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First Name
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Last Name
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Spouse First Name (if applicable)
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Spouse Last Name (if applicable)
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Did your address change, or do you need to update contact information (phone, email)?
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Do you and/or your spouse want to designate $3 to the Presidential Election Campaign Fund?
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Did any births, adoptions, marriages, separations, divorces, deaths or changes to occupation or filing status occur related to you, your spouse or any of your dependents for 2019?
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Please provide details here
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Do you have dependents? (Someone you supported more than 50% in 2019)
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Did you incur adoption expenses or adopt a U.S. child that the state has determined to have special needs?
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Did you have changes to dependents in 2019?
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Enter dependent changes here, including full name, SSN, birth date, and relation
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Did any of your dependents have unearned income of $1,100 or more ($350 if self-employed)? If yes, we need their tax information to prepare your child’s tax return. Note that unearned income can no longer be included on the parent’s tax return.
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Are you entitled to claim a dependent due to a divorce decree?
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Did any dependent child 19-23 years of age attend school full time for less than five months during the year?
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Did you pay an individual or an organization to perform services for the care of a dependent?
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Did you pay any household employee over age 18 wages of $2,100 or more?
If yes, provide a copy of form W-2 issued to each household employee.
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Did you make ANY Estimated Payments?
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Enter estimated payment details here. Provide copies of checks or other confirmation.
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Did you receive ANY income other than what is shown on the documents you provide to us? (Legal proceedings, cancellation of student loans or other indebtedness?
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Please provide details here
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Do any of the following apply to you?
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Explain above answers if any box was checked
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Did you make gift(s) to any person that total more than $15,000 this year? The gift(s) could have been made directly, indirectly or to a trust.
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Please provide details here
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Did you have ANY foreign financial activity or hold any foreign assets in 2019?
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Did you have an interest in specified foreign financial assets valued at more than $50,000 on the last day of the tax year or more than $75,000 at any time during the tax year? Please include assets not previously listed for FinCEN 114 reporting.
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Did you have any interest in, or signature or other authority over, a bank, securities or other financial account in a foreign country? If yes and the aggregate value of all of your accounts exceeded U.S. $10,000 at any time during the year, provide source documents.
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Did you have foreign income, pay any foreign taxes that are not reflected on an enclosed 1099, or file any foreign information reporting or tax forms?
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Please provide details
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Were you the grantor, transferor or beneficiary of a foreign trust?
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Did you and all members of your household maintain minimum essential health coverage for all months of 2019? Minimum essential coverage includes employer-sponsored health insurance coverage, Medicare, Medicaid or Tricare
Please provide form 1095 (A, B or C)
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Do you have a retirement plan such as a 401(k), IRA, or SEP?
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Did you receive any distribution from an IRA or other qualified plan that was partially or totally rolled over into another IRA or qualified plan within 60 days of the distribution (Form 1099-R and proof of rollover)?
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If you received an IRA distribution, which you did not roll over, provide details (Form 1099-R).
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Did you convert IRA funds or any other qualified retirement plan funds into a Roth IRA? If yes, provide details (Form 1099-R).
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Did you, or do you plan to, contribute money before April 15, 2020, to a traditional or Roth IRA for the last calendar year?
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If you or your spouse have self-employment income, do you want to make a retirement plan contribution?
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If over age 70 ½, did you or your spouse make a contribution from your IRA directly to a charitable organization?
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Do you have a health savings account?
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Did you, or do you plan to, contribute money before April 15, 2020 to a health savings account (HSA) for the last calendar year?
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Did you receive any distributions from an HSA?
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Did you own a home in 2019?
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Did you sell or purchase a principal residence or other real estate? If yes, provide the settlement sheet (Closing Disclosure) and Form 1099-S.
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Did you refinance any existing loans on your home or other real estate you own? If yes, provide the settlement sheet (Closing Disclosure).
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Did you purchase or make any energy-efficient improvements such as an electric vehicle or home improvements?
Including energy-efficient home improvements / purchased and placed into service; solar, fuel cell, wind energy, etc
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Provide details here
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Can the IRS and state tax authority discuss questions about this return with the preparer?
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Did you or any of your dependents receive a Federal IP PIN from the IRS or have you been a victim of identity theft, either in 2019 or in prior years? If you received an IP PIN, provide a copy of the IRS notice.
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Do you want your refund issued as a direct deposit, or to pay your balance due using direct withdrawal?
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Enter details here:
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Did you own a rental property in 2019?
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Did you purchase or convert property you already owned to rental property? If yes, provide the settlement sheet (Closing Disclosure).
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Description and location of property:
(if different from 2018)
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How many days was the property used personally during the year?
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How many days was the property rented during the year?
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Did you participate in the operation of the rental property during the year? Note that both requirements must be met by you (and not combined with your spouse’s activity) to qualify as a real estate professional.
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Did you maintain separate books and records with respect to each property?
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Did you make any payments during the year that would require you to file Forms 1099?
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Did you file Forms 1099?
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Select the following that apply to you and ensure we receive copies of the forms/documents related to each
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Do you have any qualifying medical or dental expenses? Please note that medical expenses must exceed 10% of adjusted gross income to be deductible as an itemized deduction.
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Premiums for health and accident insurance including Medicare
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Long-term care premiums
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Medicine and drugs (prescription only)
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Doctors, dentists, nurses
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Hospitals, clinics, laboratories
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Eyeglasses/corrective surgery
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Ambulance
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Medical supplies/equipment
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Hearing aids
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Lodging and meals related to healthcare
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Travel related to healthcare
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Mileage related to healthcare
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Long-term care expenses
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Payments for in-home care (complete later section on home care expenses)
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Other
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Insurance reimbursements received
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Were any of the above expenses related to cosmetic surgery?
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Did you make any cash or non-cash contributions or incure expenses through volunteer work?
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Contributions
Cash contributions for which you have receipts, canceled checks, etc. Note: You need to have written acknowledgment from any charity to which you made individual donations of $250 or more during the year.
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Expenses incurred in performing volunteer work for charitable organizations
Parking fees and tolls, supplies, meals and entertainment, other (itemize), automobile mileage
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Other than cash contributions (enclose receipts):
Organization name and address, description of property, date acquired, how acquired, cost or basis, date contributed, fair market value (FMV), how FMV determined
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Did you, your spouse or any dependent attend school for which you paid tuition or incurred expenses?
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Did you receive a 1099-Q? If yes, was it for educational purposes?
If yes, was it for educational purposes?
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Did you start a new business in 2019?
Email us immediatly with this information if yes, otherwise you may miss a filing deadline
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Comments/explanations/questions to any of the above questions
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Please list all entities for which we are to prepare tax returns
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The Legal Stuff
2019 INCOME TAX PREPARATION ENGAGEMENT LETTER-This letter is to confirm our understanding of the terms and objectives of our engagement and the nature and limitations of the services we will provide. We will perform our services in accordance with the Statements on Standards for Tax Services issued by the American Institute of Certified Public Accountants. Scope of Engagement: We will prepare the 2019 federal and state income tax returns that you have indicated in the questionnaire. We will not prepare any other tax returns without your written authorization to do so. We will prepare your tax returns based on information and representations that you provide to us. We will not audit or otherwise verify the data you submit to us, although we may ask you to clarify some of the information. We will prepare the tax returns solely for filing with the Internal Revenue Service ("IRS") and state and local tax authorities. They are not intended for third-party use, either to obtain credit or for any other purpose. As a result, you agree to indemnify and hold our firm and any of its partners, principals, shareholders, officers, directors, members, employees, agents or assigns harmless with respect to any and all claims arising from the use of the tax returns for any purpose other than filing with the IRS and state and local tax authorities regardless of the nature of the claim, including the negligence of any party. Client Responsibilities We will provide you with an income tax organizer to help you gather and document the information we will need to prepare your income tax returns. It is your obligation to complete the tax organizer with accurate and complete information, including all worldwide income. You are responsible for determining your state or local tax filing obligations with any state or local tax authority, including, but not limited to income, sales, use, and property taxes. You agree that we have no responsibility to research these obligations or to inform you of them. If upon reading the completed tax organizer, it comes to our attention that you may have an obligation to file additional income tax returns, we will notify you of this in writing and ask you to contact us. If you ask us to prepare these returns, we will confirm this in a letter and detail the additional charges for this service. You should retain all documents that provide evidence and support for reported income, credits, and deductions on your returns as required under tax law. You are responsible for the adequacy of all such documents. Our working papers, including any copies (digital or otherwise) of your records, are our property and are not a substitute for your own records. You agree that in the event your return cannot be completed by the due date, it may become necessary for us to apply to extend the due date. Extensions are required when we do not receive information needed to prepare a return on a timely basis and if there are unresolved tax issues or delays in processing. Applying for an extension of time to file may extend the time available for a taxing authority to undertake an audit of your return or may extend the statute of limitations. Additionally, extensions may affect your liability for penalties and interest or compliance with government deadlines. We are available to discuss this matter with you at your request at our regular hourly fee should the need arise. You have final responsibility for the income tax returns. Check them carefully for accuracy and completeness before you sign them. CPA Firm Responsibilities: We will use our judgment to resolve questions in your favor where a tax law is unclear if there is reasonable justification for doing so. Whenever we are aware that a possibly applicable tax law is unclear or that there are conflicting interpretations of the law by authorities (e.g., IRS and courts), we will explain the possible positions that may be taken on your return. We will follow the position you request, provided it is consistent with our understanding of the current tax code, regulations, and their interpretations. If the IRS or state tax authorities later contest the position taken, there may be an assessment of additional tax, interest, and penalties. We assume no liability for and you hereby release us from any such additional tax, interest, and penalties or other fees and assessments. Our engagement does not include any procedures designed to discover fraud, theft or other irregularities, should any exist. Our engagement does not include tax-planning services, which are available as a separate engagement. During the course of preparing the tax returns identified above, we may bring to your attention certain available tax saving strategies (such as available credits, deductions, or deferrals) for you to consider as possible means of reducing your income taxes in subsequent tax years. However, we have no responsibility to do so, and will take no action with respect to any such recommendations, as the responsibility for implementation remains with you, the taxpayer. This engagement does not include responding to inquiries by any governmental agency or tax authority. If your tax return is selected for examination or audit, you may request that we assist you in responding to such inquiry. We will render additional invoices for the time and expenses incurred. You agree that you will not and are not entitled to rely on any advice unless it is provided in writing. If you provide our firm with copies of brokerage (or investment advisory) statements, we will use the information from these statements solely in connection with the preparation of your income tax returns. We will rely on the accuracy of the information provided in the statements and will not undertake any action to verify this information. We will not monitor investment activity, provide investment advice, or supervise the actions of the entity or individuals performing investment activities on your behalf. We recommend that you receive and review all brokerage (or investment advisory) statements promptly and carefully, and direct any questions regarding activities on your account to your broker (or investment advisor). This engagement for the preparation of your 2019 income tax returns will end upon delivery to you of your 2019 federal and state tax returns for your review and filing with the appropriate taxing authorities. Penalties and Interest Charges: The law provides various penalties that may be imposed when taxpayers understate their tax liability. If you would like more information on the amount or the circumstances of these penalties, please contact us. Fee and Billing: Your payment for services is due upon initial delivery of the tax return(s) for review. We will not file any tax returns until payment is made in full. Our fee will be based upon our current demand, complexity of the work to be performed and the availability, quality, and completeness of your records. You agree that you will deliver all records requested to complete this engagement on a timely basis. You agree to review and pay all bills promptly. Amounts past due over 30 days incur a late charge of $25 per month until balance is paid in full. If we decide to seek collection of any past due bill, you agree to pay all reasonable costs of collection, including, but not limited to, attorney's fees and costs, and the interest set forth above, whether or not the matter is actually litigated. We reserve the right to withdraw from this engagement without completing the returns if you fail to comply with the terms of this engagement letter or as we determine professional standards require. In the event that any portion of this engagement letter is deemed invalid or unenforceable, said finding shall not operate to invalidate any other part of this engagement letter.
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