2020 Individual Tax Questionnaire

The following questions pertain to the 2020 tax year. For any question answered Yes, include supporting detail or documents.
Personal Information:
Did your marital status change?
YesNo
Are you married?
YesNo
If Yes, do you and your spouse want to file separate returns?
YesNo
If No, are you in a domestic partnership, civil union, or other state-defined relationship?
YesNo
Can you or your spouse be claimed as a dependent by another taxpayer?
YesNo
Did you or your spouse serve in the military or were you or your spouse on active duty?
YesNo
Dependents:
Were there any changes in dependents from the prior year? Note: Include non-child dependents for whom you provided more than half the support.
YesNo
Did you or your spouse pay for child care while you or your spouse worked or looked for work?
YesNo
Do you have any children under age 18 with unearned income more than $1,100?
YesNo
Do you have any children age 18 or student children, aged 19 to 23, who did not provide more than half of their cost of support with earned income and that have unearned income of more than $1,100?
YesNo
Did you adopt a child or begin adoption proceedings?
YesNo
Are any of your dependents non-U.S. citizens or non-U.S. residents?
YesNo
Healthcare:
Did you obtain healthcare coverage through the Marketplace? If Yes, include all Forms 1095-A.
YesNo
If you received advance premium tax credit, are married, and are filing separately from your spouse, are you a victim of domestic abuse or spousal abandonment?
YesNo
Did you, your spouse, or a dependent have healthcare purchased through the Marketplace and for whom you did not receive Form 1095-A?
YesNo
Did you receive Form 1095-A for someone claimed as a dependent on another taxpayer's return or who is filing their own return and is not claimed as a dependent on another taxpayer's return?
YesNo
Are any of your dependents required to file a tax return?
YesNo
Was anyone covered on your health insurance policy also covered on another health insurance policy for any part of the year?
YesNo
Were you eligible for employer-sponsored healthcare coverage?
YesNo
Did you or your spouse have any transactions pertaining to a health savings account (HSA)? If you received a distribution from an HSA, include all Forms 1099-SA.
YesNo
Did you or your spouse have any transactions pertaining to a medical savings account (MSA)? If you received a distribution from an MSA, include all Forms 1099-SA.
YesNo
Did you or your spouse receive any distributions from long-term care insurance contracts? If Yes, include all Forms 1099-LTC.
YesNo
If you or your spouse are self-employed, are you or your spouse eligible to be covered under an employer's health plan at another job?
YesNo
If Yes, how many months were you covered?
Number of months
If you or your spouse are self-employed, are you or your spouse eligible to be covered under an employer's long-term care plan at another job?
YesNo
If Yes, how many months were you covered?
Number of months
Education:
Did you or your spouse pay any student loan interest?
YesNo
Did you or your spouse withdraw any amounts from your IRA to pay for higher education expenses incurred by you, your spouse, your children or grandchildren?
YesNo
Did you or your spouse withdraw any amounts from a Coverdell Education Savings Account or Qualified Education Program (Section 529 plan)? If Yes, include all Forms 1099-Q.
YesNo
Did you or your spouse make any contributions to a Qualified Education Program (Section 529 plan)?
YesNo
If Yes, provide the following:
Name of Designated Beneficiary    1
Social Security Number   2
Account Number   3
2020 Amount Contributed   4
Did you, your spouse, or your dependents incur any post-secondary education expenses, such as tuition?
YesNo
Deductions and Credits:
Did you or your spouse contribute property (other than cash) with a fair market value of more than $5,000 to a charitable organization? If Yes, provide the appraisal of property contributed. An appraisal is not required for contributions of publicly traded securities or contributions of non-publicly traded stock of $10,000 or less.
YesNo
Did you or your spouse incur any casualty or theft losses?
YesNo
Did you or your spouse make any large purchases, such as motor vehicles and boats?
YesNo
Did you or your spouse incur any casualty or loss attributable to a federally declared disaster?
YesNo
Did you or your spouse purchase a new alternative technology vehicle, including a qualified plug-in electric drive motor vehicle?
YesNo
Did you or your spouse use gasoline or special fuels for business or farm purposes (other than for a highway vehicle)?
YesNo
If Yes, provide the number of gallons of gasoline or special fuels used for off highway business purposes. Gallons Type
Did you or your spouse install any alternative energy equipment in your residence such as solar water heaters, solar electricity equipment (photovoltaic) or fuel cells?
YesNo
Did you or your spouse install any energy efficiency improvements or energy property in your residence such as exterior doors or windows, insulation, heat pumps, furnaces, central air conditioners, or water heaters?
YesNo
Investments:
Did you or your spouse have any debts canceled, forgiven or refinanced?
YesNo
Did you or your spouse start or purchase a business, rental property, or farm, or acquire any new interest in any partnership or S corporation?
YesNo
Did you or your spouse sell an existing business, rental property, farm, or any existing interest in a partnership or S corporation?
YesNo
Did you or your spouse sell, exchange, or purchase any real estate? If Yes, include closing statements.
YesNo
Did you or your spouse receive grants of stock options from your employer, exercise any stock options granted to you or your spouse or dispose of any stock acquired under a qualified employee stock purchase plan?
YesNo
Did you or your spouse engage in any put or call transactions? If Yes, provide the transaction details
YesNo
Did you or your spouse close any open short sales?
YesNo
Did you or your spouse sell any securities not reported on Form 1099-B?
YesNo
Retirement or Severance:
Did you or your spouse contribute to a Roth IRA or convert an existing IRA into a Roth IRA?
YesNo
Did you or your spouse roll into a Roth IRA any distributions from a retirement plan, an annuity plan, tax shelter annuity or deferred compensation plan?
YesNo
Did you or your spouse turn age 70 1/2 and have money in an IRA or other retirement account without taking any distribution?
YesNo
Did you or your spouse make a qualified charitable contribution?
YesNo
Did you or your spouse retire or change jobs?
YesNo
Did you or your spouse receive deferred, retirement or severance compensation?
YesNo
Yes, enter the date received (Mo/Da/Yr).
MonthDayYear
Date
Personal Residence:
Did your address change?
YesNo
If Yes, provide the new address.
New Address
If Yes, did you move to a different home because of a change in the location of your job?
YesNo
Did you or your spouse claim a homebuyer credit for a home purchased in 2008?
YesNo
Did you or your spouse withdraw any amounts from your Individual Retirement Account (IRA) or Roth IRA to acquire a principal residence?
YesNo
Are your total mortgages on your first and/or second residence greater than $750,000?
YesNo
If Yes, provide the principal balance and interest rate at the beginning of the year Principal Balance Interest Rate and end of the year blank 5
Did you or your spouse take out a home equity loan?
YesNo
Did you or your spouse have an outstanding home equity loan at the end of the year?
YesNo
If Yes, provide the principal balance and interest rate at the beginning of the year Principal Balance Interest Rate and end of the year blank 6
Are you claiming a deduction for mortgage interest paid to a financial institution and someone else received the Form 1098?
YesNo
Did you or your mortgagee receive mortgage assistance payments? If Yes, include all Forms 1098-MA.
YesNo
Sale of Your Home:
Did you sell your home?
YesNo
Did you receive Form 1099-S? If Yes, include Form 1099-S.
YesNo
Did you or your spouse own and occupy the home as your principal residence for at least two years of the five-year period prior to the sale?
YesNo
Did you or your spouse ever rent out the property?
YesNo
Did you or your spouse ever use any portion of the home for business purposes?
YesNo
Have you or your spouse sold a principal residence within the last two years?
YesNo
At the time of the sale, the residence was owned by the
TaxpayerSpouseBoth
Gifts:
Did you or your spouse make any gifts, including birthday, holiday, anniversary, graduation, education savings, etc., with a total (aggregate) value in excess of $15,000 to any individual?
YesNo
Did you or your spouse make any gifts of difficult-to-value assets (such as non-publicly traded stock) to any person regardless of value?
YesNo
Did you or your spouse make any gifts to a trust for any amount?
YesNo
Do you or your spouse have a life insurance trust?
YesNo
Did you or your spouse assist with the purchase of any asset (auto, home) for any individual?
YesNo
Did you or your spouse forgive any indebtedness to any individual, trust or entity?
YesNo
Foreign Matters:
Did you or your spouse perform any work outside of the U.S. or pay any foreign taxes?
YesNo
Were you or your spouse a grantor or transferor for a foreign trust, have any interest in or a signature authority over a bank account, securities account or other financial account in a foreign country?
YesNo
Did you or your spouse create or transfer money or property to a foreign trust?
YesNo
Did you or your spouse own any foreign financial assets?
YesNo
Were you or your spouse subject to the transition tax on undistributed foreign income and elect to pay the tax in installments?
YesNo
Did you or your spouse have an interest in an S corporation that had undistributed foreign income subject to the transition tax?
YesNo
Did you or your spouse have an interest in an S corporation that had undistributed foreign income subject to the transition tax?
YesNo
If Yes, did the corporation cease to be an S corporation?
YesNo
If Yes, was there a sale or liquidation of substantially all of the corporation's assets or did the corporation cease business?
YesNo
If Yes, did you or your spouse transfer any share of stock in the corporation?
YesNo
Miscellaneous:
Did you or your spouse pay in excess of $1,000 in any quarter, or $2,100 during the year for domestic services performed in or around your home to individuals who could be considered household employees?
YesNo
Did you or your spouse receive unreported tip income of $20 or more in any month?
YesNo
Have you or your spouse received a punitive damage award or an award for damages other than for physical injuries or illness?
YesNo
Did you or your spouse engage in any bartering transactions?
YesNo
Did you or your spouse engage in any bartering transactions?
YesNo
Were you or your spouse notified by the IRS or other taxing authority of any changes in prior year returns?
YesNo
For any trust that you or your spouse created or are trustee, did any beneficiaries, grantors, or trustees die or move?
YesNo
Did you or your spouse sell, acquire, or exchange Bitcoin or other virtual currencies or engage in any sales or exchanges denominated in Bitcoin or other virtual currencies?
YesNo
Did you or your spouse receive an economic impact payment?
YesNo
If Yes, enter the amount of any economic impact payment received 7
If yes, did you or your spouse repay any of the economic impact payment received?
YesNo
If Yes, enter the amount of any economic impact payment received 8
Taxpayer:
Name
First Name and InitialLast Name
Social Security Number
Occupation
Date of Birth (Mo/Da/Yr)
MonthDayYear
Date
Date of Death (Mo/Da/Yr)
MonthDayYear
Date
Driver's License or State Issued ID Number
Expiration Date (Mo/Da/Yr)
MonthDayYear
Date
Does not expire
Issue Date (Mo/Da/Yr)
MonthDayYear
Date
State
Type of ID
Driver's LicenseState-Issued IDNo Identification
Taxpayer Daytime/Home Phone
Taxpayer Evening/Home Phone
Taxpayer Cell Phone
Taxpayer Email Address
example@example.com
Spouse:
Name
First Name and InitialLast Name
Social Security Number
Occupation
Date of Birth (Mo/Da/Yr)
MonthDayYear
Date
Date of Death (Mo/Da/Yr)
MonthDayYear
Date
Driver's License or State Issued ID Number
Expiration Date (Mo/Da/Yr)
MonthDayYear
Date
Does not expire
Issue Date (Mo/Da/Yr)
MonthDayYear
Date
State
Type of ID
Driver's LicenseState-Issued IDNo Identification
Spouse Daytime/Work Phone
Spouse Evening/Home Phone
Spouse Cell Phone
Street Address
Apartment Number
City
State
ZIP or Postal Code
Spouse Email Address
example@example.com
May the IRS or other taxing authority discuss the return with the preparer?
YesNo
Is the taxpayer claimed as a dependent on someone else's tax return?
YesNo
Are you considered legally blind per IRS regulations?
YesNo
Do you want to contribute to the Presidential Election Campaign Fund?
YesNo
Are you a U.S. citizen or Green Card holder?
YesNo

Federal Estimated Tax Payments:
Amount Due Check # Date Paid Amount Paid
2020 1Q(due 7-15-20)
2020 2Q(due 7-15-20)
2020 3Q(due 9-15-20)
2020 4Q(due 1-15-21)
If you have an overpayment of 2020 taxes, do you want the excess: Refunded:
YesNo
Applied to your 2021 estimated tax liability
YesNo

State
State & City Estimated Tax Payments:
Amount Due Check # Date Paid Amount Paid
2020 1Q(due 7-15-20)
2020 2Q(due 7-15-20)
2020 3Q(due 9-15-20)
2020 4Q(due 1-15-21)
State
State & City Estimated Tax Payments:
Amount Due Check # Date Paid Amount Paid
2020 1Q(due 7-15-20)
2020 2Q(due 7-15-20)
2020 3Q(due 9-15-20)
2020 4Q(due 1-15-21)
If you have an overpayment of 2020 taxes, do you want the excess: Refunded:
YesNo
Applied to your 2021 estimated tax liability
YesNo
State
State & City Estimated Tax Payments:
Amount Due Check # Date Paid Amount Paid
2020 1Q(due 7-15-20)
2020 2Q(due 7-15-20)
2020 3Q(due 9-15-20)
2020 4Q(due 1-15-21)
If you have an overpayment of 2020 taxes, do you want the excess: Refunded:
YesNo
Applied to your 2021 estimated tax liability
YesNo
Should be Empty:

	Amount Due	Check #	Date Paid	Amount Paid
2020 1Q(due 7-15-20)
2020 2Q(due 7-15-20)
2020 3Q(due 9-15-20)
2020 4Q(due 1-15-21)