Sapphire Income Tax & Financial Services 2024 CLIENT QUESTIONNAIRE
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Are You a New Or Existing Client at Sapphire Income Tax & Financial Services?
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New
Existing
Did you file your 2023 tax return?
Yes
No
Did you receive your 2023 tax refund?
Yes
No
Please explain why.
Name
First Name
Last Name
Taxpayer Date Of Birth?
-
Month
-
Day
Year
Date
Taxpayer Occupation
What is filing status?
Please Select
Single (Not Married)
Head of Household
Married Filing Jointly
Married Filing Separately
Qualifying Widow(er)
Phone
-
Area Code
Phone Number
Email
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Please Select
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
The Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
Brazil
Brunei
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos (Keeling) Islands
Colombia
Comoros
Congo
Cook Islands
Costa Rica
Cote d'Ivoire
Croatia
Cuba
Curaçao
Cyprus
Czech Republic
Democratic Republic of the Congo
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Polynesia
Gabon
The Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
North Korea
South Korea
Kosovo
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macau
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Nagorno-Karabakh
Namibia
Nauru
Nepal
Netherlands
Netherlands Antilles
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
Turkish Republic of Northern Cyprus
Northern Mariana
Norway
Oman
Pakistan
Palau
Palestine
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn Islands
Poland
Portugal
Puerto Rico
Qatar
Republic of the Congo
Romania
Russia
Rwanda
Saint Barthelemy
Saint Helena
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
Somaliland
South Africa
South Ossetia
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard
eSwatini
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Transnistria Pridnestrovie
Trinidad and Tobago
Tristan da Cunha
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
Uruguay
Uzbekistan
Vanuatu
Vatican City
Venezuela
Vietnam
British Virgin Islands
Isle of Man
US Virgin Islands
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Other
Country
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Can another taxpayer claim you as a dependent on their tax return?
Yes
No
Will you be filing a tax return with your spouse?
Yes
No
Will you be filing married filing seperated?
Yes
No
Taxpayer Photo Identification
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Utility bill
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Taxpayer Social Security Card
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Did The Taxpayer Work In 2024
Yes
No
Have you ever been disallowed for EITC/AOTC/CTC/ACTC?
Yes
No
Do you have dependants to claim on your 2024 tax return?
Yes
No
Did you, your spouse or any dependents attend college in 2024?
Yes
No
Did the student attend at least half time?
Yes
No
Did you, your spouse or dependents receive health insurance through the Marketplace in 2024 and receive form 1095-A?
Yes
No
Did you or your spouse receive unemployment benefits in 2024?
Yes
No
Do you own or rent your current residence?
Please Select
Own
Rent
Did you or your spouse pay any medical or dental expenses in 2024? (This does not include insurance premiums.
Yes
No
Do you or your spouse own rental property?
Yes
No
Did you or your spouse have any gambling winnings for 2024?
Yes
No
Did you or your spouse receive social security benefits in 2024?
Yes
No
Are you low income?
Yes
No
Do you receive any government assistance?
Yes
No
Did you make any charitable contributions in 2024? (Church, Goodwill, Salvation Army etc.)
Yes
No
Did you or your spouse make any charitable cash contributions of $300 or more in 2024
Yes
No
Did you purchase a vehicle in 2024?
Yes
No
Did you or your spouse withdraw money from their 401K in 2024?
Yes
No
Did you or your spouse earn any interest or dividends from investments in 2024?
Yes
No
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DEPENDENT INFORMATION
Total Number of dependents you claimed for the year 2024?
DEPENDENT NAME (1)
First Name
Last Name
Dependent Date Of Birth?
-
Month
-
Day
Year
Date Picker Icon
Dependent SSN
DEPENDENT (1) Identification- Birth Certificate and Social Security card
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DEPENDENT NAME (2)
First Name
Last Name
Dependent Date Of Birth?
-
Month
-
Day
Year
Date
Dependent SSN
DEPENDENT (2) Identification- Birth Certificate and Social Security card
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DEPENDENT NAME (3)
First Name
Last Name
Dependent Date Of Birth?
-
Month
-
Day
Year
Date
Dependent SSN
Dependent (3) Identification- Birth Certificate and Social Security card
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Are you self employed?
Yes
No
Do you or your spouse owe debt to any Government Agency; such as IRS, Student Loans, Child Support etc?
Yes
No
Have you or your spouse made any payments to their student loans in 2024?
Yes
No
Do you or your spouse plan to purchase a home within the next two years?
Yes
No
Are you interested in a Free Credit Consultation?
Yes
No
Are you interested in seeing if you pre-qualify for the Same Day Advance?
Yes
No
Would you like your Tax refund direct deposited in your bank account. If so, pleaae complete the bank information below.
Yes
No
Bank Name
Routing Number
Account Number
Routing Number
Account Number
Type of Account
Please Select
Checking
Savings
How did you discover Sapphire Income Tax & Financial Services?
Please Select
Social Media
Family Friend
Other:
Do you and your spouse understand and agree to the fees for Sapphire Income Tax & Financial Service to prepare your Federal/State tax return? is required.
Yes
No
Itemized Deductions
Meidcal and Dental Expenses
Mortgage Interest and Expenses
Taxes you paid
Gift to Charity
Other
Please select all forms of income
W2
1099-MISC
1099-R
1099-SSA
1099-K
1099-G
1099-DIV
W2G
1099-C
Other
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Taxpayer Signature
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Taxpayer Signature
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Taxpayer Signature
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