Individual Questionnaire

Your Name (required)

Your Email (required)

Did you receive any E Bay, Pay Pal or other income that you did not report to us or that we did not inquire about? An example of this would be rental income from another house that you haven't rented in previous years but are now. YesNo

If you answered yes, please provide the details and any related expenses:

For 2014, do you expect any major changes to your income and/or deductions? YesNo

If you answered yes, would you like us to prepare estimated tax vouchers based on those new amounts? YesNo

If you answered yes, please provide the details of the changes to your 2014 income and/or deductions

Did you have a foreign bank account or residence where the value of the account or residence was more than $ 10K anytime during this last tax year? YesNo

If you answered yes, please provide a copy of your year-end statement reflecting the value and any earned income from this investment for the taxable year in question. If the balance was more than $ 50K on the last day, a form 8938 is required to be prepared by us.

In an effort to promote "green", this year we will be E-Delivering all of your tax returns and documents via the Secure Client Portal. Please let us know how you would like your original documents returned to you:

Select OnePick up here at our office (No Charge)Priority Mail ($10.00)Fedex or Courier ($25.00)

Dependents:
Please review your previous year's return and make sure all of your dependents are listed properly. Are there any changes in the people you are claiming as dependents for this year?
YesNo

If you answered yes, what are the changes? Please provide the full name, social security number and date of birth for these individuals.

Direct Deposit:
Would you like to have any refunds due to you direct deposited into your account? YesNo

Please provide a copy of a voided check from the account where you would like the refund deposited. A deposit slip will not work.

If the account is a savings account, for which you have no checks, please provide the bank name, routing number, and account number.

IRA contribution:
Are you interested in making an IRA contribution for 2013 that's either deductible or non-deductible? YesNo

We can calculate the maximum amount for either if you are interested. IRA contributions for 2013 must be made by 04/15/14. If you have already made an IRA contribution for 2013, please provide the following:
Type of IRA: Select OneTraditional IRARoth IRA Amount of the contribution:

Internal Meals:
Did you have any employee events that were charged to “meals and entertainment” expense?
YesNo

Employee events are 100% deductible instead of just being 50% deductible as meals normally are. Please provide the amount of employee events that have been charged to “meals and entertainment” expense.

Fixed assets:
Please review the attached list of assets and mark any you’ve disposed of with a (D) and note the disposal date. Please mark any you’ve sold with an (S) and note the sale date and sales price. Please return the list with any changes.

Charitable Contributions in 2013
Did you make by cash or check any charitable contributions during 2013? If yes, please provide receipts for the contributions including name of the organization and dollar amount. For contributions of less than $250 per organization, a canceled check provides sufficient documentation. For contributions greater than $250 per organization, a receipt from the organization is required.

Non-Cash Charitable Contributions
If you made any non-cash charitable contributions during 2013, please provide receipts with the following information:
1. Name and address of the organization
2. Date the donation was made
3. Description of items donated with an estimate of the fair market value for each item.

Did you make your fourth quarter 2012 state estimated tax payment in 2013? YesNo

If you answered yes, please provide to whom it was paid, the date and the amount of the payment?
Payee Date Amount

Refinance Questions
Did you refinance your mortgage during 2013? YesNo

If you answered yes, please provide a copy of the settlement statement

If you refinanced your home mortgage, did you borrow an amount greater than your existing mortgage? YesNo

If you answered yes, please provide the 12/31/13 ending balances for each mortgage loan and explain how the excess money was utilized.

Please provide the ending balances for each of your home mortgage loans.

Also, please provide the amounts, descriptions, and dates for any home improvements made during the year. We need this information to determine and document the deductibility of your home mortgage interest. The IRS is focusing audit activity on the deductibility of home mortgage interest.

Rollover of Pension / IRA Distributions
You have a form 1099-R showing a distribution from your pension or IRA during the year that does not appear to have been directly rolled over into another pension or IRA. Did you roll over the complete distribution into another pension or IRA? YesNo

If you rolled over only part of the distribution, how much did you roll over?

Childcare

Did you pay any child care expenses for your children during 2013? YesNo

If you answered yes, please provide the name, address, and social security number of the daycare provider as well as the amount paid for each child.

Daycare
Address

Estimated Tax Payments
Did you make any estimated tax payments for 2013 to either the IRS or the state? YesNo

If you answered yes, please provide the dates and the amounts. If you report amounts that do not match IRS or state records of your payments, you will receive an assessment from the IRS or the state with penalties. We really need exact dates and amounts.

Transmittal of Draft Returns

I have attached a draft copy of your 2013 tax returns. Please review the returns and notify me if the returns are ready to be finalized as they are or provide me with the necessary changes.

Describe the necessary changes to be made to your returns.

Put a check in the box if your returns are ready to be finalized.

Home Office Deduction:

Please provide the following items for your home office deduction:

A. Homeowners insurance on your residence

B. Utilities Paid

C. Repairs

D. Improvements with description, amount, and date

E. Homeowners’ association dues paid including any special assessments

F. Total square footage of your house (approximate) and square footage of the area used exclusively for business or the total rooms in your home excluding hallways and bathrooms

Total square footage of your house (approximate)

Square footage of the area used exclusively for business

Total number of rooms in your home excluding hallways and bathrooms

How much did you pay in 2012 for income tax preparation?

Personal Property Taxes
Did you pay any personal property taxes in 2013 for cars or other vehicles? YesNo

If you answered yes, then tell us the amount paid for each vehicle.
Vehicle Description Amount
Vehicle Description Amount
Vehicle Description Amount
Vehicle Description Amount

Medical Expenses
Did you have medical expenses in 2013 in total that would have exceeded 7.5% of your gross income? YesNo

If you answered yes, please provide the amounts for each type of expense listed below:
1. Doctors

2. Prescriptions

3. Medical mileage driven

4. Long term care insurance premiums

5. Hospital care

6. Eyeglasses and optical care

7. Other medical expenses

Vehicle Mileage Deduction
Did you have any business (non-commuting) mileage in 2013? YesNo

If you answered yes, please provide the Make, Model, and Year of each car used for business, the business mileage for the year for each car used for business, and the total mileage for each car:

Vehicle 1

Vehicle 2

Vehicle 3

Rental Property(ies)

For your rental property(ies), please provide the following amounts paid in 2013:

A. Rental income received

B. Insurance paid on the property

C. Repairs and Maintenance

D. Management Fees

E. Commissions

F. Advertising

G. Cleaning

H. Homeowner’s association dues

I. Utilities you had to pay personally

J. Improvements including descriptions, dates, and amounts

K. Any other expenses incurred and paid

l. Security System

Was the average length of stay by your tenants at your rental property more or less than seven days? More than 7 daysLess than 7 days

Education

Did you pay any college or other higher education expenses in 2013? YesNo

If you answered yes, to whom, for whom, and how much was paid? How much was for tuition and how much for other expenses?

College or Educational Institution

Student 1

Tuition Paid

Other Educational Expenses

College or Educational Institution

Student 2

Tuition Paid

Other Educational Expenses

College or Educational Institution

Student 3

Tuition Paid

Other Educational Expenses

The college savings plan (529) contributions for your children or grandchildren are no longer allowed in North Carolina as of 2013.

Incentive Stock Options
Did you exercise any Incentive Stock Options (ISO's)? YesNo

If you answered yes, please provide the details along with the brokerage statements that show the sale.

Upload Brokerage Statements

Research & Development
Did you make any expenditures for research and development? YesNo

If you answered yes, what expenditures were made and how much was spent?
Expenditure
Amount

Real Estate
Did you purchase a new house during 2013? YesNo

If you answered yes, please provide a copy of the closing settlement statement.

Employee Expenses
Did you have any unreimbursed employee expenses? YesNo

If you answered yes, please provide a description of each expense and the dollar amount.
Expense Amount
Expense Amount
Expense Amount
Expense Amount
Expense Amount

Business
Does your sole proprietorship or LLC you own have a health plan where the employer pays in 50% or more of the premiums? YesNo

If you answered yes, is the average salary of the non-owner employees $ 50K or less?
YesNo

If you answered yes, please provide a breakdown of your health insurance account between 2% or more shareholders/employees and everyone else.
Breakdown of your health insurance account between 2% or more shareholders/employees and everyone else.

Please provide a copy of last year’s federal and state tax returns. Make sure to include all pages including worksheets.