Tax Preparation - Client Information Sheet

Tax Preparation - Client Information Sheet

NOTE: THERE ARE NEW QUESTIONS. PLEASE LOOK OVER CAREFULLY. COMPLETE AND SIGN.

THANK YOU!

Date: __________________________

DROP-OFFS:

If you own a Business or Rental Property, it is best that you make an

appointment with the receptionist to have your taxes prepared due to the volume of

information and questions that would need addressing. Thank you.

Please fill in the following information pertaining to your tax return.

*Note—Taxpayer is the first name on your tax return. If you are a wife filling this out, please

put your information under “Spouse”.

General Information:

Name: (Exactly as it appears on your Social Security Card): _____________________________________ Taxpayer’s Social Security Number: ________________________________________________________ Spouse’s Name (As it appears on Social Security Card):_________________________________________ Spouse’s Social Security Number: _________________________________________________________ Current Address: _______________________________________________________________________ _____________________________________________________________________________________ Home Number: _____________________________________________

Work Number: __________________________________ Days or Evenings Taxpayer or Spouse Cell Number (taxpayer): ______________________________ (spouse) _______________________

(Please circle which number you would like us to call first. Thank you.)

NEW YORK RESIDENTS ONLY:

If you earned under $18,000, and paid less than $450.00 per month for rent, you may be eligible for the Renter’s Credit. How much was your rent per month? __________________________.

Did the rent include any utilities? ______ If so, which utilities? ________________________________ Are you required by New York State to pay Child Support? YES NO

If so, and you are current with your Child Support, you may be eligible for the Non-Custodial Earned Income Credit from New York State.

Please check your filing status:

Single __________ (Can anyone else claim you as a dependent on their return?) YES NO

Head of Household _____ (Not married, or separated, from your spouse, the LAST 6-months of the year) Married Filing Joint ________

Married Filing Separate______ (If married filing separate we need spouse’s social security number and full name as it appears on their social security card):

Spouse’s Full Name: ______________________________________________________________ Spouse’s Social Security #: _________________________________________________________ Qualifying Widow(er) with dependent child ______

Dependent Information: (We will need to make copies of Social Security Cards, please present

them to us at this time)

Name (Exactly as it appears on Social Security Card): __________________________________________ Social Security Number: _________________________________________________________________ Birth Date (month, day and year): _________________________________________________________ Sex: Male ______ Female ______

How many months did this dependent live with you last year? __________________________________ Can anyone else claim this dependent? YES NO

If there are any childcare expenses to claim, please list them on the lines below.

Name and Address of Day Care:

______________________________________________________________________________ ______________________________________________________________________________ EIN (Employer Identification Number) of Day Care or SS# (if it’s an individual person):

______________________________________________________________________________ Name(s) of child(ren) that day care was provided for:

______________________________________________________________________________ ______________________________________________________________________________

If more than one child, please list the amount paid in day care for each child:

________________________________________________________________________ ________________________________________________________________________ Total Amount Paid in Day Care Expenses: _____________________________________________

Student Loan Information:

Any interest paid on a student loan by Taxpayer? If so, amount paid last year:

_____________________________________________________________________________________ Any interest paid on a student loan by Spouse? If so, amount paid last year:

_____________________________________________________________________________________

Tuition Expenses:

If you, your spouse, or any of your dependents attended a secondary school, we need the name, address and amount that you paid for education last year. If paid by loans, this also counts. We also need to know what year they were attending.

Name of the School: ____________________________________________________________ Address: ______________________________________________________________________ Amount of Tuition: _____________________________________________________________ Year: Freshman Sophomore Junior Senior

How Did You Want to File Your Tax Return? (Please circle the one you choose)

E-File

– We will call you when your return is completed and you can then come in, pay for it and sign the e-file papers and we will then transmit your tax return. You will get your refund mailed to your house or directly deposited into your checking or savings account within 2 weeks—you can check the schedule in the waiting room for the approximate date.

- Refund Mailed: _________

- Refund Direct Deposited: _________ If Direct Deposited:

Will the account be a Checking or Savings account? (Please circle choice)

Name of Bank: ___________________________________________________________ Account Number: _________________________________________________________ Routing Number: _________________________________________________________

R.A.C.

–The charge for our preparation is deducted from your refund amount. Your refund can be directly deposited into a bank account, have the check delivered to the office, or you can have your refund put on a debit card (see below for the details about the debit card). YOU MUST HAVE AN

APPOINTMENT FOR THIS OPTION.

Western Union Debit Card

– You can have your refund put on a debit card. No credit check or bank account is required. You receive the card during your appointment time BUT the refund is not loaded on it as of yet; the refund will be loaded onto it within 7-10 days (about as fast as direct deposit). YOU

MUST HAVE AN APPOINTMENT FOR THIS OPTION.

Paper Return

– (You mail in both Federal and State portions of your returns). Your refund, if any, will be mailed to your house in an average of 6-8 weeks or directly deposited into your account, whichever you choose. The return will be treated as a C.O.D.—payment will not be due until preparation of forms is completed. You will get a call when forms are completed and payment is due.

*WARNING: The IRS is frowning on paper returns. They want them all to be electronically filed. Also with New York State, you will have to pay an additional fee for a mailed return.*

Would you like Audit Shield Protection? (Audit Shield is an extended three-year warranty on your

$24.95 but Audit Shield pays up to $2,500 for certain penalties, interest, or additional taxes assessed by the IRS.) YES NO

Additional Questions:

Did you or your spouse receive any of the following?

Unemployment YES NO

(Long form) Gambling winnings YES NO

(Long form) Payment for Jury Duty YES NO

(Long form) 1099-C YES NO

(Long form) 1099-S YES NO

(Long form) 1099-A YES NO

(Long form) 1099-Misc. YES NO

Do you own a home? YES NO

If so, do you have a mortgage? YES NO (Long form) Do you own your own business? YES NO (Long form) Do you own rental property? YES NO Did you buy a new home before July 1, 2011 and were in the armed services? YES NO

If so, how much did you purchase your home for? ____________________________ What was the closing date? __________________________

(Long form) - Did you purchase any energy upgrades for your home, such as furnaces/boilers, central air conditioning, insulation, windows, doors, or skylights? YES NO Are you or your spouse a volunteer firefighter or ambulance worker? YES NO

If so, what is the name and address of the company?

(Long form) Did you receive Alimony? YES NO If so, how much for the last year? __________________________

(Long form) Did you pay Alimony? YES NO If so, what is the name and Social Security Number of the recipient?

______________________________________________________________________________ ______________________________________________________________________________ Amount paid in the last year: ______________________________________________________ If you are a teacher, do you have unreimbursed expenses you are writing off? YES NO

If so, how much? ________________________________________

Did you or your spouse put money into an IRA for last year? Or will you by April 15th of this year? YES NO If so, how much? ________________________________________________________________ Did you or your spouse receive Social Security for 2010? YES NO

If so, and you did not bring in the form, how much did you receive monthly?

______________________________________________________________________________ Do you have any interest earned from a bank account that you did not get a 1099-INT from?

YES NO

If so, how much? ________________________________________________________________ What School District do you live in? ________________________________________________________

(PLEASE SIGN HERE)