Tax Return Questionnaire

Tax Return Questionnaire
Marital Status

SingleMarried Filing JointlyMarried Filing SeparatelyHead of HouseholdQualifying Widow(er) with Dependent Children
Taxpayer Name

First NameLast NameSuffix
Taxpayer Date of Birth

MonthDayYear
Date
Taxpayer Occupation
Taxpayer Email Address
example@example.com
Taxpayer Social Security Number
Check all that apply:

Can you be claimed as a dependent on someone else's returnWere you over age 18 and a full-time student at an eligible educational institution.Taxpayer is blind.Taxpayer is deceased.Taxpayer or Spouse served in a combat zone during the current tax year.Taxpayer wishes to elect to use their 2019 earned income to figure their 2021 earned income credit and/or child tax credit.Taxpayer or Spouse was affected by a natural disaster during the current tax year.Taxpayer has received, sold, sent, exchanged, or otherwise acquired financial interest in virtual currency during the current tax year.Taxpayer prefers to receive written communications from the IRS in a language other than English.Taxpayer prefers to receive written communications from the IRS in an accessible format.
Spouse Name

First NameLast Name
Spouse Date of Birth

MonthDayYear
Date
Spouse Occupation
Spouse Email Address
example@example.com
Spouse Phone Number
Spouse Social Security Number
Check all that apply:

Can you be claimed as a dependent on someone else's returnWere you over age 18 and a full-time student at an eligible educational institution.Taxpayer is blind.Taxpayer is deceased.Taxpayer or Spouse served in a combat zone during the current tax year.Taxpayer wishes to elect to use their 2019 earned income to figure their 2021 earned income credit and/or child tax credit.Taxpayer or Spouse was affected by a natural disaster during the current tax year.Taxpayer has received, sold, sent, exchanged, or otherwise acquired financial interest in virtual currency during the current tax year.Taxpayer prefers to receive written communications from the IRS in a language other than English.Taxpayer prefers to receive written communications from the IRS in an accessible format.
Taxpayer Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Taxpayer Phone Number

DEPENDENTS INFORMATION

	FULL DEPENDENT NAME	DATE OF BIRTH	# OF MONTHS DEPENDENT RESIDE WITH TAXPAYER	DEPENDENT SOCIAL SECURTY NUMBER
DEPENDENT 1
DEPENDENT 2
DEPENDENT 3
DEPENDENT 4
DEPENDENT 5

Do you have a "Special Needs" child?

YesNo
HEALTH INSURANCE COVERAGE
DID YOU RECEIVED HEALTH COVERAGE (INSURANCE) THROUGH YOUR STATE MARKETPLACE OR HEALTHCARE.GOV? IF SO, PLEASE UPLOAD YOUR FORM 1095A*

YesNo
Please upload 1095A

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Driver's License/ Identification Card

Social Security Card (taxpayer and/or dependents)

Wages and Salaries (Attach W-2's)

Interest Income (Attach 1099's) (List and identify as non-taxable Interest Income)

Unemployment Compensation Received (FORM 1099G) PLEASE UPLOAD FORM BELOW:
File Upload*

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If you would like your tax refund (if any) deposited directly into your bank, paper check or fast money card

CheckingSavingsPaper CheckFast Money Card
Bank Name
Your Account Number
Bank Routing Number
What was your last year's AGI (Annual Gross Income)? (If you do not have your last year's return please create an account with the IRS using www.irs.gov)*
Rental & Royalty Income and Expense (Rental Property)
Property Type

ResidentialCommercial
Number of days rented
Number of days used personally
Property is owned by

TaxpayerSpouseJoint
Percentage ownership of not 100%: Please indicate if income and expenses below are listed at 100% or your percentage

YesNo
Percentage ownership of not 100%
Did you live in part of the rental property?
If yes, what percentage did you occupy as a tenant?

Check if rented to a related party. Explain relation
If yes, what percentage did you occupy as a tenant?

Business Income & Expenses (Sole Proprietorship, LLC)
Owner Name

First NameLast NameSuffix
Business name
Employer ID number
Business Type
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Employer ID number (EIN)
Do you use any part of your home regularly and exclusively for business?

YesNo
Estimated of time in home office compared to total time in this business
Description of work done in home office
Description of work done outside of work office
Total area of home
Total area of home used regularly for business
Please upload any additional tax documents below:

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Does anyone listed on the Tax Return have an Identity Pin? If so, please list the name and Identity Pin below:

Disclaimer and Acknowledgement

Dear Tax Client,

We at Divine Financial would like to thank you for choosing us this year and hopefully years to come in preparing your tax returns. We will prepare your federal and state income tax return with the information you furnish to us. We are not required to audit information that you submit, however, we may ask you to verify and/or clarify information if questions may arise. If all information is not received to complete your return by April 1 st , we will be more than happy to file an
extension for you. All extensions will be filed upon your request at a fee of $10.
It is your responsibility to maintain in your personal records the supporting documentation necessary to support your tax return. If you have any questions as to the type of records required, please ask us for advice in that regard. We are responsible for preparing only the return referred to this letter. Our fee does not include responding to inquiries from the IRS and/or Dept. of Revenue if received after the return has been filed. Our fee does not include any audits by any taxing authority. Our audit counseling and submission is a fee of $50 plus postage for the first attempt. Additional fees may apply.

In order to protect sensitive documents, client copy of tax return will be hand delivered, email to address provided on Client Data Collection form or you will be able to access via login. If a paper copy is requested it will be mailed to the address provided on your photo id at a cost of .10 (10 cents) per sheet plus postage, if required. Please keep your paper copy in a safe location, any replacement copies will be $40 per filing year including postage. Other fees may apply.

We strive to give you all the deductions to which you are entitled, however we may terminate our representation of you if you insist that we pursue objectives that we consider unethical. All payments are due before services are rendered if it shows that you will not receive a return. There will be NO exceptions. If we file your taxes and for any reason the IRS does not issue a return for varies reasons, you will have to pay out of pocket the amount for your return. Failure to do so will lead to legal involvement where the client must pay court fees and you not be able to use any services that Divine Financial Solutions has to offer

Sincerely,
Divine Financial Services

Having read and fully understand the disclaimer and engagement letter, I/WE agree to engage Divine Financial in accordance with the terms indicated. I/WE understand the return services are to be prepared from information provided and the final responsibilities for a complete and accurate return rest with ME/US. It is also MY/OUR responsibility to review and understand all information on the return
prior to filing them.
Tax Payer's Signature

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