New Client Information Sheet 2023

New Client Information Sheet 2023

Please Fill Out Completely: Due To IRS Ruling, We Need Proper Names
YOUR NAME
S.S. #
D.O.B.

MonthDayYear
Date
Cell #
Occupation
SPOUSE Name
SPOUSE S.S. #
SPOUSE D.O.B.

MonthDayYear
Date
Cell #
Occupation
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
EMAIL ADDRESS
example@example.com
Spouse Email
example@example.com
Marital Status in 2023

SingleWidower
Date of Spouse's Death

MonthDayYear
Date
File Jointly

YesNo
If Filing separately Spouses Adjusted Gross Income is required
**IOWA RESIDENTS ONLY: School District you Live In?
**ILLINOIS RESIDENTS ONLY: Parcel ID #
DEPENDENTS (CHILDREN & OTHER)

**COPY OF BIRTH CERTIFICATE AND SOCIAL SECURITY CARD REQUIRED FOR ALL DEPENDENTS**
Name (First, Last)
Relationship
Date of Birth

MonthDayYear
Date
SS
Months Lived with you
Disabled?

YesNo
Full Time Student?

YesNo
Dependent's Gross Income
Dependent # 2
Name (First, Last)
Relationship
Date of Birth

MonthDayYear
Date
SS #
Months Lived with you
Disabled?

YesNo
Full Time Student?

YesNo
Dependent's Gross Income
Dependent # 3
Name (First, Last)
Relationship
Date of Birth

MonthDayYear
Date
SS #
Months Lived with you
Disabled?

YesNo
Full Time Student?

YesNo
Dependent's Gross Income
Did you claim the First Time Homebuyer Credit on your 2008 tax return? (for payback on credit) Were you referred by someone?

YesNo
Were you referred by someone?

YesNo
(If Yes)Name
Please include documents needed for filing:

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*ALL NEW CLIENTS NEED COPY OF 2022 TAX RETURN FOR FEDERAL & STATE
Questionnaire for 2023 Tax Return
Your Name

First NameLast Name
Did you or spouse receive any unemployment income? (Need 1099G)

YesNo
Did you receive retirement or Social Security benefits? (Need Statement from SSA-1099/1099-R)

YesNo
Do you have Medicare? (Social Security health insurance)

YesNo
Do you have a secondary/supplement insurance you pay out of pocket?

YesNo
Annual Amount
Do you have Long Term Health Care policy?

YesNo
Name(s)
Cost (per individual)
Did you purchase insurance through Market Place? (Need to provide 1095-A)

YesNo
Do you purchase health insurance out of pocket?

YesNo
Amount
Have you received any of the following 1099's: (Copies Needed)
1099-R

YesNo
1099-DIV

YesNo
1099-INT

YesNo
Did you have a self employed business?

YesNo
Have you filed a Schedule C, E or F in previous tax year?

YesNo
Did you use a credit card processor for business? (You should receive a 1099-K)

YesNo
Did you have any gambling winnings/losses? (If yes, please include W2G's and loss documentation)

YesNo
Did you have any Electronic/Virtual Digital Currency transactions? (Need documentation)

YesNo
Did you sell any stocks, bonds, mutual funds or other assets? (Need to 1099)

YesNo
Did you make any contributions (outside of payroll) to any IRA in 2023?

YesNo
Whose name is it in?

First NameLast Name
Is it a Traditional or Roth?
Amount of contribution (per individual)
Did anyone else make any contributions (outside of payroll) to any IRA in 2023?

YesNo
Whose name is it in?

First NameLast Name
Is it a Traditional or Roth?
Amount of contribution (per individual)
Do you qualify for educator expense? (300 Fed- 500 Iowa)

YesNo
Amount claiming
Did you make any cash donations?

YesNo
Amount
Did you make any NON Cash donations?

YesNo
Value
Did you take early with drawl or distributions from 401K and or Roll over a 401K? (Need 1099-R)

YesNo
Do you have Mortgage Interest? (Need 1099-INT)

YesNo
Do you have Real estate/Property Tax to deduct? **Will need to provide documentation OR $ amount **If you live in ILLINOIS and pay property tax we will need your property ID #

YesNo
Dollar Amount
Property # (Illinois Only)
Did you purchase any Residential Energy property? (Need proof of Energy Star Certification & Receipt)

YesNo
Did you pay for daycare/child care expense? (Need Name, SS/EIN, Address of provider & Amount, Amount paid for each child)

YesNo
Were any of your dependents, you or your spouse in college in 2023?

YesNo
Did you pay college tuition/expenses for yourself or dependent in 2023? (Need Provide a 1098-T & Receipts)

YesNo
Have you taken American Opportunity or Lifetime Learning Education Credit on previous tax returns? (Need years taken-(per student)

YesNo
Years Taken (Per Student)
Did you contribute/withdraw money from an educational IRA or 529 plan? (Need contribution letter/ 1098-Q)

YesNo
Did you pay interest on college loans? (Need 1098-E to report interest deduction)

YesNo
Did you have any debt cancelled/forgiven (credit card, etc) or a mortgage principle reduction? (Need 1099-C)

YesNo
IA residents -License Registration: (Need payment amount & documents if available)

YesNo
Did you pay Registration fees/tuition for your dependents, grades K-12? Need amount paid for each student

YesNo
Did you contribute money to HSA account (Health Savings Account)? (Need 5498-SA and/or 1099-SA)

YesNo
Did you operate any Rental Property during tax year?

YesNo
Did you sell your primary home in 2023? (Need a copy of the closing statement for sale and NEW purchase)

YesNo
How long did you live there?
Did you sell a second home or vacation home in 2023?

YesNo
Have you moved to a different school district? (Need new school district **Iowa residents only)

YesNo
Have you moved to a different state during 2023? (Need specific date)

YesNo
Are you a member/beneficiary of an S-Corp, Partnership, Estate, Trust, Etc? Include all K-1

YesNo
Did you make any Estimated Quarterly payments for this tax year to Federal and/or State?

YesNo
Federal
Date (Payment 1)

MonthDayYear
Date
Amount Paid
Date (Payment 2)

MonthDayYear
Date
Amount Paid
Date (Payment 3)

MonthDayYear
Date
Amount Paid
Date (Payment 4)

MonthDayYear
Date
Amount Paid
State
Date (Payment 1)

MonthDayYear
Date
Amount Paid
Date (Payment 2)

MonthDayYear
Date
Amount Paid
Date (Payment 3)

MonthDayYear
Date
Amount Paid
Date (Payment 4)

MonthDayYear
Date
Amount Paid
Do you require a Federal Identity PIN # to file your taxes? (Should receive a new Pin Letter each year)

YesNo
Are you a Volunteer Fire Fighter/EMS? (Letter Required)

YesNo
Do you want a Paper Copy or Emailed Copy of your Tax Return?

PaperEmail
Do you want to receive our monthly Email Tax Tip Newsletter?

YesNo
**We will need Documentation if claiming dependents other than your own children.
**We will need Legal Documents if you are acting as Power of Attorney for someone.
Please include documents needed for filing:

Cancelof
Signature

Clear
Name

First NameLast Name
Date

MonthDayYear
Date
Banking Info 2023
Would you like your refund Direct Deposited into your bank account?

YesNo
Bank Name
Routing Number
Account Number
Checking or Savings

CheckingSavings
This information is true and correct to the best of my/our knowledge. All items of income have been reported and all Items of expense are supported by receipt or other evidence
Primary Tax Payer Name

First NameLast Name
Primary Tax Payer

Clear
Spouse Name

First NameLast Name
Spouse (joint Return):

Clear
Email & PIN Information 2023

If you would like to have the ability to call and receive a copy of your tax return after tax season, you will need to sign and enter the following information:
Tax Payer Name:

First NameLast Name
Tax Payer Phone #
Please enter a valid phone number.
Tax Payer Email:
example@example.com
Tax Payer Pass Code (4 #'s)
Spouse/Significant Other Name:

First NameLast Name
Spouse/Significant Other Phone #
Please enter a valid phone number.
Spouse/Significant Other Email
example@example.com
Spouse/Significant Other Pass Code (4 #'s)
Should be Empty:

New Client Information Sheet 2023

DEPENDENTS (CHILDREN & OTHER)

Dependent # 2

Dependent # 3

Questionnaire for 2023 Tax Return

Have you received any of the following 1099's: (Copies Needed)

Federal

State

**We will need Documentation if claiming dependents other than your own children.

**We will need Legal Documents if you are acting as Power of Attorney for someone.

Banking Info 2023

Email & PIN Information 2023