This Questionnaire is one of the FIVE Minimum Tax Packet Items Page 1 of 7 Taxpayer Names This short questionnaire covers most of the tax reporting areas that I need to know about to prepare accurate tax returns for you. For any area not addressed here, please write out notes for me. It is very important that you actually include details for all of the Yes Answers. If, for example, I ask if you funded a 529 Plan, and you check Yes, I need to know how much, for which student and all the details. ~~~~~ This questionnaire is not intended to have enough space for your answers; please enclose details. NOTES Please use this space for any questions you have. Retirement considerations, IRA distributions, taxable Social Security Yes, please discuss with me Converting IRAs to ROTH IRAs Household employee filing requirements College savings accounts and options Extension of time to file tax returns - IRS allows until 16 October 2017 Rental or Vacation Home Transactions Planning for taxes for 2017, changes in W-4, preparation of ES quarterlies Thank You Joan Lizbeth Mashburn
Page 2 of 7 GENERAL QUESTIONS YES NO 1. Did any births, adoptions, marriages, divorces or deaths occur in your immediate family last year? If yes, provide details. 2a. Do you have a different address than reported on your last return? If so, correct the address and phone number on page 1 of the Tax Organizer. Date of Move (Part-year state tax returns may apply.) 2b. If yes, was your move over 50 miles and related to work? NA 3. Do you wish to have $3 ($6 Joint Return) of your taxes applied to the Presidential Campaign Fund? This does not affect your total refund. 4. Did you receive any letters (other than refund forms 1099G) from IRS or State authorities about prior years' returns? If so, please send copies to me, if not already sent. 5. Did you receive income from any legal proceedings, cancellation of student loans or cancellation of other indebtedness? If yes, provide details. 6. Did a lender cancel any of your debt in 2016? (Enclose any 1099A/1099C forms) 7. Have you updated your will or trust in the last 3 years? The selection of a Personal Representative or Trustee is very important. Make sure your Representative has my name and contact information. CHILDREN Children with investment income under $2,000 can be included on parents' returns. Working children, and kids with high investment income or sales of stock or mutual funds, may need to file their own return. 8. Do you have children under age 19, or a full-time student under age 24, with investment income over $2,000? 9. If yes, do you want to include your child's income on your tax return? Maybe? 10. Do you have child-care expenses for children under age 13 that enable you to work or attend school full-time? Provide all details including provider's name, address, EIN, telephone, and amount paid. 11. Did any dependents 19-23 years of age not attend college, or attend college for less than 5 months, during 2016? EDUCATION College expense reporting is critical. If you or your children are in college, you may qualify for college tax deductions or credits. If you pay for tuition with 529 plans, I will need to match up costs with the funds pulled out by calendar year. Please provide details for all college costs, including tuition, room and board, and required fees. 12. Did you contribute to a college savings plan in 2016? Provide full details of beneficiaries, state plan, account number, and total amount funded, or send plan documents.
13. Did you, or any other member of your family, pay any education expenses this year for college? If so, provide student's name, institution, degree sought, year of study, amount and dates paid. Send 1098-T forms. 14. Was any of the tuition paid with funds from a 529 Plan or educational IRA? NA If so, send history of tuition payments and 529 distributions. Send 1098-T and 1099-Q forms. YES Page 3 of 7 NO WORK & RETIREMENT 15. Did you fund an IRA, ROTH IRA, SEP IRA, Pension or Solo 401K Plan for 2016? Provide details for plans that are not reported on your W-2 or K-1 forms. Provide all IRA, ROTH IRA and SEP IRA Fair Market Value amounts at 12/31/16. 16a. Do you want to fund additional amounts to IRAs, ROTHs or SEP IRAs for 2016? Maybe? 16b. Do you want to make an IRA payment for your nonworking spouse, if allowed? Maybe? If you circle "Maybe?", I will help you decide. IRAs and ROTH IRAs have a 15 April 2017 deadline. Extended tax returns will not allow more time to fund these. If you need to extend your tax return and want to take advantage of an IRA or ROTH IRA for 2016, please call me now. 17. Did you receive stock from a stock bonus plan not included in your W-2? 18. Were you granted any stock options or restricted stock? 19. Did you exercise any stock options? 20. If you have travel and entertainment deductions, do you have adequate NA records to support the amount, time and place, date, business purpose description of the gifts and business relationship of recipient? 21. Do you or your spouse plan to retire in 2017? HEALTH CARE 22. If you are covered by Medicare, is the premium paid by Social Security NA directly? If not, please list the amount you paid for Medicare for each taxpayer. 23a. Are your health insurance premiums paid by your employer or former employer? 23b. If so, are these pre-tax? Not sure? HSA & MSA are NOT the same as FSAs (Flexible Spending Accounts)! HSAs are special, high-deductible health plans. 24a. Did you contribute to or receive distributions from a HSA (health savings account) or MSA (medical savings account)? Include 1099-SA and details. 24b. Do you plan to contribute to these plans before 15 April 2017 for tax year 2016? 25. Complete ACA - Health Care Coverage Information Form on the next page. I cannot complete your 2016 tax return without this information.
A If you are participating in the Marketplace, you will get a Exemption Control Number reported on 1095-A. I need this form to complete filing. B C ACA Health Care Coverage Information page 4 of 7 PLEASE COMPLETE All individuals must have health care coverage, have an exemption, or pay a shared responsibility payment (penalty) with their tax return. Please send me any FORMS 1095, 8962 or 8965. If you have health coverage directly through a provider like an insurance company, you should get a 1095-B. Please send it to me. These are due to taxpayers 2 March 2017. Certain employers that offer health care known as "self-insured coverage" will issue you Form 1095-C. If you have one, please enclose it. These are due to taxpayers 2 March 2017. FIRST NAMES List First Names of taxpayer, spouse, all children and dependents. Covered by Employer Provided Health CHECK PROPER BOX for FULL 12 MONTHS INSURANCE COVERAGE in 2016 Covered by Retiree Health Plan Covered by Medicare Pay Self- Employment Health Not Covered Part Year NOTES If not covered for some months of 2016, or not covered at all, please explain. I may need to ask more questions later. This information will help me report for ACA properly and also help with medical premiums deductions you may be eligible for. If you pay for your health insurance on your own (not through payroll or retirement pre tax deductions), be sure to tell me how much you spent in 2016 in the organizer medical section or here.
26. Do you have medical expenses to deduct? If so please list. Medical deductions must exceed 10% of your adjusted gross income unless one taxpayer is 65 or older, then you can use the 7.5% limit. If you are unsure if you have enough, please estimate expenses and I will discuss this write-off with you and get more details later. YES Page 5 of 7 NO 27. Did you pay out-of-pocket for health care insurance, dental insurance, and/or long-term care (LTC) insurance in 2016? Please give me totals paid for taxpayer and spouse. Typically, employers provide health insurance, and pay a portion of the premium. The employee portion is usually pre-tax and is reported on your W-2 form. If you paid for all or part of your health insurance premiums yourself, provide amounts of premiums for each taxpayer and dependent. Identify amounts paid for Health, Dental, and LTC individually. HOUSE 28. Did you refinance any mortgage, or sell or purchase any property? Send any and all 2016 HUD-1 settlement sheets. 29. Did you pay more than $1,000 per quarter or $1,900 per year for domestic services? Send W-2 form and state unemployment payment amount. (If we prepared these forms, I already have them here for you.) 30. Did you make energy-efficient improvements to your home or purchase energy-saving property? If yes, send copy of invoice and details. Note: Life-time $500 limit applies--you may have used this already. FOREIGN 31a. Did you have more than $10,000 in foreign accounts any time during 2016? If so, I need to report this fact on your income tax return and you need to complete the FBAR which is due along with tax returns, 15 April 2017. In addition, foreign investment income is taxable. Please include all worldwide income. 31b. Do you want me to complete any FBAR FinCEN Form 114 that is required? NA 32. Do you own any foreign retirement accounts, stock, life insurance products, or partnership interests overseas? Provide details if amounts are over $50,000 for single filers or $100,000 married. All income from any foreign asset is taxed by IRS in the US. Please always include interest, dividend, rental and profit income in your list of items to report on 1040. We also need account numbers, names of banks and street addresses. 33. Do you own, directly or indirectly, more than 10% of a foreign corporation? 34. Are you an officer or director of a foreign corporation? 35. Do you gamble online, including poker, and have transactions in excess of $10,000?
Page 6 of 7 GIFTS 36. Did you make any gifts exceeding $14,000 per person? (This includes funding college plans for your children in excess of $14,000 in one year.) 37. Are all of your charity donations supported by proper documentation? See Tax Organizer Instructions for charity guide. We will review the IRS status of your charitable organizations. YES NO ELECTRONIC PAYMENTS AND REFUNDS I efile all eligible returns. I highly encourage clients to use direct deposit. IRS and state tax authorities are known to lose checks, and our office must charge extra to help locate a lost check. 38a. If you receive a refund, would you like direct deposit of your refund? 38b. If you receive a refund, would you like it applied to 2017 taxes? Note: DC is currently not allowing direct deposit of refunds 39. If you owe, would you like your payment to be automatically withdrawn from the bank? 40. Would you like to schedule 2017 estimated tax payments to be automatically withdrawn from the bank? These can be cancelled later. If yes to any item 37-39, please provide a voided check. Retainer check to me may be used. (See signature line of engagement letter.) You can choose to file electronically and pay by check, but you still have to get the check to the post office, so I do not recommend this mix. WRAP-UP QUESTIONS 41. Were you a resident of, or did you have income in, more than one state during the year? Please list states and identify the income. 42. Do you have any deductions that you don't know where to report? Be sure to note any items you wish to discuss with us. 43. Do you have any other income that you don't know where to report? Be sure to report alimony, tips, bartering income, disability, gambling and lottery winnings, jury duty pay, and unemployment compensation. List any item you are not sure about. 44. Are there any IRS forms like 1099s or K-1s that you are still waiting on for 2016? Please list.
2016 TAX PAYMENTS Page 7 of 7 Federal State Due Date Date Paid Amount Date Paid Amount Q1 04/18/16 Q2 06/15/16 Q3 09/17/16 Q4 01/16/17 Additional For Existing Clients - we have the following detail already, but it really helps to confirm. Federal State 2015 overpayment applied to 2016 Balance paid with 2015 return 2015 4Q payments paid in 2016 2015 extension payment paid in 2016 Other prior year taxes paid in 2016 2017 ESTIMATED TAXES Use this space to comment on 2017 changes to your residence, dependents, income, deductions, investments that might involve taxes. 1 If you regularly pay estimated quarterly payments, do you want to schedule 2017 taxes at the safe harbor level? 2 List any significant changes in your wages or self employment for 2017. 3 If you are over age 70 1/2, I can help you with the RMD (Required Minimum Distributions) for 2017. Do you want me to help you calculate your RMD and related income tax withholding? If so, provide all year end statements showing Fair Market Value for IRA, SEP IRA and related accounts. 4 List any significant changes in your capital gains for 2017. 5 List any new sources of other income for 2017. 6 List any significant changes in your deductible expenses for 2017.