Tax Preparation Agreement and Privacy Disclosure January, 2018 Dear Client: This letter serves to confirm our engagement with you, and to clarify the nature and extent of the tax preparation services we will provide. Sign and return this Agreement to us. Using the information you provide us, we will prepare your 2017 federal and resident state income tax return. Please indicate below any additional returns you would like prepared by checking the following boxes (if applicable): Local Income Tax Return Non-Resident State Income Tax Return for: Additional return(s), such as PA Rent Rebate/FBAR/etc: You are responsible for determining filing requirements outside the scope of the engagement, and for preparation of all returns not included in this Tax Preparation Agreement. If this document fairly sets forth your understanding, sign this letter in the space indicated and return to it to our office. Signature: Date: 2018 Print Name: Spouse Signature: Spouse Print Name: 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. We have worksheets to guide you in gathering information to help keep pertinent information from being overlooked. You agree that the information you are supplying to us is accurate and complete to the best of your knowledge, and that you have records as required by law to support your information. You should retain all documents pertaining to your income and deductions. These records may be necessary to prove the accuracy of the returns to a taxing authority. You have the final responsibility for the income tax returns; 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. These penalties can be substantial. If you have questions on the amount or the circumstances of these penalties, please contact us.
We will use professional judgment in resolving questions where the tax law is unclear. Unless otherwise instructed by you, we will resolve such questions in your favor whenever possible. You must review the return and sign it or sign an E-file authorization form before the return can be sent to the government. We are not responsible for the length of time it takes the IRS to process your return. Our fees for tax services are based on the number and complexity of the tax forms required, as well as any additional time spent to summarize, research or gather information in phone calls, meetings or other correspondence. This time is billed at $70 - $125 per hour. The returns may be selected for review by the taxing authorities. Any proposed adjustments are subject to certain rights of appeal. In the event of such tax notices or government tax examination, we will be available upon request to represent you at an additional cost. 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. Sincerely, Beacon Tax Services PRIVACY DISCLOSURE Under the Gramm-Leach-Bliley Act of 1999, financial institutions must provide their customers with a clear and conspicuous notice about their privacy policies and practices; the conditions under which they disclose nonpublic personal information about consumers to nonaffiliated third parties; and how consumers can prevent the disclosure of their information. You already may have received such notices from the banks and brokerage firms with which you do business. Following the passage of this legislation, the Federal Trade Commission (FTC) issued details rules on these privacy notices, including to whom they should apply. In those roles, the FTC defined financial institutions to include all those who provide financial or investment advisory services. In turn, the FTC rules chose to broadly interpret financial or investment advisory activities to cover tax planning and tax preparation. In compliance with the FTC rules, printed below is our firm s current Privacy Disclosure Statement. Be assured that this firm has always considered our professional relationship with you to be one requiring the utmost trust and confidence. Please do not hesitate to call us if you have any questions whatsoever above this notice. Beacon Tax Services does not disclose any nonpublic personal information about our clients, without permission, to anyone except (1) as absolutely required by law or (2) as needed by our employees to provide services or products to you or (3) if you choose to utilize our secure email (NeoCertified), the emails may be viewed by Geneos Wealth Management. We maintain physical, electronic, and procedural safeguards that comply with federal regulations to guard your nonpublic personal information. If you have any concerns about the disclosure of your personal information to a third parties, or wish to stop any disclosure that has been noted above, you may call the following number (610) 385-4500 or write to: Beacon Tax Services, 978 Ben Franklin Highway, Douglassville, PA 19518.
TAX ORGANIZER RETURNING CLIENTS: Only fill out CHANGES to information on this page. NEW CLIENTS: Fill out this page completely. We NEED A COPY OF YOUR 2016 TAX RETURN. Please answer ALL questions on the next 4 pages. GENERAL INFORMATION First Name Middle Initial Last Name Jr./Sr. Social Security Number Date of Birth TAXPAYER SPOUSE Home Phone Number Work Phone Number Cell Phone Number Legally Blind Yes No Yes No Totally Disabled Yes No Yes No Does anyone claim you as a dependent? Yes No Yes No Occupation Email Address State of Residence as of 12/31/17 County of Residence as of 12/31/17 School District as of 12/31/17 Municipality of Residence If moved, dates of residency at each address: to to ADDRESS Street: Apt/Suite: City: State: Zip Code: Foreign Country: Foreign Province/County: Foreign Postal Code:
DEPENDENTS (INDICATE ANY WHO DID NOT LIVE WITH YOU) *You will need to provide a birth certificate or proof of residency. Name (First, Last) Relationship Date of Birth Social Security Number Months Lived with You Disabled Full Time Student Dependent s Gross Income FILING STATUS & PAYMENT 1. Single 2. Married filing joint 3. Married filing separately (Enter spouse s name and SSN above) 4. Head of Household (Non-Dependent Name: Non-Dependent SSN: 5. Qualifying widow(er) with minor child. (Year spouse died ) If you are due a refund, how do you want to receive it? Please check one. Check sent by mail Direct Deposit to my Bank Account Circle Account Type: Checking Savings Please provide voided check Apply to next year s estimated tax If you owe taxes, how do you want to pay them? Please check one. Check sent by mail Direct Debit from my Bank Account Circle Account Type: Checking Savings Please provide voided check MISCELLANEOUS INCOME Did you receive any income or have any expense related to the following: TIPS TAX EXEMPT INT SAVINGS BONDS TAX REFUNDS ALIMONY BUSINESS INCOME BARTERING SALE OF HOME/REALESTATE RENTAL INC/SALE OF RENTAL K-1 s (S-CORP PARTNERSHIP) K-1 s (ESTATE/TRUSTS) FARMING UNEMPLOYMENT YES NO YES NO PRIZES/JURY DUTY/ EXECUTOR GAMBLING DISABILITY LEGAL SETTLEMENTS FORECLOSURE/ BANKRUPTCY ANY DEBTS CANCELLED FOSTERCARE PAYMENTS CASH INCOME INCOME FROM OUT-OF-STATE AN ABLE ACCOUNT INSTALLMENT CONTRACT CASUALTY LOSS DIRECTOR FEES
BASIC INFORMATION (Attach extra details on a separate sheet of paper) YES NO 1. Did any births, adoptions, marriages, divorces, or deaths occur in your family last year? If yes, provide details, certificates, and/or decrees. 2. Did any of your dependents have income of $1,050 or more ($400 if self-employed)? 3. Did any of your children under age 19 (age 24 if a full-time student) have investment income over $2,100? 4. Are any dependent children married and filing a joint return with their spouse? 5. Did any dependent child age 19-23 attend school full time for less than five months during the year? 6. Did the IRS, or any state or local taxing agency notify you of changes to a prior year s tax return? Please provide copies of all notices or correspondence received. 7. Did you make any gifts during the year directly, or in trust, exceeding $14,000 per person? 8. Did you mine, buy, sell, or exchange a virtual currency; use a virtual currency to pay for goods or services; or receive a virtual currency as payment for goods or services? 9. Did you have any interest in, or signature, or other authority over a bank, securities, or other financial account in a foreign country? See DISC OF FOREIGN ASSETS worksheet. 10. Did you have foreign income, pay any foreign taxes, or file any foreign information reporting or tax return forms? Provide details. 11. Were you the grantor, transferor, or beneficiary of a foreign trust? 12. Do you wish to have $3 ($6 on joint return) of your taxes applied to the Presidential Campaign Fund? 13. Did you and all members of your household maintain minimum essential health coverage for all months of 2017? 1) If yes, enclose Form 1095-A, 1095-B, a statement of coverage from your employer, or a medical bill showing payment by an insurance company, an insurance card, or a Medicare card. 2) If no, but you and all members of your household were covered for a part of 2017, provide documentation showing the months covered. 14. If you or your household did not maintain minimum essential health coverage: 1) Were you offered coverage (through your or your spouse s plan) that you declined? 2) If yes, did the coverage offer minimum value and was it affordable? 3) Were you or any member of your household eligible for Medicare or Medicaid, but did not enroll? 15. Did you and your family receive any advance premium tax credits? yes, enclose form 1095-A 16. Were either you or your spouse eligible to participate in an employer s health insurance or long-term care plan? 17. Do you expect a large fluctuation in your income, deductions, or withholding next year? If yes, provide details. 18. Did you or your spouse withdraw amounts from your IRA to acquire a personal residence or pay for unreimbursed medical expenses or higher education expenses? If yes, provide details.
19. Did you convert traditional IRA funds into a Roth IRA? If yes, provide details (Form 1099-R). 20. If over age 70 ½, did you or your spouse make a contribution from your IRA directly to a charitable organization? 21. Do you want to make a traditional IRA contribution even if part or all of it may not be deducted? Provide a copy of the latest Form 8606 filed. 22. Do you want to make the maximum deductible IRA contribution? 23. In 2017, did you have any securities that became worthless or loans that became uncollectible? 24. Did you, or do you plan to, contribute money before April 17, 2018, to a Retirement Plan for last calendar year? If yes, provide details (note that some states may have earlier due dates, such as ME or MA). 25. Did you, or do you plan to, contribute money before April 17, 2018 to a health savings account (HSA) for the last calendar year? If yes, provide details. 26. Did you receive any distributions from an HSA? If so, provide details. 27. Did you incur expenses as an elementary or secondary educator? 28. Did you purchase an energy-efficient new vehicle? 29. Did you make any energy-efficient improvements (remodel or new construction) to your home? 30. Did you acquire or sell any qualified small business stock? 31. Were you granted, or did you exercise, any stock options? If yes, provide details. 32. Were you granted any restricted stock? If yes, provide details. 33. Did you pay any household worker, including a healthcare provider, (over age 18) more than $2,000? 1) If yes, provide a copy of form W-2 issued to each household employee. 2) If yes, did you pay total wages of $1,000 or more in any calendar quarter to all household employees? 34. Did you use the proceeds from series EE U.S. savings bonds purchased after 1989 to pay for higher education expenses? 35. Did you start or sell a business? If yes, provide details. 36. Did you purchase rental property? If yes, provide the settlement sheet (Closing Disclosure). 37. Do you have records to support entertainment or gift expenses? The law requires that adequate records be maintained for entertainment and gift expenses. Documentation should include the dollar amount, time and place, date, business purpose, description of gift(s) (if any), and business relationship of recipient(s). 38. Can the IRS and state tax authority discuss questions about this return with the preparer? 39. If you have been a victim of identity theft in prior years and have a federal IP PIN, please contact us. 40. Did you pay an individual or an organization to perform services for the care of a dependent under 13 years old, in order to enable you to work or attend school on a full-time basis?
41. Did you purchase items to use in your home state without paying sales tax on such items? EDUCATIONAL EXPENSES YES NO 42. Did you or any other member of your family pay any post-secondary educational expenses this year? If yes, provide Form 1098-T and payment summary from the school, receipts for books, and loan disbursement schedules. 43. Was any of the preceding tuition paid with funds withdrawn from an educational IRA or 529 plan? If yes, how much? $ submit Form 1099-Q. ESTIMATED TAX PAID *Include any payment in 2017 for 2016 tax year Due Date Date Paid Federal Amount State Amount DEDUCTIBLE TAXES (INCLUDE RECEIPTS) DESCRIPTION AMOUNT Real estate taxes: Primary residence Secondary residence Investment Real Estate Personal property or ad valorem taxes Sales tax on major items (auto, boat, home improvements, etc.) Other sales taxes paid (if applicable) MISCELLANEOUS DEDCUTIONS (INCLUDE DOCUMENTATION) DESCRIPTION AMOUNT Income tax preparation fees Legal fees (provide details) Safe deposit box rental (if used for storage of documents or items related to incomeproducing property) Employment agency fees Investment expenses paid with money outside of a retirement account Documented gambling losses Other miscellaneous deductions itemize