📄 Tax Preparation Questionnaire – Routt Insurance & Tax Services

📄 Tax Preparation Questionnaire – Routt Insurance & Tax Services

Please complete the following form as accurately as possible. This will help us prepare your tax return efficiently and accurately.
👤 Personal Information
Name

First NameMiddle NameLast Name
Social Security Number (No Dashes)
Date of Birth

MonthDayYear
Date
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Email
example@example.com
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
👨‍👩‍👧‍👦 Filing Status

SingleMarried Filing JointlyMarried Filing SeparatelyHead of HouseholdQualifying Widow(er)
Has your marital status changed in the last year?

YesNo
👶 Dependents
Do you have any dependents? If yes, list:

YesNo
Full Name | SSN | DOB | Relationship | Months Lived with You | Full-Time Student?
💼 Employment & Income

Did you receive any of the following (check all that apply and attach relevant forms):
Type a question

W-2 (Wage Income)1099-NEC (Self-Employment/Contract Work)1099-MISC1099-INT (Interest Income)1099-DIV (Dividends)1099-R (Retirement Income)SSA-1099 (Social Security Income)Unemployment (1099-G)Other
Last Years Adjusted Gross Income (AGI)
Did you have any self-employment or business income? If yes, please provide details and expenses.

YesNo
Did you pay or have:

Mortgage Interest (Form 1098)Property TaxesCharitable ContributionsMedical Expenses (if itemizing)Childcare Expenses – Name, EIN, and amount paidCollege Tuition or Student Loan Interest (1098-T / 1098-E)Contributions to IRA or HSAHealth Insurance through Marketplace (Form 1095-A)
🏠 Deductions & Credits
💳 Banking Info for Refund (Optional)
Bank Name:
Routing Number:
Account Number:
CheckingSavings
📝 Additional Information
Any changes in address in the last year?

YesNo
Do you want to file electronically (e-file)?

YesNo
Driver’s License Number: DL Issue Date Expiration Date State
Spouses Driver’s License Number: DL Issue Date Expiration Date State
Copy of Previous Year Return (If I didn't do them)

Upload Last Years Return Below
Upload Documents (All Tax Documents & Driver's License)

Cancelof
Signature
Should be Empty:

📄 Tax Preparation Questionnaire – Routt Insurance & Tax Services

👤 Personal Information

👶 Dependents

💼 Employment & Income

🏠 Deductions & Credits

💳 Banking Info for Refund (Optional)

📝 Additional Information