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TAX QUOTE FORM
20
Questions
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1
Name
First Name
Middle Name
Last Name
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2
What is your job title?
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3
Email
example@example.com
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4
Phone Number
Please enter a valid phone number.
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5
What was your marital status on December 31, 2024?
Please Select
Single (Never Married)
Married
Divorced
Widowed
Legally Separated
Please Select
Please Select
Single (Never Married)
Married
Divorced
Widowed
Legally Separated
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6
What was the date of your divorce?
-
Date
Year
Month
Day
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7
In what year were you widowed?
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Date
Year
Month
Day
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8
Did anyone live with you in 2024?- not including married spouse
Child, Grandchild, Parent, Disabled Relative
YES
NO
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9
Do any of these situations apply to you?
Legally Blind
Totally Disabled
Issued an Identity Protection Pin?
Full-Time Student
Not a U.S Citizen
None
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10
Do any of these situations apply to your spouce?
Legally Blind
Totally Disabled
Issued an Identity Protection Pin?
Full-Time Student
Not a U.S Citizen
None
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11
What type of income do you have?
Please check all that are applicable
Employment Income (W-2)
Tips (not included on your W-2)
Retirement/ Pension/ Annuity (1099-R)
Disability Benefits (Payments from Insurance or Workers Comp; 1099-G)
Social Security or Railroad Retirement (SSA-1099, RRB-1099)
Unemployment Benefits (1099-G)
Refund of state or local taxes
Interest and/ or Dividends (1099-INT, 1099-DIV)
Sale of stocks and/ or bonds (1099-B)
Alimony
Income from renting out your house or a room in your house (more than 15 days in 2024)
Gambling Winnings/ Lottery Winnings (W2-G)
Self Employment/ Contract Work (Sch C, 1099-MISC, 1099-NEC, 1099-K)
Cash Payments/ Jury Duty/ Royalties/ Union Strike Benefits
Any income not stated above
Sold a home/ rental property (1099-S)
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12
Expenses & Tax Related Events
Check all that are applicable
Mortgage Interest (1098)
Real Estate Taxes/ Insurance
Medical/ Dental Expenses
Charitable Contributions
Student Loan Interest (1098-T)
Child & Dependent Care
Retirement Account Contributions
Educator Supplies
Alimony Payments (after 12/31/18)
Education Expenses
Sold a home (1099-S)
HSA Contributions/ Deductions
Marketplace Health Ins. (1095-A)
Canceled Debt (1099-C)
Federal Disaster Loss (1099-A)
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13
Did you previously have a disallowed credit? (ex. Earned Income Credit, Child Tax Credit, American Opportunity Credit)
YES
NO
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14
Have you received a letter from the IRS ?
YES
NO
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15
Did you make estimated payments in 2024?
YES
NO
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16
Will you need to file a State Tax Return?
YES
NO
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17
Is there any information you would like to include?
Huge
Large
Normal
Small
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quote
Created with Sketch.
Ok
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18
How would you like to receive your quote?
Email me- no need to meet!
Phone Call
Video Meeting (Zoom)
Other
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19
Please schedule a video review below
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20
Please schedule a phone review below
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