INDIVIDUAL TAX PREPARATION TAX RETURN CHECKLIST Please provide the following items for your tax return preparation: Signed ENGAGEMENT LETTER Completed INDIVIDUAL TAX QUESTIONNAIRE PAYMENT INFORMATION form Original or copied documents of information reported to the IRS: a. Wages, pension income (W-2) b. Rents, dividend, interest, non-employee compensation (1099) c. Retirement plan distributions (1099) d. Investment income (1099) e. Mortgage interest paid (1098) f. Income from partnerships, trusts, or S-corporations (K-1) Documents to support additional taxable income such as alimony, rent income, or selfemployment income not reported on 1099 Documents to support additional tax deductions such as medical expenses (if more than 10 % of gross income), charitable contributions (cash and non-cash). Closing statements for any real estate transactions. The ENGAGEMENT LETTER and INDIVIDUAL TAX QUESTIONNAIRE can be downloaded from our web site: www.kmlarsoncpa.com. You may also send an email to accounting@kmlarsoncpa.com and request the individual client forms. Please contact our office if you would also like a tax organizer listing your information to help you gather tax information for your tax return. If this is the first year we have prepared your tax return, we will also need the following: 1. Previous 3 years income tax returns 2. Social security numbers for taxpayer, spouse, and dependents (if not included in prior returns) 3. Birthdays for taxpayer, spouse, and dependents Information provided for the preparation of an income tax return will be retained as part of you client file. Original documents will NOT be returned to you unless requested. Please provide copies of original documents when possible. You may also fax to us at 801-606-7896 or upload to a secure client portal using our website. Please contact our office if you have questions about the information required to prepare your tax return: KM Larson & Company, PC Office: 801-571-1760 Fax: 801-606-7896 www.kmlarsoncpa.com Email: accounting@kmlarsoncpa.com
K.M. Larson & Company, P.C. Certified Public Accountants ENGAGEMENT LETTER INDIVIDUAL INCOME TAX RETURN Dear Client: This letter is to specify the terms of our engagement with you and to clarify the nature and extent of the 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 agreements: We will: 1. Prepare your federal and requested state income tax returns from information that you will provide. We will not audit or otherwise verify the data you submit, although it may be necessary to request clarification of some of the information. 2. Use professional judgment in resolving questions where the tax law is unclear, or where there may be conflicts between the taxing authorities interpretations of the law and other supportable positions. Unless otherwise instructed by you, we will resolve such questions in your favor whenever possible. 3. Represent you (at your request) if your return is selected for review by the taxing authorities. Any additional fees will be discussed at that time. 4. Prepare the tax returns solely for filing with the Internal Revenue Service (IRS) and state and local tax authorities. A. The tax returns we prepare are not intended to benefit or influence any third party, either to obtain credit or for any other purpose. As a result, we are not responsible for 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. B. Any representation by us to a third party regarding the tax returns will require additional written authorization from you and a minimum charge of $150 will apply to each representation whether written, verbal or electronic. You agree to: 1. Provide all the information required for the preparation of complete and accurate return in a timely manner. 2. Pay any tax due by the payment due date (April 16) and also be responsible for interest late payment penalties assessed on payments made after the due date, and any late filing penalties assessed. 3. Hold our firm and any of its shareholders, employees, or agents harmless from 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 negligence by any party. 4. Take final responsibility for the income tax returns and carefully review them for completeness and accuracy before they are filed Please verify that you understand the terms of our engagement by signing the in the space indicated and return it to our office. Tax Year: Taxpayer Name: Spouse Name: Signature: Signature: Date: Date: 12401 South 450 East, Suite B2 Draper, Utah 84020 (801) 571-1760 www.kmlarsoncpa.com
K.M. Larson & Company, P.C. Certified Public Accountants INDIVIDUAL INCOME TAX QUESTIONNAIRE Taxpayer name(s): Tax Year Person responsible for tax return: Address: 9 Same as last year Home Phone: Work Phone: Mobile Phone: Email Address: What is the best way to contact you? (You may check more than one) Home Work Mobile E-Mail Mail Do you want original documents returned to you? Yes No How do you want your client copy of the tax return delivered? (You may select more than one) pdf in secure internet portal paper copy If any of the following items pertain to you or your spouse for the tax year, please check the appropriate box and provide additional information if necessary. YES NO REQUIRED INFORMATION 9 9 Did you have any foreign income or pay any foreign taxes? 9 9 Did you receive a distribution from, or were you the grantor of, or transferor to, a foreign trust? 9 9 Do you have ownership or authority over any foreign bank accounts, investment or property? 9 9 Did you own any cryptocurrency or use cryptocurrency in any transactions during the year? 9 9 Did you and your dependents have health care coverage for the full year? 9 9 Did you purchase health insurance through a state or federal insurance exchange? (Please see attached Form 1095A). 9 9 May the IRS discuss your tax return with your preparer? PERSONAL INFORMATION 9 9 Did your marital status change during the year? 9 9 Did your address change during the year? 9 9 Were there any changes in dependents? 9 9 Did you have any unmarried children, with interest and dividend income in excess of $1,000, or total investment income in excess of $2,000? Individual Tax Questionnaire, Page 1 of 3
YES NO HEALTH CARE COVERAGE 9 9 Did you receive a distribution from a health saving account (HSA) that was not a reimbursement for health care costs? 9 9 Did you make contributions to a health savings account (HSA)? 9 9 If you or your dependents did not have health care coverage during the year, do you fall into one of the following exemptions: Indian tribe membership, health sharing ministry membership, religious sect membership, incarceration, exemption non citizen or economic hardship? If you receive and exemption certificate please attach. INCOME 9 9 Did you receive any other income not reported on a W-2 or 1099? 9 9 Did you receive unreported tip income of $20.00 or more in any month? 9 9 Was your home, or other property you own, rented out or used for business? DEDUCTIONS 9 9 Did you incur a loss because of damaged or stolen property? 9 9 Did you work out of town for part of the year? 9 9 Did you use your car on the job (other than to and from work)? EDUCATION 9 9 Did you receive a distribution from an Education Savings Account or a Qualified Tuition Program? 9 9 Did you, your spouse, or a dependent incur any tuition expenses that are required to attend a college, university, or vocational school? PURCHASES, SALES AND DEBT 9 9 Did you start a business or farm, purchase rental or royalty property, or acquire an interest in a partnership, S corporation, trust, or REMIC? 9 9 Did you buy or sell any stocks, bonds or other investment property? 9 9 Did you sell or do you plan to sell any dividend generating stocks or mutual funds during the first 60 days? 9 9 Did you purchase, sell, or refinance your principal home or second home, or did you take a home equity loan? 9 9 Did you make any residential energy-efficient improvements or purchases involving solar, wind, geothermal or fuel cell energy sources? 9 9 Did you have any debts canceled or forgiven? 9 9 Did anyone owe you money which had become uncollectible? RETIREMENT PLANS 9 9 Did you receive a distribution from a retirement plan (401(k), IRA, SEP, SIMPLE, Qualified Plan, etc.)? 9 9 Did you make a contribution to a retirement plan (401(k), IRA, SEP, SIMPLE, Qualified Plan, etc.)? 9 9 Did you transfer or rollover any amount from one retirement plan to another retirement plan? 9 9 Did you convert part or all of your traditional, SEP or SIMPLE IRA to a Roth IRA during the year? Individual Tax Questionnaire, Page 2 of 3
YES NO MISCELLANEOUS 9 9 Did you incur moving expenses due to a change of employment? 9 9 Did you engage the services of any household employees? 9 9 Were you notified or audited by either the Internal Revenue Service or the State taxing agency? 9 9 Did you or your spouse make any gifts to an individual that total more than $14,000, or any gifts to a trust? Individual Tax Questionnaire, Page 3 of 3
KM Larson & Company Payment Information Name on Tax Return Tax Year Contact Name Payment Amount $ Payment Method: Check enclosed Payment on web site www.kmlarsoncpa.com Debit/Credit card (provide information below) Credit Card Information Name on Card Credit Card # Card Code Exp Date Zip Code I authorize KM Larson & Company to bill the credit card below for the estimated accounting fee or deposit. If the fee is different than the deposit, any difference will be billed or refunded upon my approval. Signature Date Email address for receipt