has divorce decree changed at any time after 12/31/2021. *If yes, attach
Taxpayer has received, sold, sent, exchanged or otherwise acquired any financial interest in virtual currency.
Do you have any other income not reported elsewhere? Attach forms.
RETIREMENT INCOME / IRA INFORMATION
Taxpayer has received social security or railroad retirement income (Form SSA/RRB-1099). Attach forms.
Taxpayer has received any pension or annuity income (Form 1099-R). Attach forms.
Taxpayer has received any qualified CARES Act early/hardship retirement account distributions - Employer sponsored 401k, 403b etc. or IRA (Form 1099-R). Attach forms.
The funds will be repaid within three years from distribution.
Taxpayer has received any Traditional IRA distributions (Form 1099-R). Attach forms.
If yes, was it a rollover.
Taxpayer or taxpayer's spouse has converted a Traditional IRA to a Roth IRA in 2022 (Form 1099-R). Attach forms.
Taxpayer or taxpayer's spouse has made (or plan to make by 4/15/2022) any 2022 IRA contributions.
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EDUCATION EXPENSES FOR TAXPAYER / SPOUSE ONLY
Taxpayer and/or spouse has education expenses in 2022.
If yes, attach Form 1098-T and detailed account activity statement showing amounts billed and paid in 2022.
Student (taxpayer and/or spouse) completed the first 4 years of postsecondary education before 2020. What year of school is student (taxpayer/spouse) currently in?
Student (taxpayer and/or spouse) enrolled in a program leading to a degree or certificate.
Student (taxpayer and/or spouse) has a federal or state felony drug conviction.
Student (taxpayer and/or spouse) received a distribution from an education savings account or qualified tuition program. If yes, attach Form 1099-Q.
Taxpayer and/or spouse paid student loan interest Form 1098-E. If yes, attach forms
HEALTH CARE
Taxpayer has insurance through the marketplace (e.g., "Obama Care"). If yes, please attach Form 1095-A
Taxpayer has or plans to make any contributions to a Health Savings Account (HSA). (Form 5498-SA)
Taxpayer has distributions from an HSA account (Form 1099-SA). Attach forms.
Student (taxpayer / spouse) was enrolled in a program leading to a degree or certificate.
Health Savings Account (HSA) (Form 5498-SA) Information
MEDICAL EXPENSE DEDUCTIONS
**Do not include amounts reimbursed by insurance, flex, or HSA funds.**
Please add up all medical/dental/vision/prescription receipts and enter totals here (if receipts are furnished to us instead of totals, we can compute the totals for you at a rate of $125/hr. Keep all receipts for your records.
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OTHER EXPENSES
Taxpayer and/or spouse a full-time teacher with out-of-pocket expenses.
Taxpayer has paid alimony.
Taxpayer's divorce decree has changed at any time after 12/31/2021. *If yes, attach
Taxpayer has employed household employees (i.e. nanny).
Taxpayer owes sales tax on any out of state purchases.
Taxpayer has gambling losses (only to the extent of winnings).
Did you make any EdVest/Tomorrow's Scholar (Section 529) contributions? If yes, please complete information below: AmountName of Beneficiary
Did you make any cash gifts to charity? Retain receipts for your records Enter totals below or attach itemized list only. Only attach receipts for donations over $1,000.
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Did you make any noncash gifts to charity (Clothes, Shoes, Appliances, Electronics)? Retain receipts for your records. Do not attach receipts here. Tax return will be prepared based on the complete information furnished below
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PERSONAL RESIDENCE
Taxpayer moved in 2022.
Taxpayer paid rent in 2022.
Taxpayer paid utilities in 2022.
Taxpayer paid real estate taxes in 2022. If yes, attach tax bill and receipts.
Taxpayer paid home mortgage interest in 2022. If yes, attach Form(s) 1098.
Taxpayer paid home mortgage interest that was not reported to you on Form 1098. If yes, please provide:
Taxpayer refinanced a mortgage in 2022.
Taxpayer has a Home Equity Line of Credit.
Taxpayer made solar energy efficient improvements to your main home. If yes, please attach receipts.
Taxpayer purchased a home in 2022. If yes, attach closing statements
Taxpayer sold a home in 2022. If yes, attach closing statements
This home was taxpayer's primary residence for at least 2 of the last 5 years.
Taxpayer has rented out the property or used any portion of the home for business purposes.
Taxpayer and/or spouse sold a principal residence within the last two years.
FEDERAL and / or STATE ESTIMATED TAX PAYMENTS
Taxpayer made Federal or State estimated tax payments in 2022. Attach your statements / bank records that indicated deposits were made
If there is a refund, taxpayer would like the refund applied to next year's taxes.
If there is a balance due, taxpayer would like us to calculate 2022 estimated tax payments.
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REFUND(S): If you would like your federal and/or state refund(s) direct deposited, please provide bank information below:
Client Questions
TAXPAYER SIGNATURE: I / we verify that the information provided in this document is true and correct to the best of my/our knowledge. I / we understandthat any questions not answered will be assumed "no"
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SPOUSE SIGNATURE: I / we verify that the information provided in this document is true and correct to the best of my/our knowledge. I / we understandthat any questions not answered will be assumed "no"
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Submit
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