2023 TAx Questionairre v2

2023 Tax Return Questionnaire
Your Name

First NameLast Name
Are you claiming any dependents in 2023? - IF YES ADDITIONAL SHEET REQUIRED

YesNo
Did you or spouse receive any unemployment income? If yes, please provide 1099G Yes No

YesNo
Did you receive retirement or Social Security benefits? If yes please include Statement from SSA-1099/1099-R

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

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

YesNo
Annual Amount
Do you have Long Term Health Care policy? (Nursing Home Insurance)

YesNo
Names (separate with comma)
Cost Per Individual (separate with comma)
Did you purchase insurance through Market Place? Will need to provide 1095-A question

YesNo
Have you received any of the following 1099's: (Copies Needed)
1099-R - For distributions from Retirement accounts / including Roll Oversstion

YesNo
1099-DIV - From Stock held

YesNo
1099-INT - Interest Income from Banks, Stocks, ETC Yes No

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/VirtuaI Digital Currency transactions? (Need documentation)

YesNo
Did you sell any stocks, bonds, mutual funds or other assets? Will need to provide a 1099B

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

YesNo
Who name is it in? (separate with comma)
Is it a Traditional or Roth?
Amount of contribution per individual (separate with comma)
Do you qualify for educator expense? (300 Fed— 500 Iowa)

YesNo
Amount Claiming
Did you make any cash donations?

YesNo
Amount Claiming
Did you make any NON Cash donations? (GoodWill, Salvation Army, Referral Center, etc)

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? Will need to provide 1098-INT

YesNo
Do you have Real estate/Property Tax to deduct?

YesNo
Will need to provide documentation OR dollar amount
If you live in ILLINOIS and pay property tax we will need your property ID #
Did you purchase any Residential Energy property? Will need proof of Energy Star Certification & Receipt. (Doors, windows, furnace, water heater, etc...)

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

YesNo
Amount paid for each child (separate with comma)
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? Provide a 1098-T & Receipts

YesNo
Have you taken American Opportunity or Lifetime Learning Education Credit on previous tax returns?Type a question

YesNo
Years taken per student
Did you contribute/withdraw money from an educational IRA or 529 plan? - Will need contribution letter/ 1098-Q

YesNo
Did you pay interest on college loans? Will need to provide a 1098-E to report interest deduction

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

YesNo
IA Residents - Did you have vehicle registration fees?

YesNo
IA residents - Vehicle License Registration: Payment amount & documents if available (attach at end)
Did you pay registration fees/tuition for your dependents, grades K-12?

YesNo
Amount paid for each student (separate with comma)
Did you contribute money to HSA account (Health Savings Account)? Will need to provide 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?

YesNo
How long did you live there? **Need a copy of the closing statement for sale of home and for NEW home you purchased (attach at end)
Did you sell a second home or vacation home in 2023?

YesNo
IA Residents - Have you moved to a different school district? - Need new school district

YesNo
Have you moved to a different state during 2023? - Need specific dates of residency on next question

YesNo
Specific dates of residency
Example: 01/01/2022 - 01/01/2023
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
Q1 Federal Date
Q1 Federal Amount
Q2 Federal Date
Q2 Federal Amount
Q3 Federal Date
Q3 Federal Amount
Q4 Federal Date
Q4 Federal Amount
State
Q1 State Date
Q1 State Amount
Q2 State Date
Q2 State Amount
Q3 State Date
Q3 State Amount
Q4 State Date
Q4 State Amount
Do you require a Federal Identity PIN # to file your taxes? (A new Pin Letter required each year)

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

YesNo
**We will need Documentation if claiming dependents other than your own children.
**We will need legal Documents if you are acting as a Power of Attorney for someone.
Do you want a Paper Copy or Email Copy of your Tax Return?

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

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

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

Do you want to receive our monthly Email Tax Tip Newsletter?
Please include documents needed for filing:

Cancelof
Signature

Clear
Date

MonthDayYear
Date
Should be Empty:

2023 Tax Return Questionnaire

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 a Power of Attorney for someone.