INCOME TAX QUESTIONNAIRE

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INCOME TAX QUESTIONNAIRE

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Tax > Tax Forms

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INCOME TAX QUESTIONNAIRE, Income Tax, Income Tax Return, Business

Income Tax, Income Tax Department, Personal Income Tax, Tax Forms, Ohio
income tax, city tax, Social Security number

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12/11/2008

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INCOME TAX QUESTIONNAIRE Last Name Home Phone Your Name Age Work
Phone Spouses Name Age Work Phone Home Address Your Social Security
Number Spouses Occupation Spouses Birth Date Spouses Cell Phone Spouses
Email address DEPENDENTS Name Birth Date Social Security Relationship #
Months In Number Your Home This Year INCOME T/S Employer Wages Federal
Social Medicare State W/H Security T T T TOTALS 0 $0.00 $0.00 $0.00 $0.00
IRA / PENSION DISTRIBUTIONS: T/S Source Amount Rec Federal W/H State
W/H T T INTEREST INCOME DIVIDEND INCOME Received From Amount
Received From Ordinary Qualified Cap Gain Partnership, Estate, Trust, Small
Business Corporation Income: (Please Bring Schedule K-1 Received From
Each) Other Income (Please Bring Copies Of 1099’s) State Tax Refund
Received Alimony Received Social Security Benefits Received: You Spouse
Unemployment Compensation Received: You Spouse Do You Have Business
Income? Select One If Yes Please Bring All Books And Records. Did You Sell
Any Property During The Year? Select One If Yes Please Bring All Records Of
The Sale. If you or any of your dependents attended college, please supply us
with the amount of tuition you paid plus what year of college they are in. THE
INFORMATIONCONTAINED HEREIN IS, TO THE BEST OF MY KNOWLEDGE,
CORRECT AND COMPLETE. TAXPAYER: ____________________________ DATE:
_________________________ SPOUSE: ____________________________ DATE:
_________________________ ITEMIZED DEDUCTIONS MEDICAL EXPENSES
CONTRIBUTIONS Prescription Churches/Cash/ETC. Drugs/Doctors/Dentist/ Non
Cash Contributions Hospital/Laboratory If Over $500 State Date Donated, To
Whom, & Fair Market Value ETC. Health Insurance Travel Miles Salvation
Army Other: Goodwill TAXES CASUALTY LOSS State Income Tax Paid Total
Casualty Loss Real Estate Tax Advalorem Tax MISCELLANEOUS Union Dues
INTEREST Dues & Subscriptions Home Mortgage Tax Preparation Fees Home
Equity Loans Safe Deposit Box Mort Insurance Prem Small Tools Home
Mortgage Paid To Individuals Safety Equipment Show To Whom Paid, Address
& ID # Uniforms & Upkeep Job Hunting Expenses IRA Fees CHILD CARE SHOW
TO WHOM PAID, ID# OF EACH AND AMOUNT PAID TO EACH PROVIDER: Name
Address ID Number Amount Paid DEPENDENT INFORMATION FOR CHILD
CARE: (SHOW HOW MUCH PAID PER CHILD) Name of Child Cared For Amount
Paid For This Child EXPLANATIONS AND COMMENTS: IF YOUR RETURNS
SHOWS A REFUND DUE, WOULD YOU LIKE DIRECT DEPOSIT OF YOUR
REFUND? Yes IF YES, PLEASE ENTER THE FOLLOWING: NAME: ACCOUNT
NUMBER: RTN # WOULD YOU LIKE FOR YOUR COPY OF YOUR TAX RETURN TO
BE EMAILED TO YOU? Select One WOULD YOU LIKE FOR YOUR
QUESTIONNAIRE TO BE EMAILED TO YOU NEXT YEAR? Select One IF YES,
VERIFY EMAIL: IF YOU REFINANCED YOUR HOME DURING THE YEAR, PLEASE
BRING THE CLOSING STATEMENT AND OTHER DETAILS OF THE
TRANSACTION. C & S ACCOUNTING AND TAX SERVICE 982 MT. ZION RD.
MORROW, GA. 30260 770-961-4456 Fax 770-961-4367 Email:
csaccountingandtax.com BUSINESS OR PROFESSIONAL INCOME AND
EXPENSE Name of Proprietor Business Name Business Address Business
Activity Did You “Materially Participate” In This Business This Year? Select
One Did You Incur Any Expenses For An Office In Your Homes This Year?
Select One Gross Receipts or Sales LESS: Returns and Allowances Other
Income: Beginning Inventory Purchases (Less Cost of Personal Use Items)
Labor Costs Materials and Supplies Inventory at the End Of Year BUSINESS
DEDUCTIONS: Advertising Repairs Bad Debts Supplies Car & Truck Expenses
Taxes Freight Meals & Entertainment Insurance Utilities & Phone Mort Int Pd
to Fin Inst Wages Other Interest Other Expenses: Legal & Professional Office
Expense Rent (Mach & Equip) Rent (Other Bus Prop) LIST ANY MAJOR
PURCHASES OF BUSINESS PROPERTY DURING THE YEAR Description Date
Acquired Cost VEHICLE INFORMATION VEHICLE 1 VEHICLE 2 Total Miles
Driven During The Year Total Business Miles Driven This Year Total
Commuting Miles Driven This Year Was the Auto Available for Personal Use
During Off Duty Hours? Select One Is Another Auto Available For Personal
Use? Select One Do You Have Evidence To Support Deduction? Select One Is
it Written? Select One OFFICE IN HOME EXPENSES: If you are Claiming
Expenses For An Office In The Home, Please Fill Out The Following: Did You
Use The Space Regularly And Exclusively As An Office? Select One Total
Square Footage Of The Office Or # Of Rooms Used Total Square Footage Of
The Home Or Total # Of Rooms Used Cost Of Home Insurance Repairs
Utilities ESTIMATED TAXES: If You Paid Any Federal Or State Estimated Tax
Payments During The Year, Please Complete the Following: Federal State
DATE PAID AMOUNT PAID DATE PAID AMOUNT PAID 1st Quarter 2nd Quarter
3rd Quarter 4th Quarter

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