Client Interview Questionnaire
Due Diligence
Date of interview
Time of Interview
Location of appointment/Interview
Please Select
In Office
Virtual
Interviewing Tax Preparer ?
Please Select
Brenisha McBride
Ariel Young
Shamika Chambers
Interviewed by.
New or Returning Client
Please Select
New
Returning
What’s your filing status
Please Select
Single
Head of household
Married filing joint
Married filing separate
Injured spouse
Widow
Filing status might change after all information has been collected
What documents can be provided to validate your head of household status?
Mortgage/Lease
Utility bill: light water gas
Rent receipts
Mortgage Deed
Other
Do you own any depths, or have any obligations that would prevent you from receiving your Federal Tax Return? If so, please explain below.
FOR EXAMPLE: Child Support, Student Loan, IRS fees/fines,
Did you receive a Federal Tax Return last year?
Please Select
Yes
No
Partial Refund
CLIENT INFORMATION
First Name
Last Name
Date of birth
-
Month
-
Day
Year
Date
Social Security #
Occupation
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
Please enter a valid phone number.
Email
example@example.com
SPOUSE INFORMATION
First Name
Last Name
Spouse Date of Birth
-
Month
-
Day
Year
Date
Spouse Social Security #
Spouse Occupation
Spouse phone number
Please enter a valid phone number.
Spouse Email
example@example.com
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DEPENDENTS
DEPENDENT 1
First Name
Last Name
Date of birth
-
Month
-
Day
Year
Date
Social Security number
How many months did the dependent live with you?
Please Select
1
2
3
4
5
6
7
8
9
10
11
12
Is the dependent your biological child?
Please Select
Yes
No
Why aren’t the parents claiming the dependents on their tax return?
Where are the parents?
Do you have legal custody court documents of the dependent and can provide them if needed?
Please Select
Yes
No
Is the dependent over the age of 18 and in a credentialed school?
Please Select
Yes
No
Is the dependent disabled, and was diagnosed by a doctor?
Please provide a copy of disability letter
DEPENDENT 2
First Name
Last Name
Date
-
Month
-
Day
Year
Date
Social Security number
How many months did the dependent live with you?
Please Select
1
2
3
4
5
6
7
8
9
10
11
12
Is the dependent your biological child?
Please Select
Yes
No
Why are the parents not claiming the child?
Where are the parents?
Do you have legal custody court documentation and can be provided upon request?
Please Select
Yes
No
Is the dependent over the age of 18 and in credential school?
Please Select
Yes
No
Is the Dependent disabled, and been diagnosed by a doctor?
DEPENDENT 3
First Name
Last Name
Date of birth
-
Month
-
Day
Year
Date
Social Security Number
How many months the dependent live with you?
Please Select
1
2
3
4
5
6
7
8
9
12
11
12
Is the dependent your biological dependent?
Please Select
Yes
No
Why are the parents not claiming the dependent?
Where are the parents?
Do you have legal court custody documents and can be provided upon request?
Please Select
Yes
No
Is the dependent over the age of 18 and attending a credential school?
Please Select
Yes
No
Dependent disabled, and been diagnosed by doctor?
Up on request, can you provide the following documents per the IRS request for the credits claimed on this federal tax return in the event of an audit? EX: Birth certificate, medical records, school records residential lease, mortgage deed/ interest form, legal guardianship court documentation, disability award letter?
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INCOME
Report all income.
Income
W2 Statement
1099NEC
1099MISC
UNEMPLOYMENT
1099R RETIREMENT
GAMBLING WINNINGS
SELF EMPLOYED
BUSINESS INCOME/EXPENSES
What is your business?
Example: barber, Nails, caterer, Event planner, baby sitter, Tax preparation ECT.
What is your business entity?
Sole proprietor
LLC
SCORP
C-CORP
EIN
What documents can you provide to show business income
Business/ Bank Statements
Canceled checks
Receipts
Invoices
Excel spreadsheet
Other
What documents can you provide to show business expenses?
Bank statement
Invoice
Receipts
other
Did you pay quarterly federal/state Taxes on your business?
Please Select
Yes
No
Do you use your vehicle for your business?
Please Select
Yes
No
Average miles driven for business
Do you have employees or contractors for your business?
Employees
Contractors
Employee & Contractors
Internships
Other
The event of an audit, can you provide income/Business income, and expenses per the IRS request?
Please Select
Yes
No
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CREDITS
**PLEASE UPLOAD ALL DOCUMENTS FOR CREDITS CLAIMED ON THIS RETURN **
Choose all credits that apply to this tax return.
Child / Dependent Care
AOTC 1098T Education credit/College
Resident Energy Credit/ solar
Adoption Credit
CTC Child Tax Credit
ACTC Advance Child Tax Credit
UPLOAD ALL DOCUMENTATION HERE THAT PERTAINS TO YOUR 2024 FEDERAL TAX RETURN. EXAMPLES ARE LISTED BELOW
Browse Files
Drag and drop files here
Choose a file
**EXAMPLES: State issued identification ,household documentation (UTILITY BILL), social security cards… ** upload ALL documents that needs to be filed with your 2024 tax return
Cancel
of
The information/ credits claim on this return is true and accurate to the best of my knowledge, In the event of audit I the taxpayer can and will provide all documentation for credit claimed on this return. I agree to this statement by providing and below.
Signature
Date
-
Month
-
Day
Year
Date
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MISCELLANEOUS QUESTIONS
Do you have medical/ dental bills that totals over 12,000?
Please Select
Yes
No
Not Sure
Type a question
Type option 1
Type option 2
Type option 3
Type option 4
Did you live in an area that was declared a natural disaster and was affected?
Yes
No
Date and State of Disaster?
Submit
Should be Empty: