SEALY TAX PREPARATION QUESTIONNAIRE
This form will give us the information we need to process your tax quote for the current tax year
We will need the following:
ID
SS card/Birth certificate
W2
1099
Self Employment Expenses
Account/Routing #
Email address *
Tax Payers First and Last Name *
CONTACT # *
OCCUPATION *
RETURNING CLIENT? *IF NO WRITE WHO REFERRED YOU*return *
ADDRESS (CITY, STATE & ZIP) *
TAXPAYER DATE OF BIRTH *
MM
/
DD
/
YYYY
THIS YEAR FILING STATUS *
SSN *
DID YOU HAVE HEALTHCARE ALL YEAR? *
IF FILING MARRIED, PLEASE PROVIDE SPOUSE FULL NAME, DOB & 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 #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 THE CHILD LIVES IN YOUR HOME? EX: SCHOOL & MEDICAL RECORDS ETC...
Clear selection
DID YOU RECEIVE ANY OF THE FOLLOWING FINANCIAL ASSISTANCE FOR THE CHILD(REN)?
INCOME *
Required
IF SELECTED SELF EMPLOYED PLEASE ANSWER THE FOLLOWING:
IF NOT SKIP TO QUESTION 31
WHAT IS THE NAME/TYPE OF BUSINESS/EIN?
HOW LONG HAVE YOU BEEN IN BUSINESS? (MONTHS,YEARS)
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?
DID 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 *
ARE YOU ENROLLED IN SCHOOL? *
HOW WOULD YOU LIKE TO PAY FOR YOUR TAX PREP FEES? *
HOW WOULD YOU LIKE TO RECEIVE YOUR REFUND? *
If yes, select Amount you want to apply for an Easy Advance?
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Clear selection
Do you need furniture? *
*WE ARE PARTNERED WITH RIGHT ON TIME FURNITURE*
Do you need a car? *
*WE ARE PARTNERED WITH LONE STAR MOTOR CO.*
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 an Easy 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 *
ASK ABOUT OUR $1000.00 REFERRAL PROGRAM !!!
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