Tax Preparation Questionnaire

        Daytime Telephone #_______________________________


E-Mail Address__________________________________________


Name: ___________________________________________________________________________________________________________


Client PIN # 5 Random Digits or Philip Selects

T/P________________            Spouse_________________                                                                            



Personal Information: YES  /  NO

1. Did your marital status change during the year? _____ _____

2. Will the address on your current returns be different a prior years returns? ____    ____

3. Did you retire or change jobs during the year? ____    ____

4. Were you notified by IRS or other taxing authority of any changes in prior year? ____    ____

5. Have you or your spouse been a victim of identity theft and have you contacted the IRS?____    ___

Income, General

1. Do you have any income from the following list; if yes how many?

Wages (W-2), ____ _____

Social Security Income (1099SSA), _____ _______

Interest Income (1099 Int),   _____      ______

Dividends Income (1099 Div)  ____    ____

Retirement Income (1099 R)  _____      _____

Capital Gains (Brokerage Statement) ______      ______

Gambling Income (W2G) _____     ______

Government Payments (1099G) _____     ______

Miscellaneous Income (1099 Misc) ______     ______

2. Did you receive deferred retirement or severance compensation? ____    ____

3. Do you receive or pay alimony? ____    ____

4. Do you have income from self-employment? ____    ____

5. Do you have rental income? ____    ____



1. Were there any changes in dependents from prior years?____    ____

2. Did you pay for childcare while you worked or looked for work?____    ____

3. Do you have any children under age 24 with unearned income more than $2,100?____    ____

4. Are any of your dependents required to file a tax return?____    ____


1. Did you have healthcare coverage (health insurance) for you, your spouse and any dependents?  If Yes, include all Forms 1095-A, 1095-B and 1095-C?____    ____

2. Did you or your spouse have any transactions pertaining to a health savings account (HSA) or (MSA)? If you received a distribution from an HSA or MSA, include all Forms 1099-SA. ____    ____

3. Did you or your spouse receive any distributions from long-term care insurance contracts? If Yes, include Form 1099-LTC. ____    ____

4. Did you or your spouse lose your job because of foreign competition and pay for your own health insurance?         ____    ____

Purchase Sales and Debts:

1. Did you sell exchange or purchase any real estate (Including Home) during the tax year? (Closing statement required) (Form 1099) ____    ____

2. Did you sell an existing business, rental property, farm or any existing interest in a Partnership or S-Corporation during the tax year ____    ____

3. Did you sell or convert any stocks, bonds, options or mutual funds? (1099B Required) ____    ____   

4. Did you engage in any put or call transactions or did you close any short sales during the tax year?____    ____

5. Did you sell any securities not reported on Form 1099B? ____    ____

6. Did you receive any grants of stock options from your employer, exercise any stock options granted to you or dispose of any stock acquired under a qualified employee stock purchase plan? ____    ____     

7. Did you have any debts canceled, forgiven, or refinanced during the year? ____    ____

Itemized Deductions:

1. Did you contribute property other than cash to charity with a FMV more than $5000? ____    ____

2. Do you have receipts for your charitable contributions? ____    ____

3. Did you make any large purchases such as motor vehicle or boat? ____    ____

4. Did you pay real estate or personal property taxes?  _____    _____

4. Did you incur any large medical bills (more than 7% of your income) during the year? (Including long term care)?  ____    ____

5. Did you pay any Student Loan Interest for yourself, spouse or your dependent during the year? ____    ____

6. Did you pay home mortgage on Equity Loan Interest? (Form 1098)(indicate # of form 1098) ____    ____

7. Did you refinance home mortgage, home equity or other loans? ____    ____

8. Do all of your Mortgages Exceed 1 million dollars? ____    ____

9. Did you incur any casualty or theft losses during the year?  ____    ____


IRA/ROTH IRA’S/ Educational IRA’s:

1. Did you contribute to any IRA’s, including ROTH IRA or convert to a Roth IRA?  ____    ____

2. Did you receive a distribution from an IRA or qualified retirement plan during the tax year? (Form 1099-R)        ____    ____

3. In 2010 did you or your spouse convert an IRA into a Roth IRA during the tax year? ____    ____

4. Did you or your spouse turn age 70 ½ during the year and have money in an IRA or other retirement account

   without taking any distribution? ____    ____


1. Did you or your dependents incur any post-secondary education expenses such as tuition? (Form 1098-T)    ____    ____

2. If you deduct business use of vehicle, do you maintain a log? ____    ____

3. Did you make gifts of more than $15,000 to any individual? ____    ____

4. Did you pay an individual for domestic services performed in your home, greater than $1,900? ____    ____

5. Did you receive unreported tip income of $20 or more in any month, not reported to employer? ____    ____

6. Have you received a punitive damage award? ____    ____

7. Did you purchase a new alternative technology vehicle, including plug-in electric? ____    ____

8. Did you install any energy equipment in you residence in 2019 (Solar, Wind, Windows, Heat Pump) etc _____ _____

9. Were you displaced or did you suffer casualty losses as a result of Federally Declared Disaster? ____    ____

10. Did you or your spouse claim a homebuyer credit for a home purchased in 2008? ____    ____

Sharing Economy: (If yes, provide documentation)

1. Did you engage in any bartering transaction? ____    ____

2. Did you engage or incur expenses associated with car sharing (e.g., Lyft,or  Uber)?

   If yes, attach Form 1099-MISC and Form 1099-K ____    ____

3. Did you receive income or incur expenses associated with freelancing (e.g., Upwork or TaskRabbit)?

   If yes attach Form 1099-K ____    ____

4. Did you receive or incur expenses associated with a short-term rental (e.g., Airbnb or HomeAway)    ____    ____

5. Did you receive income or incur expenses associated with crowdfunding (e.g., Kickstarter or Indiegogo)

    If yes, attach Form 1099-K. ____    ____

. Did you receive income or incur expenses associated with fashion sharing (e.g., Poshmark) _____     ____

Foreign Income and Taxes:

1. Were you or your spouse a grantor or transferor for a foreign trust, have an interest in or a signature or other authority over a bank account, securities account, or other financial account in a foreign country? ____    ____

2. Do you or your spouse own any foreign financial assets? ____    ____

3. Did the aggregate value of foreign accounts exceed $10,000 at any time during the year? _____    _____

4. Did you have any foreign income or pay foreign taxes?  ____    ____

5. Did you perform any work outside of the US? ____    ____



1.  Total purchases outside of MA during the year, subject to Mass. Sales/Use Tax ___________

2.  Rental Deduction information:

    Name of Landlord: ____________________________ Rent Paid $___________

3.  MA Health Care Insurance Form MA-1099HC REQUIRED ____    ____

4.  Fast Lane cost if more than $150 in 2018 or MBTA Commuter pass. ____    ____

5.  Do you have MBTA Pass for dependent student?____    ____

7.  Did you do Lead paint removal? ______ ______