Hempstead Tax Preparation Questionnaire
Email *
First, Last *
Contact # *
Occupation *
Returning Client? If not who referred you? *
Address (city, state and zip) *
Tax Payer Date of Birth *
MM
/
DD
/
YYYY
This year's filing status: *
SSN # *
Did you have heath care all year? *
If filing married please provide spouses full name , dob and ssn.
If you do not have any dependents skip the following questions 13-21
Child #1(name/DOB/SSN/relationship/grade level)
Child #2(name/DOB/SSN/relationship/grade level)
Child #3(name/DOB/SSN/relationship/grade level)
Child #4(name/DOB/SSN/relationship/grade level)
Child #5(name/DOB/SSN/relationship/grade level)
Did the child(ren) live with you for the entire year? If not, please explain:
Could anyone other than yourself claim the child(ren) as dependent(s)? If yes, who.
Do you have any evidence to prove this child lives in your home? Ex: school & medical records ect...
Clear selection
Did you receive financial assistance for the child?
Income *
Required
If selected SELF EMPLOYED please answer the following:
if not skip to question 30
What is the name/type of your business and EIN?
How long have you been in business? (yrs)
What evidence do you have to support your business?
Do you have a separate business account
Clear selection
If not, how do you track your business?
Have you filed any sales tax returns or payroll
Clear selection
How are you keeping track of your expenses?
Do you file 1099's for subcontractors?
Clear selection
Have you made any big purchases the previous year? *
if no type n/a
Do you plan on buying a house soon? *
Other Expenses *
Required
Are you/have you been ordered to pay child support? *
Do you have payment arrangements set up with the IRS? *
Have any of your previous tax returns been offset by the IRS? If yes what year(s) *
Are you enrolled in school? *
How would you like to pay for your tax preparation fees? *
How would you like to receive your refund? *
At K&A we offer several different services please check all that apply to you. *
Required
Under penalties of perjury I have answered the above questions correctly to the best of my knowledge. *
Did you receive your stimulus check? *
*IF THIS IS NOT ANSWERED TRUTHFULLY YOU WILL BE AUDITED AND YOUR TAX RETURN WILL BE DELAYED BY THE IRS* this could incur fees with K&A
DO YOU WANT TO APPLY FOR THE EASY TAX ADVANCE? *
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IF YES PLEASE WRITE THE AMOUNT OR N/A *
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In the event your tax return is offset for any reason K&A will reserve the right to seek legal action for tax preparation fees.
K&A Mobile Tax Services may occasionally have products or services that we think may interest you. By checking this box and using this form you give us consent to use automated technology to call and text you at the phone number(s) above, including your wireless number if provided. Please note that you are not required to provide this consent to make a purchase from us. *
Signature *
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