Having this information in advance will alllow us to serve you in the most efficient and effective manner possible.

Transcription

1 660 Patrick Place Brownsburg, IN FAX West Oak Street Zionsville, IN FAX Welcome to Storen Financial! We are glad you chose us for your tax planning and preparation needs. As a family-run business with more than 50 years of experience, we strive to provide professional tax preparation at a reasonable price and in a welcoming setting. Our educated, personable staff is ready to help you navigate the process. We want you to feel at ease. While you are here, please enjoy a hot cup of coffee, our public wifi and our children s play area. We know your time is precious, so we encourage you to mail, , fax or drop off the following documents in advance of your appointment: Your tax returns from the last 2 years The new client information sheet Your supporting documents for the current return Having this information in advance will alllow us to serve you in the most efficient and effective manner possible. Our website has a wealth of information and resources for you. Look for sheets on how to value your goodwill donations, links to help you track your refunds and up-to-date tax information on our blog. To keep your documents accessible to you, we have a secure Client Portal, accessible from our website, that allows you to retrieve your tax returns anytime. We also offer a full range of small business services from payroll to bookkeeping to audit representation and more. With CPAs, MBAs and IRS Enrolled Agents on staff we are ready to assist you any way we can. Please contact us with your questions we are here year-round to serve you! Sincerely, The Team at Storen Financial P.S. Follow us on INVEST Financial Corporation, member FINRA/SIPC, and its affiliated insurance agencies offer securities, advisory services and certain insurance products and are not affiliated with Storen Financial. INVEST does not provide tax and accounting advice.

2 storenfinancial new client information filing status check box that best describes your situation on the last day of the year. single can someone else claim you as a dependent? yes no I don t know married filing joint married at year end or lost spouse during year married filing separate married at year end and not including spouse s income on return head of house not married/legally separated AND you supported a child, dependent, or relative supported person s name ssn qualifying widow(er) lost spouse within past 2 years and have dependent child(ren) need help in determining what my best option is. Let s talk about it. tax payer social security # first name & m.i last name occupation date of birth / / date of death / / preferred phone ( ) ext. name preferred to be addressed by alternate phone ( ) Cell Home Work Cell Home Work county of residence Jan. 1of tax year county of employment Jan. 1 of tax year school distict spouse social security # first name & m.i last name occupation date of birth / / date of death / / preferred phone ( ) ext. Cell Home Work name preferred to be addressed by alternate phone ( ) Cell Home Work county of residence Jan. 1of tax year county of employment Jan. 1 of tax year home mailing address street city/state/zip address for correspondence dependent information first name last name (if different) date of birth social security # relationship lives with taxpayer (yes/no) direct deposit information bank name routing # acct # account type: checking savings signature of person completing form 11/10/2016

3 660 Patrick Place Brownsburg, IN [ZIONSVILLE] 334/116th St. [CARMEL] 86th St West Oak Street Zionsville, IN FAX I-74 [BROWNSBURG] I-65 Michigan Rd. Meridian St. I th St. [AVON] 36/Rockville Rd. [DOWNTOWN] I-70 SR 267/Green St. I-70 N [PLAINFIELD] Airport Meridian St. I-65 I-465 BROWNSBURG ZIONSVILLE WALMART Northfield Drive I-74 BILL ESTES FORD STOREN FINANCIAL 1630 WEST OAK STREET [CVS] Oak Street [BOONE VILLAGE] Green St./267 K-MART Patrick Place POST OFFICE STOREN FINANCIAL 660 PATRICK PLACE 56th St. [POST OFFICE] [ZIONSVILLE] Ford Rd. N Zionsville Rd. Northfield Dr. Main St./136 N [BROWNSBURG] INVEST Financial Corporation, member FINRA/SIPC, and its affiliated insurance agencies offer securities, advisory services and certain insurance products and are not affiliated with Storen Financial. INVEST does not provide tax and accounting advice.

4 660 Patrick Place Brownsburg, IN West Oak Street Zionsville, IN What should I bring to my tax appointment? FAX storen@storenfinancial.com Tax returns from the past 2 years if this is your first visit W-2s Distributions from IRAs, Annuities, 401ks (1099-R) Interest and dividend income (1099-INT and/or 1099DIV) Stock sales with cost basis (1099-B) Mortgage interest statement (1098) Property taxes paid Contributions to charities Income and expenses for your business Any other income received (ex. Social Security SSA 1099; rent; gambling winnings) Closing papers from home sale/purchase Closing papers from mortgage refinance Auto registration cards for excise tax Student loan interest paid College tuition paid Unreimbursed expense for your job Mileage for work, charity, or medical K-1s from corporations/investments/partnerships Insurance forms (1095) For information and resources: INVEST Financial Corporation, member FINRA/SIPC, and its affiliated insurance agencies offer securities, advisory services and certain insurance products and are not affiliated with Storen Financial. INVEST does not provide tax and accounting advice.

5 AFFORDABLE CARE ACT (Obamacare) Client Questionnaire: CAUTION: The Affordable Care Act is an important part of your tax return for This questionnaire must be answered accurately. If there are any questions on how to complete this questionnaire please address them with your preparer. Client Name: 1) Were you (and your family if applicable) covered by health insurance Circle one: Yes No and/or Medicare for any month of 2016? 2) If you had health insurance or Medicare coverage, mark the months covered. If you were covered for a full year, please indicate by marking Full Year in the first column below. Taxpayer Spouse Dependent 1 Dependent 2 Dependent 3 Full Year Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec 3) If you did not have health insurance every month of 2016, did you apply for or qualify for an exception to the penalty or an exemption from coverage?* Circle one: Yes No N/A *if you re uncertain or need assistance answering this, please indicate by checking this box: 4) Do you have a dependent for whom someone else is court ordered to carry health insurance on that dependent? Circle one: Yes No N/A 5) Did you or any family member purchase insurance from the marketplace? (healthcare.gov you should have received Form 1095-A) Circle one: Yes No N/A 6) Did you or any family member change health plans during the year? (changed jobs, canceled existing policy, added to someone else s plan, etc.) Circle one: Yes No N/A Client Initial: Date: / / Preparer Initial: Date: / /

6 storenplus program coverage for tax year client name The storenplus program (spp) is a program you may enroll in to prevent any additional charges associated with your Storen Financial prepared Tax Return after the original return filing. Our fees for post-filing representation are not included in the tax preparation fees. Charges for post-filing representation may arise from, but are not limited to: Amendment of your return; Response to a letter received from a taxing agency, such as the Internal Revenue Service or the Indiana Department of Revenue; Audit representation, and/or; Other situations that may arise after the original filing of the return. In the event you choose not to enroll in the storenplus program and post-filing representation is required, fees for representing you will be charged at our standard hourly rates plus expenses incurred for the services provided. The current hourly rates charged by Storen Financial Group for post-filing representation are as follows: audit representation... $120/hour general correspondence... $60/hour amendments $60 minimum fee If post-filing representation is required as a result of an error made by Storen Financial Group, there will be no additional charges assessed. You will, however, be responsible for any additional taxes owed. Storen Financial Group will cover penalties and interest assessed as a result of the error. annual storenplus program cost: Individual..... $2 0 Individual with Schedule C (Small Business), E (Rental Property or K-1), F (Farm) $40 Individual with multiple security sales on Schedule D $40 Corporations and Partnerships..... $60 please check the appropriate line and sign below: yes, I wish to participate in the storenplus program and acknowledge the cost of the program will be added directly to my tax preparation invoice. no, I do not wish to participate in the storenplus program and acknowledge that I will be billed an additional fee for all post-filing representation by Storen Financial Group. signature date *** ** printed social security number If at any time a fraud or criminal investigation begins, we may withdraw from the engagement, and a recommendation to an attorney specializing in such matters will be made.

7 name: (please print) Engagement Letter & Questionnaire This letter is to confirm and specify the terms of our engagment with you and to clarify the nature and extent of services we will provide. In order to ensure an understanding of our mutual responsibilities, we ask all clients for whom returns are prepared to confirm the following arrangements. We will prepare your 2016 federal and state income tax returns from information which you will furnish to us. We will not audit or otherwise verify the data you submit, although it may be necessary to ask you for clarification of some of the information. It is your responsibility to provide all the information required for the preparation of complete and accurate returns. This applies also to the following questionnaire in that each question has been answered correctly. You should retain all the documents, cancelled checks and other data that form the basis of income and deductions. These may be necessary to prove the accuracy and completeness of the returns to a taxing authority. You have the final responsibility for the income tax returns and therefore you should review them carefully before you sign them. The law provides various penalties that may be imposed when taxpayers understate their tax liability. If you would like information on the amount of the circumstances of these penalties, please contact us. Your returns may be selected for review by the taxing authorities. Any proposed adjustments by the examining agent are subject to certain rights of appeal. In the event of such government tax examination, we will be available upon request to represent you and may render additional invoices for the time and expenses incurred*. Our fee for these services will be based upon the amount of time required at standard billing rates plus out-of-pocket expenses. All invoices are due and payable upon presentation. (*Unless you are enrolled in the Storen Plus program. Ask your preparer for information.) We want to express our appreciation for this opportunity to work with you. Personal information yes no Other than a spouse, does another person financially support you? Were there any changes in dependents from the prior year? Did you sell, exchange, purchase or lease any real estate during the year? Did you foreclose or abandon a principal residence or real property during the year? Did you have any debts canceled or forgiven this year? Did you pay any student loan interest this year? Did you make any withdrawals from an IRA, Roth, Keogh, SIMPLE, SEP, 401(k), 403(b), or other qualified retirement plan? Did you use your Health Savings Account (HSA) for any reason? Did you receive any unemployment benefits during the year? Did your receive any awards, prizes, hobby income, gambling or lottery winnings? Do you have any foreign accounts or assets (real estate, pension, investments)? Did you receive an Identity Protection PIN from the Internal Revenue Service or have you been a victim of identity theft? I (we) agree that the above data is correct for the 2016 tax return, and I (we) acknowledge I (we) have the records to support the data furnished for the preparation of the tax return. Also, I (we) am (are) citizen(s) of and have lived in the United States for at least half the tax year. Taxpayer: Spouse : Date: Date: