Optimum Financial Services CLIENT Intake Form

LETTER OF ENGAGEMENT

OUR RESPONSIBILITIES

Our work (whether it is a tax consultation, tax return preparation, tax planning or other related services or products) is based on data you provide.

• We are not responsible to audit or verify the data that you give to us.

• We may ask for clarification of your data or additional information.

• We are not responsible for discovering fraud or other irregularities, should any exist.

• We will work to find all the credits and deductions you are legally entitled to.

YOUR RESPONSIBILITIES
- To provide all the information required for a complete and accurate finished service.
- To provide this information in a timely manner.
- To retain, with the completed work, all the documents, receipts, bank statements and other data that form the basis of the income, credits and deductions claimed since you may later have to provide them to a taxing authority.
- To carefully review all work completed by our office before you sign the final documents. You have the final responsibility for anything submitted on your behalf to a taxing authority to be corrected prior to being transmitted.
- You are responsible not to commit fraud.
- You are responsible to let us know if you received the Child Tax Credit Payments in 2022 or to let us know if you did not receive your stimulus payment 1, 2, and/or 3 payment (if you are filing a 2020 or 2021 tax return). You are also responsible to let us know if you did not receive any other tax forms that may impact your tax return such as but not limited to your 1099K Form, 1099NEC Form or Unemployment Form.
PENALTIES AND/ OR INTEREST, EXAMINATIONS AND NOTICES

The IRS and state taxing authorities (they) impose penalties and/or interest for certain offenses, including understatement of income, filing after the deadline, underpaying estimated taxes, or under withholding taxes If you would like more information, please contact the IRS and state taxing authorities. They can also select any of your tax returns for examination at any time. We also do not guarantee a specific time frame that you can expect to receive your tax refunds.

PRIVACY POLICY

Our tax professionals are bound by professional standards of confidentiality. Therefore, we will always protect your right to privacy. For current and former clients, we do not disclose any nonpublic personal information obtained in the course of our practice except as required or permitted by law, and as is necessary to properly provide our services to you.

CONFIDENTIALITY STATEMENT

In engaging our tax services, you, as the client, acknowledge and agree to maintain strict confidentiality regarding all aspects of our professional relationship. This includes, but is not limited to, information related to products, services, pricing, disputes, details from consultations, and copies of office documents.

CONFIDENTIALITY COMMITMENT

Non-Disclosure: You agree not to disclose, share, or disseminate any information provided or discussed during the course of our professional engagement to any third party without our explicit written consent. Documentation: All documents, electronic or otherwise, shared with you during our engagement are confidential and should not be shared or reproduced without our prior authorization. Pricing and Fee Information: Any pricing, fee structures, or financial arrangements discussed or disclosed are considered confidential and should not be disclosed to others.

CONSEQUENCES OF VIOLATION

Any breach of this confidentiality commitment may result in severe consequences, including but not limited to: Termination of Services: We reserve the right to terminate our professional relationship if confidentiality is breached. Legal Action: Violation of confidentiality may lead to legal action seeking damages and injunctive relief. Financial Penalties: You may be subject to financial penalties for any damages incurred due to the unauthorized disclosure of confidential information. By accepting our services, you affirm that you understand and agree to abide by the confidentiality terms outlined above. Your commitment to confidentiality is essential to maintaining the integrity of our professional relationship. We appreciate your cooperation and adherence to these terms.

Types of Nonpublic Personal Information We Collect. We collect nonpublic personal information about you that is provided to us by you or obtained by us with your authorization. You also give us authorization to use your likeness of photos, videos and reviews in our promotional advertisements. Parties to Whom We Disclose Information. We make available information to our employees and to nonaffiliated third parties who need to know that information to assist us in providing services to you. In all such situations, we require a contractual agreement that includes procedural safeguards that protect the confidential nature of the information being shared, such as our Consent & Disclosure Forms. All information given is also shared with Financial Powerhouse LLC, doing business as Optimum Financial Services formerly Quality Tax. Protecting the Confidentiality and Security of Current and Former Client Information. We retain records (based on the IRS and state taxing authorities regulations) relating to professional services that we provide so that we are better able to assist you with your professional needs and, in some cases, to comply with professional guidelines. In order to guard your nonpublic personal information, we maintain physical, electronic, and procedural safeguards that comply with our professional standards.

OUR FEES

We invoice for our tax professionals time spent assisting you and based on the difficulty of the tax returns or services, depending on schedules and forms completed and out-of-pocket expenses incurred by the company, our rates vary depending. For our new clients we do not offer free estimates, we invoice an nonrefundable upfront deposit to start the process of completing your return(s), itemizing your documents, consultations and also for partially completed work that is placed on extension or remains undone. The total of the deposit is applied to your tax preparation fee or service fee. The amount of your deposit depends on the difficulty of your tax return(s) or service(s). For a *basic tax return we require a $25 nonrefundable deposit and for **complex tax returns require a $75 nonrefundable deposit prior to service being performed. We do have several of our services that the entire nonrefundable cost of the service or product must be paid in full up front. If for any reason your tax return is offset for collection obligations and all or a portion of your tax preparation fees are not paid due to the offset. In the event that your tax return is offset or rejected due to outstanding obligations or any other reasons, you, as the client, are still fully responsible for all unpaid tax preparation fees. By engaging our services, you agree to fulfill your financial obligations promptly. Payment Obligation: If your tax return is offset or rejected, you are obligated to pay any outstanding tax preparation fees within 30 days of the offset or rejection date. Acknowledgment of Liability: Regardless of the status of your tax return, the responsibility for unpaid tax preparation fees remains with you.

CONSEQUENCES OF NON-COMPLIANCE

Failure to adhere to these terms may result in the following consequences: Late Payment Fees: A late payment fee may be applied for any unpaid tax preparation fees not settled within the specified 30-day period. Interest Charges: Interest charges may accrue on the unpaid balance if not paid within the stipulated time frame. Restriction of Services: Non-compliance may result in the restriction of future services until all outstanding fees are settled. Legal Action: Persistent failure to fulfill payment obligations may lead to legal action or involvement of a collection agency that will help in seeking the recovery of unpaid fees, including associated costs and attorney fees.This debt may also be reported to all 3 credit bureaus.

TAX DOCUMENTS

All clients are provided a copy of their tax documents at the conclusion of their tax preparation, if return is e-filed to the IRS and all up front fees have been paid in full. Tax documents are issued via your customer portal, email and/or in office as a paper copy. In order to provide you with an additional copy of your tax documents, your tax return must be e-filed and APPROVED by the IRS and/or state. Any additional copies of your e-filed tax documents are $5-$25 per year tax year and per additional tax or identity document requested (price depends on if you are or are note a loyal customer).

ARBITRATION

If a customer dispute arises out of or relates to this contract or engagement letter, or the obligations of the parties therein, and if the customer dispute cannot be settled through negotiation, the parties agree first to try in good faith to settle the dispute by mediation administered by the American Arbitration Association under its commercial Mediation Rules before resorting to arbitration, litigation, or some other dispute resolution procedure. We do not provide monetary refunds but will offer to amend your tax return(s) or fix your incorrect service(s) or product(s) at no cost to you if the mistake is of our tax professionals doing; or we will offer a credit on future services based on our management value of the damage to the customer for the incorrect service or product redored.

AGREEMENT

The foregoing is in accordance with my (our) understanding of your engagement to provide tax and financial services and you are hereby advised that each item of revenue or expense can be substantiated by receipts, canceled checks, or other documents. This information is true, correct, and complete to the best of my (our) knowledge. Further, it is my (our) understanding that these terms will continue to be enforced for the succeeding years of our engagement. If there are multiple tax year returns completed or a prior year tax return completed all the same terms and conditions apply in this engagement letter.

*Basic Tax Return = Dependents, W2s, 1098T, EIC, CTC, ACTC, Day Care Credit, Social Security, Unemployment, Student Loans, IPPIN Letter just to name a few forms

** Complex Tax Return = Schedule C (small business),1099NEC, 1099K, 1099MISC, Schedule A (itemizing), Real Estate, Investments & Income, Retirement 1099R, Gambling Wins & Losses, HSA, 1099C, 1095A Health Insurance, 1099C, 1st Home Buyers Credit, 1099INT, 1099DIV, SCorp, Partnership, Nonprofit, Estimated Taxes, Daycare Credit, Educator Expense, IRA Distributions or Contribution, Capital Gains & Losses, Farming, Adoption Credit, K1, Household Help just to name a few forms
Taxpayer Signature*

Clear
Date*

MonthDayYear
Date
Spouse Signature

Clear
Date

MonthDayYear
Date

CLIENT PROFILE SHEET

EVERY QUESTION REQUIRES AN ANSWER.
I. Personal Information:
What tax year(s) are you filing with the information in these packets (you can select multiple years):*

202420232022202120202019Other
DO NOT complete the questions for your spouse if your filing status is single or head of household.
Taxpayer’s Name: *

First NameMiddle NameLast Name
Taxpayer’s Social Security Number / ITIN: *
Taxpayer’s Date of Birth: *

MonthDayYear
Date
Taxpayer’s Occupation:*
Upload the Tax Payers ID*

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Upload the Tax Payers Social Security Card*

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Spouse’s Name:

First NameMiddle NameLast Name
Spouse Social Security Number / ITIN:
Spouse Date of Birth:

MonthDayYear
Date
Spouse Occupation:
Upload the Spouse ID

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Upload the Spouse Social Security Card

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MARRIED FILING

Head of Household OR Single Form
I certify that I have been separated/ divorced from my spouse,
First Name   Last Name      (Spouse Name) during the tax year, and that my spouse and I did not cohabitate during the last six months of the tax year. I resided at the address shown on this tax return the last six months of the tax year and my spouse resided at   Street Address   Address Line 2   City   State   Zip      the last six months the tax year.
(Sign the One That Applies 3. or 4.)
Signature      I further certify that I have one or more qualified dependents living in my home more than 6 months of the year and for whom I provide more than half of the support. The address on this return was the main address for the dependents and I all year. I therefore qualify to file as “Head of Household” and desire to file my tax return using that status for the tax year instead of Married Filing Separate. My tax preparer has explained to me the penalties that could be imposed if I file as “Head of Household”, and it is determined at a later date that I was not authorized to file with this status.
Signature      I further certify that I have NO qualified dependents living in my home. I therefore qualify to file as “Single” and desire to file my tax return using that status for the tax year instead of Married Filing Separate. My tax preparer has explained to me the penalties that could be imposed if I file as “Single”, and it is determined at a later date that I was not authorized to file with this status.
Additional Notes in regards to why you and your spouse are separated and not filing together:
(I can provided proof that my spouse and I did not live together the last 6 months of the tax year)
Taxpayer Signature

Clear
Date

MonthDayYear
Date

III. General Questions:

Can the taxpayer or spouse be claimed as a dependent on someone else’s return? *

	Yes	No
Taxpayer:
Spouse:

iF YES, You do not qualify for EIC

Was Taxpayer or Spouse over the age of 18 and a fulltime student during the tax year (s) you are currently filing?*

	Yes	No
Taxpayer:
Spouse:

Is the taxpayer or spouse blind? *

	Yes	No
Taxpayer:
Spouse:

PLEASE ATTACH SUPPORTING DOCUMENTS FOR PROOF OF BEING BLIND (if Applies).

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Are the taxpayer or spouse deceased? *

	Yes	No
Taxpayer:
Spouse:

Was the taxpayer or spouse affected by a natural disaster during the tax year?*

	Yes	No
Taxpayer:
Spouse:

Has the taxpayer or the spouse received, sold, sent, exchanged, or otherwise acquired financial interest in virtual currency during the current tax year? (i.e bitcoin or coinbase)*

	Yes	No
Taxpayer:
Spouse:

Address:*

Street Address

Street Address Line 2

CityState

Zip Code
Taxpayer Phone Number (2 numbers required):
Daytime*
Evening
Spouse’s Phone Number (2 numbers required):
Daytime
Evening
Taxpayer Email Address:*
example@example.com
Spouse Email Address:
example@example.com
Email
example@example.com
Do you have a IRS IP PIN (Identification Pin)*

YesNo
Upload Your IPPIN Letter or Screen Shot of Your IP PIN from your IRS portal here

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Does your spouse have an IRS IP PIN (Identification Pin)

YesNo
Upload Your Spouse IPPIN Letter or Screen Shot of Your IP PIN from your IRS portal here

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Is the taxpayer or spouse a U.S. Citizen/Resident Alien? *

	Yes	No
Taxpayer:
Spouse:

Has your Earned Income Credit previously been disallowed (Form 8862)?*

YesNoDoes Not Apply
If yes, WHY and what tax year? If does not apply type "Does Not Apply"*

Did you, your spouse or a dependent purchase health insurance via Healthcare.gov or a State Marketplace and received a 1095A, B or C? *

	Yes	No
Taxpayer:
Spouse:

If yes, Does your 1095A include all coverage January – December?*

YesNoDoes Not Apply
Upload your 1095A, B AND/ OR C here:

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Resident State as of December 31*

Is the TAXPAYER or SPOUSE totally and permanently disabled? *

	Yes	No
Taxpayer:
Spouse:

PLEASE ATTACH SUPPORTING DOCUMENTS FOR PROOF.

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Did You File Taxes Last Year?*

YesNo
Please provide a copy of the tax return if you did not file with Optimum Financial Services.

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Do you need to file any amended returns? *

YesNo
If yes, What years *
Did you own your own small business/ home based business/ self contractor/ rideshare and need to claim your income & expenses (Schedule C)(1099Misc)(1099K)?*

YesNo
IF YES, PLEASE COMPLETE THE SMALL BUSINESS PACKET (BLUE)
PLEASE ATTACH YOUR PROOF OF INCOME

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PLEASE ATTACH YOUR PROOF OF EXPENSES

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PLEASE ATTACH ANY ADDITIONAL small business/ home based business/ self contractor/ rideshare PROOF NOT ATTACHED ABOVE THAT YOU WANT TO INCLUDE

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THE SMALL BUSINESS PACKET
STOP!

NO PROOF, NO FILING

Under penalty and perjury of law I understand that by signing this form and by completing the pages in the attached Schedule C packet that I am claiming income/expenses and/or deductions on my tax return and have provided & reviewed all of the information on the Schedule C packet with my tax preparer prior to my taxes being submitted to the IRS and/or State.

If any information in the Tax Software is different from the packet attached, it is because I gave my tax preparer verbal information or additional documents after completing this form and this form was not updated (as allowed under circular 230). I agree with all the information reported on my tax return. I understand that if I am audited by the Federal and/or State it is my sole responsibility to meet the federal and/or state proof requirements.
Taxpayer Name Printed
Date

MonthDayYear
Date
Taxpayer Signature

Clear
SMALL BUSINESS/ SELF CONTRACTOR/ RIDE SHARE PACKET
Responsibility and Declaration: I acknowledge that I bear full responsibility for providing proof of any information reported on this form, should it be required. Optimum Financial Services (OFS) holds no liability in this regard. I am fully aware that the information provided on this form can significantly impact my social security benefits, government assistance, car loans, home loans, business funding, and all other financial obligations.

By completing this document, I affirm that I operate as a small business owner, sole proprietor, or self-contracted laborer. I understand the necessity of providing receipts and substantiating proof for any details listed in the Schedule C Packet, if requested. I solemnly declare, under penalty of perjury, that all the information presented herein is accurate and true. I acknowledge that misrepresenting any material information as true, knowing it to be false, may subject me to penalties associated with perjury.
This business or profession is owned by the:

TaxpayerSpouseBothWith Other Business Partners
How did you compute your business income reported on this form?
How did you compute your business expenses reported on this form?
Do you have a different credit card and/or banking account for the business from your personal accounts?

YesNo
List the details of your business bank accounts:
How do you separate your business and personal transactions?:
Who is responsible for maintaining the business records?
What was the start-up cost of the business?
Do you have a business card that you use to advertise your products/ services?

YesNo
Please attach a picture of your business card.

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What is your website for your business (or social media pages)?
How do you promote your product or services?
What is your business email address?
If there is no income for the business, explain why:
If there are no expenses for the business, explain why:
Were the expenses in pursuit of profit for your business?

YesNo
Did you include all of your income and expenses for the business?

YesNo
Is this a valid business?

YesNo
Type of Business:
Is this your first Schedule C filed on the business?

YesNo
Business Name (if no separate business name, leave blank):
Employer ID number (EIN):
(Leave blank if you use your sociall security number for your business ID)
If you do not have a EIN, would you like to apply for one?

YesNo
Business address (if different from home address):

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Is this business in-home, online-based only, or in a storefront?

In-HomeOnline OnlyStore FrontOther
Accounting method:

CashAccrualOther
Is the business a (Circle One):

LLCPartnershipScorpCCorpNoneOther
Is a License required for your occupation?

YesNoUnsureDoes Not Apply
725 Forms Filing Up to Date:

YesNoUnsureDoes Not Apply
Sales Tax Filing Up to Date:

YesNoUnsureDoes Not Apply
Payroll Taxes Filing Up To Date:

YesNoUnsureDoes Not Apply
City Taxes Filing Up To Date:

YesNoUnsureDoes Not Apply
Would you like assistance properly registering your business?

YesNo (Business is Already Registered with the State)Unsure
Is the business for rental property income and expenses (Schedule E)?

YesNo
Did you “materially participate” in the operation of this business during the tax year?

YesNo
Did you start or acquire the business this year?

YesNo
What month and year was the business acquired?
Did you make any payments during the tax year that would require you to file Form(s) 1099 for self contractors that you hired?

YesNo
Part I: Income
Do you have any Forms 1099MISC/ 1099NEC/ 1099K?

YesNoUnsure
PLEASE ATTACH ALL FORMS 1099MISC/ 1099NEC/ 1099K.

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Total Gross receipts or sales
Returns and allowances:
Other income, including Federal and state gasoline or fuel tax credit or refund:
Upload Proof Of All Business Income

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Part II: Cost of Goods Sold - Skip this section and go to Part III if you do not sale inventory in your business
Method used to value closing inventory:

CostLower of cost or marketDoes Not ApplyOther
Was there any change in determining quantities, costs, or valuation between opening and closing inventory?

YesNoDoes Not Apply
Explain the Changes Here:
Inventory at the beginning of the year:
Purchases less cost of items withdrawn for personal use:
Cost of labor to directly produce the products you sale. Do not include any amounts paid to yourself:
Materials and supplies (directly related to creating the products you sale):
Other Cost:
Inventory at the end of the year:
Part III: Expenses
List the total cost for all of your ADVERTISING expenses for your business (i.e cost of Radio/ TV / Social Media Ads / Business Cards / Website Cost / Yard Signs ? Car Magnets and ALL other Advertising Expenses
Total Paid Out For Contract Labor/Employees/Salary Pay/ Recruiting and Bonuses:
Total Commissions and fees cost:
Total Depletion cost:
Total Employee benefit programs cost (other than pension and profit-sharing plans):
Total Self Employed Health Insurance cost:
Total Self Employed Health Insurance Cost:
Total Cost of Insurance, other than health insurance:
Total Business Interest (i.e earned from your business bank account):
Total Legal and professional services cost:
Total Name Badges & Company Appareal Cost:
Total Supplies Cost (not included in Cost of Goods Sold section):
Total Office Expense Cost:
Total Self Employed Pension, Retirement, 401K, and profit-sharing plans cost:
Total Business Personal property cost (i.e. business car tags):
Total Business Taxes and Licenses Cost:
Total Business property/ office rent or lease:
Total Vehicles, machinery, and equipment Lease or Rental Cost:
Total Repairs and maintenance cost:
Total Business Travel Cost:
Total Business Meals and entertainment cost:
Total Business Utilities Cost (i.e gas, water, electric, alarm system or security
Total W2 Employees Wages Paid Out:
Total Payroll Taxes Cost:
Total Business Uniforms/ Wardrobe Cost (must have company logo):
Total Work Shoes/Boots Cost:
Total Business Bad Debts Cost:
Business Use of Cell Phone/ Business Phone or Business Pager Cost:
Total Machinery Cost:
Total Equipment Cost:
List Totals and Descriptions for All other Business Expenses not reported above:
Upload Proof of All Business Expenses

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Part IV: Information on Your Business Vehicle or Business Use

(Complete this section ONLY if you are claiming expenses related to a car or truck expenses related to only business use if does not apply skip to section V)
Business Vehicle Description (Year Make Or Model):
When did you place your vehicle in service for business purposes?
Total Business Use of Car Actual Expense(s) (i.e oil changes, maintenance, tires)
Of the total number miles you drove your vehicle during the year, enter the number of miles you used your vehicle for:
Business Miles:
Business Commuting Miles:
Other Business Miles:
Was your vehicle available for personal use during off-duty business hours?

YesNo
Do you (or your spouse) have another vehicle available for personal use?

YesNo
Do you have evidence to support your business car expenses?

YesNo
Total Square Footage of Area used regularly and exclusively for business, regularly for daycare, or for storage of inventory or product samples:
Is the evidence written?

YesNo
Can you provide proof of your car(s) beginning and end of year odometer readings, if audited by the federal and/ or state?

YesNo
If you have additional cars you used for business use please list all of the details below for each vehicle:
Part V: Depreciation of Business Property
Are you claiming depreciation of any listed property or cars that are business related?

YesNoDoes Not Apply
Description Depreciating asset:
Date Placed In Service:

MonthDayYear
Date
Asset Cost:
Percentage of Business Use:
Section 179:
Prior Year Depreciation:
Accumulated Depreciation:
Useful Life:
Depreciation Method:
Add details of all other items that you need to depreciate that is business related
Part VI: List ALL Other Business Expenses not listed above:

Upload Proof of Additional Expenses Not Included Above:

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Part VII: Qualified Business Income (QBI) (if applies):
QBI Adjustment Amount:
W2 Wages Paid:
Part VIII: Business Use of Home

Expenses for Business Use of Your Home
Expenses
Business Use of Home Casualty losses:
Business Use of Home Deductible business mortgage interest:
Business Use of Home Real estate & Property taxes:
Business Use of Home Excess mortgage interest (not reported when itemizing):
Business Use of Home, Home Insurance:
Business Use of Home Office Furniture & Supplies:
Business Use of Home All other Expenses
Carryover of operating expenses from last year’s return (if applies):
Carryover of excess casualty losses and depreciation from last year’s return (if applies):
Are you interested in bookkeeping or accounting services?

YesNoUnsure
Are you interested in payroll services?

YesNoUnsure
Are you interested in changing your business entity type?

YesNoUnsure
Taxpayer Signature:

Clear
Date

MonthDayYear
Date
Spouse/ Business Partner Signature (if someone else owns the business with you):

Clear
Date

MonthDayYear
Date
Do you have itemized expenses (Schedule A)? (I.e. medical bills, tithes & offering, car tags, union dues, mortgage interest, real estate taxes and so forth)*

YesNo
ITEMIZED EXPENSES PACKET
STOP!

NO PROOF, NO FILING

Under penalty and perjury of law I understand that by signing this form and by completing the pages in the attached Schedule C and/or Schedule A (circle which apply) that I am claiming income/expenses and/or deductions on my Type a label (year) tax return and have provided/reviewed all of the information on the Schedule A with my tax preparer.

If any information in the Tax Pro Software is different from the packet attached, it is because I gave my tax preparer verbal information (as allowed under circular 230). I agree with all information on my tax return. I understand that if I am audited it is my responsibility to meet the federal and/or state proof requirements.
Taxpayer Name Printed
Date

MonthDayYear
Date
Taxpayer Signature

Clear
ITEMIZED EXPENSES PACKET
What is your filing status?
Standard deduction by filing status:
(2023) Single $13,850; Married Filing Jointly or Qualifying Widow(er): $27,700; Head of household: $20,800

(2022) Single $12,950; Married Filing Jointly or Qualifying Widow(er): $25,900; Head of household: $19,400

(2021) Single $12,550; Married Filing Jointly or Qualifying Widow(er): $25,100; Head of household: $18,800

In order for the Schedule A to take effect your total itemized expenses on this form must be equal to or more than your standard deduction for your federal and/ or state return
I certify that I incurred the following itemize expenses:

Medical and Dental Paid

	Amount
Insurance Premiums Paid
Prescription Medicines
Legally Obtained Drugs
Insulin
Doctors/Dentists/Nurses Fees Out of Pocket
Eyeglasses & Contact Lenses Eye Exam
Transportation for Medical Treatment/ Miles
Nonprescription medical supplies
Canes/ Crutches/ Braces
Co-Pays
Ultrasounds
Fees for Operations Out of Pocket
Long-Term Care Insurance
Hospital & Emergency Room Fees
Lab & X-Ray
Visiting Nurse/ In-Home Care
Dentures & Braces
Hearing Aids & Batteries
Orthopedic Shoes
Therapy Treatments
Wheelchairs
Air Conditioning (with Doctor’s Advice)
Vaporizers (with Doctor’s Advice)
Thermometers & Bandage (with Doctor’s Advice)
Other Medical Birth Control, Braces, chiropractor, dancing lessons, abortion, vitamins, beast pump and supplies

PLEASE ATTACH SUPPORTING DOCUMENTS FOR PROOF

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Contributions ($250 or more requires proof)

Paid

	Amount
Churches (tithes & offering)
College Donations
Cash Donation
United Way/ March of Dimes
Cash Donations to Salvation Army/ Goodwill
Value of Furniture Donated to Salvation Army/ Goodwill
Other Donations to Salvation Army/ Goodwill
Auto Miles Driven for Charity

Taxes Paid

	Amount
Real Estate Tax
Personal Property Tax (car tags)
State Income Tax
State & Local Sales Tax (owed)

Interest Paid

	Amount
Home Mortgage Interest (1098)
2nd Mortgage/ Home Equity
Home Mortgage to Individual
Points Paid Closing
Investment Interest
Mortgage Insurance Premiums

Casualty Losses

Amount

Natural Disasters
Expenses for Business Use of Your Home
A. Part of Your Home Used for Business
Area used regularly and exclusively for business, regularly for daycare, or for storage of inventory of product samples:
Total Area of the Home:
Casualty losses:
Deductible mortgage interest:
Real estate taxes:
Excess mortgage interest:
Insurance:
Rent:
Repairs and Maintenance:
Utilities:
Other expenses:
Carryover of operating expenses from last year’s return:
Excess casualty losses:
Carryover of excess casualty losses and depreciation from last year’s return:
B. Depreciation of Your Home
Enter the smaller of your home’s adjusted basis or its fair market value:
Value of land:
II. Employee Business Expenses
A. Do not include expenses that were reimbursed by your employer.
Parking Fees:
Tolls:
Transportation (including train, bus, etc.):
Travel expense (lodging, airplane, car rental, etc.):
Meals and Entertainment Expenses:
Other Expenses:
Tax Preparation Fees:
Safe Deposit Box:
Union Dues:
Uniforms:
Job Education Expense:
Uniform Cleaning:
Miles Driven to 2nd Job:
Employment/ Job Seeking Fee:
Business Cell Phone:
Safety Shoes, Gloves, and Equipment:
Work Tools:
III. Depreciation
Description of Asset:
Asset Type:
Date placed in service:
If the property is real estate, is it residential rental?

YesNo
Cost or basis:
Was the asset acquired in 2022?

YesNo
How much cash was paid for it?
Was the property tangible and bought and sold in 2022?

YesNo
Land value:
Percentage of business use of asset: Type a label %
Prior section 179 deduction:
Prior special depreciation allowance:
Life of the asset: Type a label Years
Convention:

Half-YearMid-monthMid-quarterNoneShort year
Prior depreciation:
Does this property qualify and are you electing to take the 50% special depreciation for this property?

YesNo
Carryover of disallowed deduction from 2022:
IV. Other Expenses

	Amount
Natural Disasters

	Name of Expense	Taxpayer/Spouse or Joint	Amount
1
2
3
4
5
6
7
8

Optimum Financial Services (OFS) holds no liability for information reported on my Schedule A. In the event of an audit, I acknowledge the obligation to furnish supporting evidence for all claims made on this schedule. I am aware that the particulars disclosed in this packet can influence applications for social security, car loans, or home mortgage loans.

Any discrepancies between the Cloud Tax Office Pro software and the information provided on this form shall be governed by verbal communication. In accordance with Circular 230, I am permitted to rely on verbal communication for guidance.
How did you compute these deductions?
Taxpayer Signature:

Clear
Date

MonthDayYear
Date
Spouse Signature:

Clear
Date

MonthDayYear
Date

Did you pay into a 401K (Form 8880)?

	Yes	No
Taxpayer:
Spouse:

Did you draw from a 401K (1099-R)?

	Yes	No
Taxpayer:
Spouse:

PLEASE ATTACH SUPPORTING DOCUMENTS (IF THROUGH YOUR EMPLOYER, INFORMATION IS LISTED ON YOUR W2)

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Did you pay into a Health Saving Account HSA (Line 25) or a Flexible Spending Account FSA?

	Yes	No
Taxpayer:
Spouse:

PLEASE ATTACH SUPPORTING DOCUMENTS.

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Did you pay into an IRA (Line 32)?

	Yes	No
Taxpayer:
Spouse:

Did you draw from an IRA (1099-R)?

	Yes	No
Taxpayer:
Spouse:

PLEASE ATTACH SUPPORTING DOCUMENTS.

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Did you pay for any higher education expenses for yourself, your spouse, or your dependents?

	Yes	No
Taxpayer:
Spouse:
Dependents:

EDUCATION CREDITS/DEDUCTIONS PACKET

A 1098T IS REQUIRED FOR ALL EDUCATION CREDITS.
What type of degree is the person claiming the school credit obtaining?
Did someone else list you as a dependent on their tax return?

YesNo
STOP HERE. YOU DO NOT QUALIFY FOR AN EDUCATION CREDIT
Is your filing status married filing separately?

YesNo
STOP HERE. YOU DO NOT QUALIFY FOR AN EDUCATION CREDIT.
Were you or your spouse a non-resident alien for any part of the year?

YesNo
STOP HERE. YOU DO NOT QUALIFY FOR AN EDUCATION CREDIT.
Is the eligible student yourself, your spouse or a dependent you list on your tax return?

YesNo
STOP HERE. YOU DO NOT QUALIFY FOR AN EDUCATION CREDIT.
Did yourself, your spouse, or you dependent pay qualified education expenses?

YesNo
You can claim an education credit for qualified education expenses paid by cash, check, credit, debit card or paid with money from a loan.

Qualified expenses are amounts paid for tuition, fees and other related expenses for an eligible student that are required for enrollment or attendance at an eligible educational institution.

Even if you pay the following expenses to enroll or attend the school, the following are not qualified education expenses:
- Room and board
- Insurance
- Medical expenses (including student health fees)
- Transportation
- Similar personal, living or family expenses
STOP HERE. YOU DO NOT QUALIFY FOR AN EDUCATION CREDIT.
Was the eligible student enrolled at least half time for at least one academic period beginning in 2022?

YesNo
You may qualify for the LIFETIME LEARNING CREDIT OR THE TUITION AND FEES DEDUCTION.
Did the eligible student receive a 1098T?

YesNo
If you did not receive a 1098T, contact the educational institution.
YOU CANNOT CLAIM SCHOOL CREDITS UNTIL FORM IS RECEIVED BY TAX PREPARER.
Has the eligible student finished the first four years of higher education?

YesNo
You may qualify for the LIFETIME LEARNING CREDIT OR THE TUITION AND FEES DEDUCTION.
Has the eligible student claimed the American Opportunity Credit for more than four tax years?

YesNo
You may qualify for the LIFETIME LEARNING CREDIT OR THE TUITION AND FEES DEDUCTION.
Is the student claiming the credit enrolled at an eligible institution?

YesNo
You may qualify for the LIFETIME LEARNING CREDIT OR THE TUITION AND FEES DEDUCTION.
Does the eligible student have a felony drug conviction?

YesNo
You may qualify for the LIFETIME LEARNING CREDIT OR THE TUITION AND FEES DEDUCTION.
You qualify for the AMERICAN OPPORTUNITY CREDIT.
Circle Only One:

American Opportunity CreditLifetime Learning Credit/Tuition and Fees DeductionNo Education Credit
PLEASE ATTACH 1098T FORM

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YOUR TAX PREPARER WILL APPLY THE CREDIT THAT IS MOST BENEFICIAL.

MUST ATTACH 1098T (8863) FORM.

Anything in Quality Tax Pro Software overrides anything in this packet based on my ability to rely on verbal communication with my client based on circular 230.
Taxpayer Sign

Clear
Date

MonthDayYear
Date
Spouse Sign

Clear
Date

MonthDayYear
Date

Did you pay any interest for student loans (Line 33)?

	Yes	No
Taxpayer:
Spouse:

PLEASE ATTACH SUPPORTING DOCUMENTS.

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Did you or your spouse receive any unemployment pay/ compensation (1099G, Line 19)?

	Yes	No
Taxpayer:
Spouse:

PLEASE ATTACH FORM 1099G.

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Are you owed a rebate for unemployment taxes owed in 2022?

YesNo

Do you or your spouse need to repay any 1st Time Homebuyers Credit Loan from 2008-2010 taxes (Form 5405)?

	Yes	No
Taxpayer:
Spouse:
Both

How Much

Did you receive a 1099-C (Cancellation of Debt) or a 1099-A (Acquisition or Abandonment of Secured Property)?

	Yes	No
Taxpayer:
Spouse:

Did you or your spouse receive social security benefits (line 20a)?

	Yes	No
Taxpayer:
Spouse:

PLEASE ATTACH SUPPORTING DOCUMENTS

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Did you or your spouse earn income from military/ National Guard?

	Yes	No
Taxpayer:
Spouse:
Both

The taxpayer or spouse is known to the tax professional?

TaxpayerSpouseBothNeither
IV. Earned Income Credit Qualifications
Is your filing status married filing separate?

YesNo
Did you or your spouse EARN income in 2022?

YesNo
Are you claiming any dependents?

YesNo
DEPENDENT PACKET
I. Dependent Detail
II. IP PIN
Do any of your Dependents have a IRS IP PIN (Identification Pin)*

YesNo
MUST provided IP PIN for each dependent

(Cannot claim spouse, girlfriend or boyfriend.)(If the dependent is not your biological child you MUST also provide form 8332 completed by bio parent and/ court documents and proof dependent lived in your home)
III. Qualifying Child Rules for EIC
Do all of the dependents on the return have a relationship to you that is your son, daughter, adopted child, foster child, stepchild (through marriage) or descendant of any of them (such as your grandchild)?*

YesNoDoes Not Apply
If not your biological child, explain why BOTH the biological parent(s) are not claiming the dependent for each non-bio dependent:
Do all of the dependents on the return have a relationship to you that is your brother, sister, half-brother, half-sister, step brother, step sister or a descendant of any of them (such as a niece or nephew)?*

YesNoDoes Not Apply
If not your biological child, explain why BOTH the biological parent is not claiming the dependent for each non-bio dependent:
PLEASE PROVIDE PROOF OF RELATIONSHIP (ex. Birth Certificate, Court Documents, School Records etc.). IF IT’S NOT YOUR BIOLOGICAL CHILD, PROVIDED ANY OF THE FOLLOWING PROOF CHILD LIVED WITH YOU MORE THAN 50% OF THE YEAR, THAT YOU PROVIDED 50% SUPPORT, CUSTODY PROOF!!!

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At the end of the tax year, were all dependents younger than you (or your spouse if filing a joint return)?

YesNo
If dependent is within 5 years of your age, please explain why you are claiming them:
At the end of the tax year, were all dependents younger than 19?

YesNo
At the end of the tax year were dependents OLDER THAN 19 and younger than 24, a full-time student?

YesNoDoes Not Apply
Name of Dependent:
PLEASE PROVIDE PROOF OF ENROLLMENT.

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At the end of the tax year, were ANY dependents permanently and totally disabled (for dependents 24 and older and who do not go to school)?

YesNoDoes Not Apply
PLEASE PROVIDE PROOF OF DISABILITY, provide explanation below.

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Name of Dependent:
Explain the type of disability.
How long has the dependent been disabled?
How long will the disability last? What type of proof do you have to support the disability?
Did all dependents live with you (or your spouse if you file a joint return) in the United States for more than half of the year?

YesNo
(If dependent is over 19, not in college or disabled you can’t claim them.)
PLEASE PROVIDE SUPPORTING DOCUMENTS (ex. School Records, Mail, etc.)

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IV. Earned Income Credit With Qualifying Child
Were all dependents US Citizens?

YesNo
Did you provide more than 50% of the support for the dependents claimed?

YesNo
Did or will any of the dependents file a married filing joint return during the tax year?

YesNo
Did any of the dependents receive more than $4100 of earned or unearned income in during the tax year?

YesNo
V. Additional Questions (Only answer these questions if you have qualifying children)
Are you a single parent?

YesNo
Please provide an name & address(s) for the other parent (in the US or outside of the US) or define if deceased, and describe details whether or not they are eligible to claim the dependent(s)
Do you provide more than 50% support for dependents?

YesNo
Do any of the dependents have a different last name from the taxpayer?

YesNoDoes Not Apply
List their first & last name, explain why:
Do all dependents share the same last name?

YesNoDoes Not Apply
Explain why:
Did you receive any type of government assistance (i.e. food stamps, section 8 housing, healthcare coverage, etc.) or child support?

YesNoDoes Not Apply
Explain why:
Did you pay for daycare or dependent care for any dependents in order to work? (Form 2441)

YesNoDoes Not Apply

If dependent(s) is age 5 and under and you didn’t pay for daycare, list dependent first and last name and describe in detail who took care of them while you worked? Does not apply
VI. Dependency Exemption for Qualifying Relative
Do not complete this section if you are claiming a qualifying child SKIP to signature
Is the person your qualifying child or the qualifying child of any other taxpayer?

YesNo
Can anyone else claim them?

YesNo
Was the person your son, daughter, stepchild, foster child, or a descendant of any of them (i.e., your grandchild)?

YesNo
Was the person your brother, sister, half-brother, half-sister, or a son or daughter of any of them?

YesNo
Was the person your stepbrother, stepsister, stepfather, stepmother, son-in-law, daughter-in-law, father-in-law, mother-in-law, brother-in-law, or sister-in-law?

YesNo
Not including your spouse, was the person someone who lived in your household all year?

YesNo
Did the person have gross income of less than $4,050 in 2022?

YesNo
PLEASE ATTACH SUPPORTING DOCUMENTS FOR PROOF OF INCOME

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Did you provide more than half the person’s total support for the year?

YesNo
Did another person provide more than half the person’s total support?

YesNo
Did two or more people together provide more than half the person’s total support?

YesNo
Did you provide more than 10% of the person’s total support for the year?

YesNo
Did the other person(s) providing more than 10% of the person’s total support for the year provide you with a signed statement agreeing not to claim the exemption?

YesNoDoes not apply
By signing below I/We hereby acknowledge that the information provided within this five page Dependent Packet is true and correct.
Taxpayer Signature:

Clear
Date

MonthDayYear
Date
Spouse Signature:

Clear
Date

MonthDayYear
Date
Were you or your spouse at least 25 but under 65 years old at the end of 2022?

YesNo
V. Personal Information Continued:
I would like my federal and/ or state refund as a *

CheckCash CardDirect Deposit
For DIRECT DEPOSIT include banking information below:
Name of Financial Institution:
CheckingSavings
Routing number:
Account number:
VI. Referral Program
Did you file with us last year? *

YesNo
If No, How did you hear about us?

FriendRadioTVSocial Mediaetc.
Full Name & Phone Number of Referral:
Please upload w2s, various income, various credits and deductions proof

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Please upload any other tax documents that your tax accountant may need

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Client Agreement & Authorization for Tax Preparation Services

This document serves as an agreement between you the Client Name and Optimum Financial Services (OFS) for the preparation of your tax year(s) you are currently filing individual federal and state tax returns and any prior year tax returns that you may need.

Accuracy and Responsibility: By signing below, you affirm that all information provided on the OFS Client Profile Sheet and accompanying packets is true, correct, and accurate to the best of your knowledge. You acknowledge receiving copies of bank forms, your 1040 Forms, state documents, and relevant protection plus documents. It is understood that any differences between the information in Quality Tax Pro Software being used by Financial Powerhouse LLC dba Optimum Financial Services and the provided packets shall override information in these packets based on as the differences may come from verbal communications with the clients, as allowed under Circular 230.

Confidentiality and Dependents: OFS guarantees the confidentiality of all information provided to our office. By signing below, you affirm that all dependents listed in this application are legally yours and that you possess appropriate documentation, if required.

Preparation and Filing: Optimum Financial Services will prepare your tax return based on the information provided. We do not alter, audit, or verify the information furnished. You, the taxpayer, bear ultimate responsibility for the accuracy and filing of your tax return. In case of misrepresentation leading to an audit, you are solely responsible for any consequences arising thereof.

Fees and Submission: You acknowledge and understand all fees charged for the services rendered. You grant OFS permission to submit your return to the IRS as deemed necessary. Additionally, by signing, you authorize the application of fees to any remaining refund if your return undergoes processing through the bank (state or federal) after any applicable debts or offsets.

Authorization for E-Signature: You provide consent for OFS to use your e-signature on your behalf in relation to the tax year(s) you are currently filing a tax return for.
By signing below, you acknowledge that you have read, understood, and agree to the terms outlined in this Client Agreement and Authorization for Tax Preparation Services.
Taxpayer Signature:

Clear
Date

MonthDayYear
Date
Spouse Signature:

Clear
Date

MonthDayYear
Date
Should be Empty:

	Dependent First & Last Name	Date of Birth	SS#	Relationship To Taxpayer	# of Months in Home in 2022
1
2
3
4

	Care provider’s name:	Address of Caregiver:	EIN or SSN:	Amount Paid Per Child:	Total Paid:
1
2
3
4
5

	Description of Business Expense	Total Amount Spent on Business Expense
1
2
3
4
5
6
7
8
9
10

CLIENT PROFILE SHEET

I. Personal Information:

II. Filing Status:

MARRIED FILING

III. General Questions:

THE SMALL BUSINESS PACKET

SMALL BUSINESS/ SELF CONTRACTOR/ RIDE SHARE PACKET

Part I: Income

Part II: Cost of Goods Sold - Skip this section and go to Part III if you do not sale inventory in your business

Part III: Expenses

Part IV: Information on Your Business Vehicle or Business Use

Part V: Depreciation of Business Property

Part VI: List ALL Other Business Expenses not listed above:

Part VII: Qualified Business Income (QBI) (if applies):

Part VIII: Business Use of Home

Expenses

ITEMIZED EXPENSES PACKET

ITEMIZED EXPENSES PACKET

Contributions ($250 or more requires proof)

Expenses for Business Use of Your Home

A. Part of Your Home Used for Business

B. Depreciation of Your Home

II. Employee Business Expenses

A. Do not include expenses that were reimbursed by your employer.

III. Depreciation

IV. Other Expenses

EDUCATION CREDITS/DEDUCTIONS PACKET

IV. Earned Income Credit Qualifications

DEPENDENT PACKET

I. Dependent Detail

II. IP PIN

III. Qualifying Child Rules for EIC

IV. Earned Income Credit With Qualifying Child

V. Additional Questions (Only answer these questions if you have qualifying children)

VI. Dependency Exemption for Qualifying Relative

Do not complete this section if you are claiming a qualifying child SKIP to signature

V. Personal Information Continued:

For DIRECT DEPOSIT include banking information below:

VI. Referral Program