NONSTOP TAX SERVICE CLIENT DATA SHEET

Transcription

1 NONSTOP TAX SERVICE CLIENT DATA SHEET Personal Information Please fill out the entire form. If you have any questions, please ask an agent to assist you with completing the form. TAXPAYER NAME OCCUPATION ADDRESS SPOUSE NAME OCCUPATION CITY STATE ZIP APT# PHONE EXT CELL ALT. PHONE CELL Please check if your address has changed from 2014 (address still must be completed if no changes) FORM OF IDENTIFICATION: DL OR ID DL/ID NO DATE OF ISSUANCE/STATE EXPIRATION DATE SPOUSE DL/ID DATE OF ISSUANCE/STATE EXPIRATION DATE Nonstop Tax service may have products or services that we think may be of interest to you. By checking this box and submitting this form, you give us consent to use automated technology to call and text you at the phone number (s) shown above, including your w ireless number if provided. Please note that you are not required to provide this consent to purchase a product or service from us. Dependents: (List Youngest First) Name (Last, First, M.I.) Date of Birth Dependent s Relationship Months lived in your home this tax year? Education Credit? (Yes or No) Childcare? (Yes or No) INCOME INFORMATION CHECK ALL THAT APPLY Filing Status: Single Married Head of Household Married Filing Jointly Married Filing Separately Did You, and if applicable, all your qualifying dependent have medical insurance? Who is your health insurance provider? Did you have coverage for the entire year (Jan 1 st -Dec 31 st ) Yes No Someone else can claim you as a dependent. You and your spouse lived apart during the year. If yes, did you live together at any time after June 30? Yes No You paid estimated Federal or State taxes last year. Federal $ State$ You itemized last year. If yes, amount of Refund from/balance Due to State$. You or your spouse were a resident of another state or earned income in another state during the last year. You purchased a home in 2008 and received the up to $7,5000 First-time Home Buyers credit. You were a student, had education expenses, or made student loan payment Are you Self Employed? Yes No If yes, please fill out the Self Employed Income Data Sheet Phone: (281) Fax: info@nonstoptaxservice.com

2 Wage State-W-2s Tips/Other Income 1099s Received Interest Received Dividends Sold Stocks or Bonds Pension or Retirement Income Alimony (Paid or Received) Buy or sell a home Own Rental Property Mortgage Interest Mortgage Points (i.e. closing points) Paid real estate taxes Property Tax Sold a business asset Farm income CIRCLE ALL THAT APPLY Paid qualified education expense Medical Expense Lottery or Gambling Winnings Cancellation of Debt Charity or Religious Contributions Significant Loss or Theft Union Dues CHILD CARE INFORMATION (Note This information is required for each provider. (Use the back of this sheet if more space is needed.) Provider s Name Provider s Address Job Related Expenses or Training Used personal vehicle for Work Business Expense Phone Internet Computers/Internet Provider s /EIN Amount Paid to Provider$ SERVICE REQUESTED **************************These rates are in addition to tax preparation fees. Refunding are pending IRS Approval once submitted*************************** REFUND TRANSFER (10-14 DAYS) $150 DIRECT DEPOSIT ELECTRONIC FILING (receive IRS deposit in 3 weeks) $135 DIRECT DEPOSIT (receive IRS check in 4 weeks) CHECK MAIL IN (receive IRS deposit in 5 weeks) No charge DIRECT DEPOSIT (receive IRS check in 6-8 weeks) AMERICAN EXPRESS DEBIT CARD/GREEN DOT $25 DIRECT DEPOSIT WALMART DIRECT CASH (UP TO 7500) $150 DIRECT DEPOSIT AUDIT PROTECTION (UP to three years) $100 Would you like your refund deposited into your bank account? Yes No Name of Bank/Financial Institution Checking Savings Routing Number Account Number I declare that all information on this form to the best of my knowledge and belief is true, correct, and complete. By signing this information sheet I authorize Nonstop Tax Service to prepare Income Tax Returns on my behalf and to verify with the IRS on prior outstanding debts owed to the IRS, Student Loans or Child Support. X X TAXPAYER S SIGNATURE SPOUSE S SIGNATURE DATE DATE Phone: (281) Fax: info@nonstoptaxservice.com

3 Preparation Checklist Having the right information at hand is half the battle when doing your taxes. Use this checklist to help you gather your important personal, employment, residential and financial information. You can avoid multiple trips to your tax professional by getting it all together now. Personal Data Social Security Numbers (including spouse and children) Child care provider: Name, address and tax I.D. or Social Security Number Alimony paid: Social Security Number W-2 Forms: Employment & Income Data Unemployment compensation: Forms 1099-G Miscellaneous income including rent: Forms 1099-MISC Partnership, S Corporation, & trust income: Schedules K-1 Pensions and annuities: Forms 1099-R Social Security/RR1 benefits: Forms RRB-1099 Alimony received Jury duty pay Gambling and lottery winning Prizes and awards Scholarships and fellowships State and local income tax refunds: Form 1099-G Homeowner/Renter Data Residential address(es) for this year: (see notes) Mortgage interest: Form 1098 Sale of your home or other real estate: Form 1099-S Second mortgage interest paid Rent paid during tax year Moving expenses

4 Financial Assets Interest income statements: Form 1099-INT & 1099-OID Dividend income statements: Form 1099-DIV Proceeds from broker transactions: Form 1099-B Retirement plan distribution: Form 1099-R Financial Liabilities Auto loans and leases (account numbers and car value) if vehicle used for business Student loan interest paid Early withdrawal penalties on CDs and other time deposits Automobiles Personal property tax information Expenses Gifts to charity (qualified written statement from charity for any single donations of $250 or more) Unreimbursed expenses related to volunteer work Unreimbursed expenses related to your job (travel expenses, uniforms, union dues, subscriptions) Investment expenses Job-hunting expenses Job-related education expenses Child care expenses Medical Savings Accounts Adoption expenses Alimony paid Tax return preparation expenses and fees Self-employment Data Business income: Forms 1099-MISC and/or own records Partnership SE income: Schedules K-1 Farm-related expenses: Receipts, other documents & own records Employment taxes & other business taxes paid for current year: Payment records Miscellaneous Tax Documents

5 Federal, state & local estimated income tax paid for current year: Estimated tax vouchers, cancelled Checks & other payment records IRA, Keogh and other retirement plan contributions: If self-employed, identify as for self or employees Records to document medical expenses Records to document casualty or theft losses Records for any other expenditure that may be deductible Records for any other revenue or sales of property that may be taxable or reportable

6 Schedule A Information Sheet I certify that I incurred the following expenses and itemizations for the tax year. Client E- Signature. Expenses Type Amount Expense Type Amount Medicine and drugs Insurance premiums Doctors, dentist, hospitals etc. State and local income taxes Real Estate Taxes Personal Property Taxes General taxes Home mortgage interest/credit (or See forms) Qualified mortgage insurance premiums Gifts by cash or check Church name Church tithes Donations to charities Union and professional Dues Job seeking expenses Education seminars Job searching Small tools safety/ protective Uniforms cost and clothing Vocational supplies Investment expense Safe deposit box Attorney fees Hobby expense Gambling Cell phone Misc. Tax preparation fees Casual or theft loss(es) Form 2106 Reimbursed Employee Expenses Tolls Parking Transportation Gas Travel Expenses (lodging, car rental, Airfare) Business expenses Total miles for the year Business miles for the year Print Name Last 4 of Date Leave blank Leave blank

7 Schedule C Information Sheet I certify that I incurred the following expenses and received gross revenue for tax year_. Type of business or Hobby Client E- Signature Description Amount Description Amount Advertising Purchases Bad debts Personal use total Commission paid Other costs Fees paid Ending inventory Depletion Equipment purchases Depreciation/sec 179 Equipment sold Insurance (not health) Mortgage interest Vehicle year make/model Other interest payments Car expenses Licenses Mileage Professional services Business Legal services Personal Office expenses Commuting Phones Other Business line Actual expenses Cell phone Gas Pager Oil Rent Tires Vehicle Repairs Machinery Tolls/parking Equipment Other business rent Supplies Taxes Real estate Personal property Employee expense Utilities Travel Meals/entertainment Wages Pension and profit sharing Print Name Cost of goods sold Beginning inventory Date