Askotzky Accounting
Tax year 2016 (filed in 2017)
Please fill out all applicable items in the questionnaire. Please use the fill-in spaces and email it to me or just print it and fill it in by hand and fax it to me.
The IRS now requires me to have signed approval before I e-file a return (and I am required to e-file any return which I can). I will therefore need to email, mail or fax you a copy of the return and ask you to email,mail or fax back the signed form ASAP.
Please make sure you fill in your email and cell#.
Please provide your credit card information. I will charge your account when I e-file or e-mail you your return.
Pick from the drop down menu
Credit Card type Credit Card#
Exp date/ Sec code (3 or 4 digit)
The tax landscape has forever changed as the IRS is now the manager for the tax for the Affordable Care Act (Obamacare). There is information in this form which is necessary to see if you need to pay the health insurance tax (penalty) if you don’t have credible coverage and to reconcile any subsides you may have received if you joined Obamacare.
Askotzky Accounting
Harayl Askotzky
Specializing in personal tax returns
National Association of Tax Professionals member
IRS ID # P00428406
Cell 917.974.7515-Efax 561.526-8667 -
7230 San Sebastian Dr.Boca Raton, FL 33433
Thank you for using my services.
- I am trying to send and receive all documents by email or efax this year.
- Please do not mail it in a way that requires a signature, as it will be returned to you.
- Please feel free to contact me if you have any questions.
- Please return this form to me with all other tax information at the above address by email or by fax
- It is my goal to send back your return within 2-3 weeks of receiving it.
- The following checklist of items is needed in order to have all the basic information to fill out your tax return. Please answer all questions and fill in all requested information if applicable. Please be as specific and detailed as possible.
- To simplify this questionnaire,I have designated each page for a different topic. Please skip any page that is not applicable.
- Please include last year’s tax return (if I did not do it for you last year) as you may have carryover credits.
- If you don’t know an answer write “don’t know”
(If I did your return last year,you only need to fill out items that changed. Example;new address, new dependents)
Personal Information
Name(s) of main taxpayer(s) / SS# / Date of Birth//
//
Address
Cell Phone Number Fax # Home phone
Email address
What is the best way to contact you and When?
What are your occupations? Him Her
List your dependents (children), SS#’s and Dates of birth
Name / SS# / Date of Birth / Name / SS# / Date of Birth// / //
// / //
// / //
Wages and income
1)Did you receive any W-2 forms from your employer(s)? yes/no. If yes, how many? Please include them
2)Did you receive interest (you should have received a form 1099int)? yes/no. If yes, how many? . Please include them.
3)Did you receive any dividends(1099div). (If you own stock or mutual funds you may have received dividends)? yes/no Please make sure you received a statement from all the institutions that are holding securities for you.
Please include these statements(1099div).
4)Did you sell any stock or mutual funds? Yes/no
If yes, I need to know 5 things (please attach this or fax to me)
a)What was sold,
b)When it was sold,
c)How much it was sold for,
d)When it was purchased,
e)How much it was purchased for.
If your statement clearly states all this just include your statement.
If your purchase price is not included, you may need to go to the statements in the year it was purchased to find out.
If it is not clear from your statement, please list the 5 needed items of information on another paper.
If not, please give me all the statements that you have in order to have me figure it out for you.
5)Is there any other income you received that I should know about (unemployment, disability, family trust fund (K-1), jury duty)?
Self-employment
If you receive a 1099misc, you are generally self-employed.
(Most therapists that go toclient’s homes or people who set their own hours are self-employed.) If you are self-employed, you may deduct business expenses, because the government views you as if you are running your own business.
If you have more then one business please list them separately.
7) What is the nature of your business?
8) Did you buy any supplies to run your business? yes/no.If yes, please list them and their costs.
9) Did you buy any equipment (computer,fax, phone…) for your business? Please detail
10) Do you have a home office (dedicated exclusively as a work area)?
If yes,(There is a rule that you can get $5 a SF up to 300sf or use actual expenses)
a)What is the square footage of the office?
b)What is the square footage of your house?
c)What is the square footage of your house?
d)What is your rent/mortgage for the year?
e)What is your yearly utility cost?
f)What is your yearly house insurance cost?
g)Any other expenses?
11) Did you pay anything for advertising? If yes, how much?
12) Did you have any car expenses for this business? Yes/ No
If yes, (I generally use the per mile method, if you lease a car or have a very expensive car, please contact me)
a)What car did you drive? ModelYear
b)How many miles did you drive for this business over the year?
c)How many miles were driven with this car in total for the year?
d)Do you have a log to prove miles?
13) Did you pay out of pocket for your health insurance?If yes, how much? . Questions related to Obamacare tax and health coverage will be in the last section.
14) Did you take any continuing education courses for this business? If yes, how much did you spend?
15)Did you have a cell phone or second line for this business?
Explain?If yes, how much?
16) Did you receive a 1099 for work done in this business?If yes, how many? Was there any income for this business that was not reported on a 1099? If yes, how much?
17) Please list any other business related expenses:
Deductions and credits
You may leave blank any question that the answer is no.
18) Did you invest in an IRA or other tax deferred retirement accounts. If yes, give details of who invested, in what and how much?
19) Did you pay any Higher Education fees (college) in 2016(even if they were paid for you, ex. parents, loans) for you or for a dependent? yes/no. how many collegesand did you receive a form from the college? yes/noPlease include the forms.
If yes,
a)Who had these expenses
b)To what institution(s),how much to each,what type of institution
c)Graduate/undergraduate
d)What year college was it?
20) Did you pay interest on student loans? Yes/No. How much and to where? Please include the form if received.
21) If you are a teacher, did you pay for any supplies that you did not get reimbursed for (up to $250 per spouse)?How much?for who?
22) Did you pay someone to watch your childrenso you could work or look for a job? (This includes: a babysitter, preschool, daycare and summer day camp) yes/no.
If yes, please write for each child:
a)Who watched them (or what school, institution)
b) How much you paid
c) Their address
d) SS# or tax id number.
If you try to obtain your child care provider’s information and they will not give it to you write “refused” in that box.
Please Note: NYS has been auditing many of the people who submit “refused”; if you don’t pay with check they will reject the claim and it is not advisable to claim.
Provider’s name / Amount paid / Address / SS#/Tax ID of provider/camp/school / Child(ren) watched/age & grade
22a) Did you move more then 50 miles for a new job and were not reimbursed? If yes, list your expenses.
22b) Did you buy a house or co-op in the last year?If yes, give details.
Itemizing
(This generally will only apply if you own a home or co-op or have an income over 80K.)
The standard deduction for 2016 is $12900 for a family. If you have higher “deductions” you can itemize.
Some of the things that count are medical expenses (over 10% of your adjusted gross income) mortgage interest, property taxes, and charity.
If you think you may be able to itemize fill out this page.
23) What were your out of pocket medical expenses (not including payments taken out of your paycheck?
24) Did you pay mortgage interest? Yes/ No If yes, please include your statement.
25) Did you pay property tax? Yes/No. If yes, how much?.
26) How much did you give in cash/check to charity?
Please attach a detailed list.(Don’t spend your time making a detailed list unless you know you can itemize)
If you gave anything non-cash to charity how much was its value?
Please attach a detailed list.(Don’t spend your time making a detailed list unless you know you can itemize)
26a) Did you buy a new(not used) car(may help in some states)?If yes, how much sales tax did you pay?
26b) Did you pay any significant non-reimbursed business expenses (over 2% of your income)?. If yes, how much?Detail what they were
Other information
27) Did you rent out a house or co-op you own? If yes, please list-
a)Property address
b)Total rent received
c)List expenses (inc. tax, mortgage interest, repairs, maintenance fees….)
d)What was your purchase price?
e)When did you buy it
28) Parsonage. It is the IRS position that Social Security tax (15.3%) must be paid on parsonage. Please list your parsonage amount here if received.
29) Did you apply for and receive Obamacare this past year?If yes, I will need the form sent to you regarding your subsidy as that is treated like a tax refund and needs to be calculated if it was too much and will reduce your refund or require you to pay or if the subsidy was too little and you will get funds back or owe less.
30) Did you have approved health insurance for all of 2016, If no, please explain? . You should have received a form 1095 documenting you had approved insurance coverage or you may be subject to penalty. Please provide that form.
30) If you want your refund to be direct deposited into your checking or savings account, please fill in the following information.
Routing # (9 digits usually the first digits on the bottom left of your checks)Account #
31) I am authorized and registered with the IRS to e-file(to send your return electronically to the IRS), which enables you to receive your refund in about 2 weeks. Not all returns are eligible for e-file.I am required by law to e-file all eligible returns.
32) Please writeany additional information that I may need to know in order to prepare your tax return.
The purpose of this form is to ensure you gather all necessaryinformation when you are at home, and to make sure we don’t forget any information. If I need any additional information, I will contact you.
I am required according to Circular 230 to disclose that I am with my best judgment to prepare your tax return according to the IRS code based on the information and facts presented to me. The fee is based on my tax rate schedule, available upon request and on my website. The minimum charge is $250 (any return that cannot be e-filed will be subject to a $25 possessing fee). All returns for which I am not given the information before March 15,or are needed within 4 weeks,are subject to a higher fee for rushing, all returns given after April 15th will be charged an out-of-season fee. Additional charges are based on complexity, including, self-employment, K1, multiple investment transactions, childcare, state returns, quarterly calculations, Obamacare(Health penalty calculation), itemizing and other factors. Payment will be charged to your provided Credit Card account when the copy of the return is sent to you for signature. I use my due diligence to fill out the return properly. Keep in mind you are the filer and I am just the tax preparer and it is your job to review the return for omissions and to question me about anything you are unsure of. My liability is limited to my fee.
This form is copyrighted by Askotzky Accounting
Please scan and emailor fax tome the following:
- A copy of last year’s return (if I didn’t do it last year)
- All W-2s (end of year wages statement)
- All 1099s (can be interest, dividends, self employment income or mortgage interest)
- All Health Insurance forms (1095)
- All end of year statements, which list your stock, mutual fund sales
- If you are itemizing, please make sure to submit all information.
- If you sold stocks or other securities make sure that the original purchase price and date of purchase are submitted
- Fill out this questionnaire to the best of your ability.
Please do not hesitate to call me if you have any questions.
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