2023 Tax Client QuestionnaireIf you're a new or returning client please fill out the questionnaire below. You can save your progress and close the form and return at any time. Step 1 of 7 14% Taxpayer InformationTaxpayer Name(Required) First Middle Last Taxpayer Email(Required) Primary Phone(Required)Secondary PhoneTaxpayer Address(Required) Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Taxpayer Occupation(Required) Taxpayer Driver's License Number(Required) What Country is Your Driver's License Issued in?(Required) United States/US Territories Canada Other Taxpayer Driver's License State(Required)AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces PacificTaxpayer Driver's License Province(Required)AlbertaBritish ColumbiaManitobaNew BrunswickNewfoundland and LabradorNorthwest TerritoriesNova ScotiaNunavutOntarioPrince Edward IslandQuebecSaskatchewanYukonTaxpayer Driver's License Issue Date(Required) Month Day Year Taxpayer Driver's License Expiration Date(Required) Month Day Year Taxpayer Social Security Number(Required) Taxpayer Birthdate(Required) Month Day Year Spouse?(Required) Yes No Spouse Name(Required) First Middle Last Spouse Birth Date(Required) Month Day Year Spouse Social Security Number(Required) Spouse PhoneSpouse Email Spouse Occupation(Required) Spouse Driver's License Number(Required) Spouse License Issue Date(Required) Month Day Year Spouse License Expiration Date(Required) Month Day Year Spouse License Country United States/US Territories Canada Other Spouse License State(Required)AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces PacificSpouse License Province(Required)AlbertaBritish ColumbiaManitobaNew BrunswickNewfoundland and LabradorNorthwest TerritoriesNova ScotiaNunavutOntarioPrince Edward IslandQuebecSaskatchewanYukon Dependent InformationNumber of Dependents?(Required)0123456Dependent 1 Name(Required) First Middle Last Dependent 1 SSN(Required) Dependent 1 Birthdate(Required) Month Day Year Dependent 1 Gender(Required) Male Female Dependent 2 Name(Required) First Middle Last Dependent 2 SSN(Required) Dependent 2 Birthdate(Required) Month Day Year Dependent 2 Gender(Required) Male Female Dependent 3 Name(Required) First Middle Last Dependent 3 SSN(Required) Dependent 3 Birthdate(Required) Month Day Year Dependent 3 Gender(Required) Male Female Dependent 4 Name(Required) First Middle Last Dependent 4 SSN(Required) Dependent 4 Birthdate(Required) Month Day Year Dependent 4 Gender(Required) Male Female Dependent 5 Name(Required) First Middle Last Dependent 5 SSN(Required) Dependent 5 Birthdate(Required) Month Day Year Dependent 5 Gender(Required) Male Female Dependent 6 Name(Required) First Middle Last Dependent 6 SSN(Required) Dependent 6 Birthdate(Required) Month Day Year Dependent 6 Gender(Required) Male Female What is your filing status?(Required) Single (S) Married filing jointly (MFJ) Married filing separate (MFS) Head of Household (HOH) Qualifying surviving spouse (QSS) Do you want $3 to go to the Presidential Election Campaign Fund?(Required) No Yes If your bank is in the US, do you want to use direct deposit to get a refund?(Required) Yes No Bank Name(Required) Account Type Checking Savings Account Number(Required) Routing Number(Required) Income InformationDid you receive wage income (W-2)?(Required) Yes No Did you receive interest or dividends (1099-INT, 1099-DIV)?(Required) Yes No Did you have a business or self-employment (1099-NEC)?(Required) Yes No Did you sell an asset such as stocks, property, house, etc. (1099-B, 1099-S)?(Required) Yes No Did you receive or roll over retirement funds (1099-R, SSA-1099)?(Required)For example, an IRA, 401K, 403B, pension, Social security, etc. Yes No Did you receive rental income from a house, farm, etc. (1099-MISC)?(Required) Yes No Did you receive unemployment income (1099-G)?(Required) Yes No Did you receive other income, e.g. royalties, prize, jury duty, etc.(1099-MISC)?(Required) Yes No Did you receive corporate or partnership income (K-1)?(Required) Yes No Did you have gambling winnings (W-2G)?(Required) Yes No Income AdjustmentsWere you a classroom teacher and had educator expenses for the classroom?(Required) Yes No Did you have a Health Savings Account (1099-SA)?(Required) Yes No I don't know Were all distributions for qualified medical expenses?(Required) Yes No I don't know Did you contribute to a retirement fund other than through your job?(Required) Yes No I don't know Did you have subsidized health insurance through the Marketplace (1095-A)?(Required) Yes No I don't know Did you pay student loan interest (1098-E)?(Required) Yes No I don't know Did anyone in your immediate family have college or trade school expenses (1098-T)?(Required) Yes No I don't know Did you have long-term care insurance (nursing home insurance)?(Required) Yes No I don't know Deductions and CreditsDid you pay daycare for dependents?(Required) Yes No Did you make energy efficient upgrades to your US residence?(Required) Yes No I don't know Did you have any medical expenses post-tax?(Required)(insurance/doctor/dentist/vision/prescriptions/hospital/miles)? Yes No I don't know Did you pay real estate or personal property taxes?(Required)(insurance/doctor/dentist/vision/prescriptions/hospital/miles)? Yes No I don't know Did you pay mortgage interest?(Required) Yes No I don't know Did you have any charitable contributions? Cash/Check/Credit Card Payments Non-cash (used items given to non-profits) Miscellaneous QuestionsDid you buy a home or refinance?(Required) Yes No Did you pay any state or federal estimated quarterly taxes (different than withholding)?(Required) Yes No I don't know Are you the owner or signer of a foreign financial account or the grantor to a foreign trust?(Required) Yes No I don't know Does an FBAR need to be filed?(Required) Yes No I don't know Should I file the FBAR?(Required) Yes No I don't know During the year, did you acquire or sell any interest in virtual currency(Required)(Bitcoin, ETH, etc) Yes No I don't know Did you pay sales tax on all online purchases?(Required) Yes No I don't know Did you have a Qualified Charitable Distribution (QCD) from a retirement account?(Required) Yes No I don't know Clients Outside the USDo you live in a foreign country outside the United States?(Required) No Yes Did you spend any time in the United States during the last tax year (2023)?(Required) Yes No List specific dates you spent in the United States during the last tax year (2023)(Required) NameThis field is for validation purposes and should be left unchanged.
