Tax Organizer
Please complete this tax organizer so we are ready for you when you come in for your appointment.
Client Name *
Your answer
Birthdate
MM
/
DD
/
YYYY
E-mail Address
Your answer
Spouse's Name
Your answer
Spouse's Date of Birth
MM
/
DD
/
YYYY
Will your dependents claimed be the same as last year? (child/non-relative only)
Please list all dependent information on the Dependent Information Form
Has your phone number changed from last year? *
If yes, what is your new phone number?
Your answer
Healthcare Coverage Questions
Did you and/or your spouse have health insurance last year? *
Where did you obtain your health insurance? *
If you did not have health insurance the whole year or bought it in the marketplace please inform us, we may need additional information.
If you have no health insurance and refuse to make the penalty payment it may result in IRS collection efforts. By checking this box, you understand and agree to the above statement.
Banking Information
Bank Name
Your answer
Routing Number
Your answer
Account Number
Your answer
Retirement Information
Do you or your spouse have a Personal Retirement Account?
Which type of Personal Retirement Account?
Amount of contribution made?
Your answer
Charitable Giving
Did you have any tax-deductible donation to charities this year?
If yes, please provide the name and dollar amounts (we will need copies of approved tax documents).
Your answer
Ohio Sales and Use Tax
Did you purchase anything on the internet in which you did not pay sales tax to the State of Ohio? *
If yes, what was the total purchase(s) price(s) (please include all purchases where sales tax ws not collected).
Your answer
Please be advised that you will be required to pay tax on that amount and your total tax will be increased.
Ohio Direct Deposit Disclosure Statement
The taxpayer has read and understands the terms of the Direct Deposit Disclosure statement and accepts its conditions. Acceptance of the Ohio Direct Deposit Statement is required for all taxpayers having any portion of their refund automatically deposited into an account by the Ohio Department of Taxation.
I have read and agree to the above statement: *
Ohio Refund Donation
Do you wish for your refund to go to any of the following charities?
Amount of Contribution
Your answer
Statement of Understanding
By my checking the box below and entering my initials, I certify the information provided on and it connections with this form is true, accurate, and complete. I also understand that Susan A. Comko CPA LLC or its agents will use the information to complete requested tax forms, and I agree to hold Susan A. Comko CPA LLC or its agents not at fault for relying on the provided information. *
Required
Initials *
Your answer
Submit
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google.