Questionnaire
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1 Questionnaire Please check the appropriate box. Any YES answers require you to attach details and/or documentation! Personal Information YES NO Did your marital status change during the year?... Did you get married to a same-sex spouse in a state that legally recognizes same-sex marriage?... Did your address change from last year?... Can you be claimed as a dependent by another taxpayer?... Did you change any bank accounts that have been used to direct deposit (or direct debit) funds from (or to) the IRS or other taxing authority during the tax year?... Dependent Information Were there any changes in dependents from the prior year?... Do you have any children under age 19 or a full-time student under age 24 with unearned (ie: interest, dividends or capital gains) income in excess of $2,000?... Do you have dependents who must file a tax return?... Did you provide over half the support for any other person(s) other than your dependent children during the year?... Did you pay for child care while you worked or looked for work?... Did you pay any expenses related to the adoption of a child during the year?... If you are divorced or separated with child(ren), do you have a divorce decree or other form of separation agreement which establishes custodial responsibilities?... Principal Residence / Property Information If you paid rent during the year, please enter the total amount: $ If you paid rent during the year, was heat included? Did you purchase a principal residence during the year?... If yes, include copy of closing statement Did you sell your principal residence during the year?... If yes, include copy of closing statement. If yes, did you own & occupy the home as your principal residence for at least two years of the five-year period prior to the sale?... If yes, did you ever rent out this property?... If yes, did you ever use any portion of the home for business purposes?... If yes, at the time of the sale was the residence owned by: Taxpayer Spouse Both Did you foreclose or abandon a principal residence or real property during the year?... Did you have an outstanding home equity loan at the end of 2014? If so, please provide the principal balance at the beginning & end of the year and what the proceeds were used for... Did you refinance a principal residence or second home this year?... If yes, were any proceeds taken out & what were they used for?... Are your total mortgages on your first and/or second residence greater than $1,000,000? If so, please provide the principal balance at the beginning & end of the year... Did you pay state & local real estate property taxes this year? If yes, please attach supporting statement.... Did you make energy efficient improvements to your main home this year?... Did you transfer to or was a home transferred from your parents to you?...
2 Purchases, Sales and Debt Information YES NO Did you start a new business or purchase rental property during the year?... If you were self-employed, owned a rental property, or owned a farm, did you make any payments in 2014 that require you to file Form(s) 1099?... If yes, did you or will you file all required Form(s) 1099?... Did you acquire a new or additional interest in a partnership or S corporation?... Did you sell, exchange, or purchase any real estate during the year?... Did you acquire or dispose of any stock during the year?... Did you engage in any put or call transactions? If Yes, please provide details... Did you sell any securities not reported to you on Form 1099-B?... Did you sell an existing business, rental, or other property this year?... Did you lend money with the understanding of repayment and it became totally uncollectable this year?... Did you have any debts canceled or forgiven this year such as a home mortgage or student loan?... Income Information Did you receive any income from property sold prior to this year?... Did you receive any Social Security benefits during the year?... Did you receive any unemployment benefits during the year?... Did you receive any disability income during the year?... Did you receive tip income not reported to your employer this year?... Did any of your life insurance policies mature, or did you surrender any policies?... Did you receive grants of stock options from your employer, exercise any stock options granted to you or dispose of any stock acquired under a qualified employee stock purchase plan?... Did you receive any awards, prizes, hobby income, gambling or lottery winnings?... Do you expect a large fluctuation in income, deductions or withholding next year?... If you are self employed, did you do business in any state other than Wisconsin?... Retirement Related Information Are you an active participant in a pension or retirement plan?... Did you make any withdrawals from an IRA, Roth, Keogh, SIMPLE, SEP, 401(k) or other qualified retirement plan?... If yes, was it for a home purchase or medical disability?... Did you receive any lump-sum payments from a pension, profit sharing or 401(k) plan?... Did you make any contributions to an IRA, Roth, Keogh, SIMPLE, SEP, 401(k), or other qualified retirement plan that are not included on your W-2 or K-1... Did you or your spouse turn age 70 1/2 during the year and have money in an IRA or other retirement account while not taking a distribution?... Did you make any non-deductible contributions to a retirement plan?... Do you want to contribute the maximum allowable traditional IRA contribution amount?... If yes, enter the applicable code: (1=Deductible Only. 2= Both deductible and nondeductible... Do you want to contribute the maximum allowable Roth IRA contribution?... Education Information Did you, your spouse, or your dependents attend a post-secondary school during the year or plan to attend one in the coming year?... Did you have any educational expenses during the year on behalf of yourself, your spouse, or a depedent?... Did anyone in your family receive a scholarship of any kind during the year?...
3 Education Information - Continued YES NO Did you pay any student loan interest this year?... Did you cash any Series EE or I U.S. Savings bonds issued after 1989?... Did you make any contributions to an education savings account or 529 Plan?... Was it a Wisconsin 529 Plan account?... Did you make any withdrawals from an education savings or 529 Plan account?... Did you or a relative pay private school tuition this year for your dependent children for kindergarten thru high school? If yes, provide statement for each child.... Health Care Information Did you have qualifying health care coverage, such as employer-sponsored coverage, government-sponsored coverage (i.e. Medicare/Medicaid), or other personal health insurance coverage for every month of 2014 for your family? "Your family" for health care coverage refers to you, your spouse if filing jointly, and anyone you can claim as a dependent... If yes, how did you obtain this coverage? Did anyone in your family qualify for an exemption from the health care coverage mandate?... Did you enroll for Marketplace Coverage through healthcare.gov under the Affordable Care Act? If yes, please provide any Form(s) 1095-A you received... Did you make any contributions to a Health savings account (HSA) or Archer MSA? Did you receive any distributions from a Health savings account (HSA), Archer MSA, or Medicare Advantage MSA this year that were not used for qualifying medical expenses?... Did you pay any COBRA health care coverage continuation premiums?... If you are a Schedule C business owner, did you pay health insurance premiums for your employees this year through the Exchange?... Itemized Deduction Information Did you incur a casualty or theft loss or any condemnation awards during the year?... Did you pay out-of-pocket medical expenses (co-pays, prescription drugs, etc.) from a source other than a flex/medical reimbursement plan?... Did you make any cash or noncash (clothes, furniture, etc.) contributions?... If yes, do you have evidence to substantiate all charitable contributions?... Did you donate a vehicle or boat during the year? If yes, attach Form 1098-C... Do you have business expenses such as travel, meals and entertainment?... If yes, do you have evidence to substantiate all expenses?... Did you use your car on the job (other than for commuting) or incur any business expenses that were not reimbursed by your employer?... Did you have an expense account or allowance during the year?... Did you have any expenses related to seeking a new job during the year?... Did you make any major purchases during the year (cars, boats, etc.)?... Did you pay long-term (ie: nursing home) care premiums for yourself or your family? Did you pay any investment fees during the year?... ** Your return cannot be filed unless you answer this question below** Did you make any out of state purchases (by telephone, internet, mail, or in person) that the seller did not collect state sales or use tax? If yes, enter total purchase amount: $
4 Miscellaneous Information YES NO Did you have any foreign income or pay any foreign taxes during the year, directly or indirectly, such as investment accounts or partnerships or foreign employer? This does not apply to holdings in US brokerage accounts... Did you receive, create or receive a distribution from, or were you a grantor or transferor for a foreign trust?... Did you have a financial interest in or signature authority over a financial account such as a bank account, securities account, or brokerage account, located in a foreign country?... Do you have any foreign financial accounts, foreign financial assets, or hold interest in a foreign entity?... Did you make gifts of more than $14,000 to any individual?... Did you utilize an area of your home regularly and exclusively for business purposes?... Did you engage in any bartering transactions?... Did you retire or change jobs this year?... Did you incur moving costs because of a job change?... Did you pay any individual as a household employee during the year?... Did you purchase a qualified plug-in electric vehicle or qualified fuel cell vehicle this year?... Did you receive correspondence from the State or the Internal Revenue Service?... Have you been an identity theft victim & have you contacted the IRS?... If yes, furnish the 6-digit identity protection number issued to you by the IRS: Do you want to designate $3 to the Presidential Election Campaign Fund? If you check yes, it will not change your tax or reduce your refund... Did you pay any Federal or state estimates? If yes, enter amount paid and date paid below. If you list the information here, you do not need to list again within the Organizer. FEDERAL Date Amount STATE Date Amount Foreign Accounts Disclaimer If you and/or your entity have a financial interest in, or signature authority over, any foreign accounts, you are responsible for providing our firm with all the information necessary to prepare the Report of Foreign Bank and Financial Accounts (FBAR) required by the U.S. Department of the Treasury in order for the FBAR to be received by the Department on or before June 30th of each tax year. Failure to timely file the appropriate forms with the U.S. Department of the Treasury and the Internal Revenue Service may result in substantial monetary penalties. You accept responsibility for informing us if you believe that you may have foreign reporting requirements with the U.S. Department of the Treasury and/or Internal Revenue Service and you agree to timely provide us with the information necessary to prepare the appropriate form(s). We assume no liability for penalties associated with the failure to file, or untimely filing, of any of these forms.
5 YES NO Would you like to receive your Organizer via next year?... How would you like to receive your completed tax return & documentation this year? Please indicate your preference below by marking one box: Pick up at our office - photo ID will be required U.S. Postal Service - free - free (documentation will be mailed via USPS) U.P.S. - $10 local / $25 for non-wisconsin residents Federal Express - $35 Please verify and/or add your address on the Present Mailing Address section or Client Contact Information in the Organizer. This is used to provide electronic acknowledgement of the acceptance of your tax returns and other important communications from our firm.
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