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2009 YES/NO Questionnaire Time saving instructions: 1)
Skip
doing a questionnaire for a young child’s tax return. 2)
Skip entire sections that do
not apply to you. 3)
Please
complete at home at least 1 week prior to your appointment. You may need time to contact 3rd
parties for missing information. 4) If you have a question on a line item, star it *** and
we can discuss at your appointment. 5) When
there is a blank area to be completed ($_____), please supply the amount on
the questionnaire itself rather than writing “see attached”. 6) When
supplying dollars and mileage, don’t supply round numbers such as 1,000 which
makes it appear to the IRS that you haven’t kept records. Use actual amounts,
not guesstimates. 7) Printed
reports vs. computer files… Quickbooks
files are welcome for business or rental activities. Otherwise, it is preferred that you print
at home and bring the reports along to your appointment. 8)
If you
choose to skip this questionnaire… please sign the last page and bring the
blank questionnaire to your appointment which acknowledges that you are
filing at your own risk of missed deductions. 9)
Please
sign and date the questionnaire at home. Only one signature is needed per married
couple. YES NO General: ___ ___ Did your address change? _X_ ___ What
municipality do you live within? (Township or Boro) _________________________
. ___ ___ Did
you incur moving expenses due to a change in employment? You must move at least 50 miles unless
military. Students moving at least 50
miles to their first full-time job may qualify. ___ ___ Was
there a birth, traditional adoption, special needs adoption, marriage,
divorce, or death in your family that affect your tax return? Note: Social security numbers are necessary
for all dependents. Call 800-772-1213
to apply. ___ ___ FREE
TAX RETURNS… Are you a repeat client who served in Iraq or Afghanistan
for any part of 2009? ___ ___ Do
you need an out-of-state tax return prepared (any state other than PA)? This potentially affects your Federal, PA,
and Local returns. Due to the added
complexity, all clients requiring out-of-state tax returns will be processed
as extension clients after 04/15/10.
Accordingly, you should schedule a tax appointment now for after
04/15/10. Note: clients in states
that do not require state tax returns are not affected (Florida, Texas,
etc.) ___ ___ Did
you or your spouse receive a one-time $250 economic recovery payment
in 2009 that was paid to social security recipients, railroad retirement
recipients, and certain veterans? If
you can’t recall, then please contact your respective agency for
confirmation. SSA checks should have
arrived in May 2009. (Making Work
Pay Credit) ___ ___ Did
you or your spouse receive a pension or annuity in 2009 for past services
performed as a Federal, State, or local government employee from work not
covered by social security? (Government
Retiree Credit; n/a for pension or annuity reported on W-2 rather than 1099R) Dependents: ___ ___ Do
you have a dependent child, grandchild, foster child, brother, sister, or any
of their children under age 17 at 12/31/09? ___ ___ Were
any of your unmarried dependent children age 19 or older at 12/31/09? If yes, please answer
the following question: ___ ___ ……..Was
your child under age 24 at 12/31/09 and a full-time student for some part of
5 individual months? ___ ___ Did
you pay day-care expenses for a child under age 13 or for a physically or
mentally impaired dependent so that you and your spouse could earn a living
or attend school full-time? Please
provide year-end statements from each daycare provider with their tax ID#. No overnight camps. Include 100% of schooling before kindergarten level. Available to custodial parents only. Include housekeeper or cook if hired in
part for the well-being of your child. ___ ___ Do
you have children under age 24 at 01/01/09 with interest, dividends, and
capital gains over $500 for 2009?
Ignore earnings from Sec 529 Qualified Tuition Programs. (Kiddie tax $1900, 01/01/10: <18; 18 yr
olds who don’t provide >50% of own support with earned inc; f/t students
<24 who don’t provide >50% of own support with earned inc.) Investments: ___ ___ Did
you sell or transfer any stocks, bonds, or mutual funds? Please bring form 1099-B and “cost
basis summary” from your investment advisor.
The “cost basis summary” includes the purchase date and purchase price
for each item sold. Note: often
transfers of stock or mutual funds within a brokerage account are actually
the sale of one investment and purchase of another. Even if you did not receive any cash from
the transaction, you may have a taxable gain or loss. Form 1099-B lists these taxable transfers,
if they exist. (0% =
2008-2010) ___ ___ Did
you cash U.S. Savings Bonds? Please
bring 1099 forms given by bank. ___ ___ Did
you own investments that became worthless… not sellable for even $1? ___ ___ Did
you close-out any of your 529 college savings plans and suffer a significant
loss? ___ ___ Did
anyone owe you money which became uncollectible during 2009? NOT
unpaid business income or rents.
NOT loans to relatives. NOT
loans without loan documents. ___ ___ Did
you discover a theft loss during 2009 due to a fraudulent investment scheme?
(theft loss rules) ___ ___ Did
you pay an early withdrawal penalty on a CD? ___ ___ Did
you borrow money in order to invest and pay margin interest expense? ___ ___ Did
you sell insurance stock during 2009 given to you by your insurance company? ___ ___ Did
you have a financial interest in, signature authority, or other authority
over foreign bank accounts, foreign investments, or other foreign financial
instruments exceeding $10,000 in aggregate.
(form TDF 90-22.1 due
06/30th; form 3520) Retirement Plans &
IRA’s: ___ ___ Did
you withdraw funds from a retirement account or IRA? ___ ___ Are
you a retired public safety employee (police, fire, etc.) age 50 or
older with a distribution from a government pension plan? (no 10% penalty, annual $3k exclusion if
direct payment for health, accident, or LTD insurance). ___ ___ Did
you or will you contribute to a 2009 IRA before Circle: traditional IRA, Roth IRA,
SEP IRA Provide amounts: Taxpayer $________ Spouse $________ Note: By request, we can process your tax return
with various IRA amounts and call you to discuss the result from each
scenario before you make your final IRA decision. The additional fee is $10. ___ ___ Did
you contribute to a 2009 employer retirement plan, 401k, etc.? (2k max*rate, S<27,750 /
HH<41,625 / MFJ<55,500, >17, not ft student, not dependent) ___ ___ Did
you cash in all existing Roth IRA’s or Traditional IRA’s during 2009
and incur a loss? (need 8606 basis) ___ ___ Did
you transfer funds directly out of your IRA to a qualified charity? Up to $100,000 qualifies as non-taxable if
taxpayer is age 70 ½ or older. The
distribution counts toward your minimum distribution requirement. No benefit can be received by you for the
donation… such as a free
membership. Retirement Age / Disabled taxpayers: ___ ___ Were
you or your spouse legally blind? ___ ___ Were
you or your spouse 70 1/2 or older at 12/31/09 and owners of an IRA? (Note:
2009 RMD waived) ___ ___ Are
you over age 64 or permanently disabled at 12/31/09 with taxable disability
income? (elderly / disabled credit, S<17,500 / MFJ<20k one spouse
eligible / MJF<25k both spouses eligible)
___ ___ PA
Property Tax/Rent Rebate… Are you a homeowner paying real estate taxes
with $35,000 or less of household income (only include ½ of Social Security
and ½ of Railroad Tier 1 income)? Or are
you a tenant paying rent with $15,000 or less of household income (only
include ½ of Social Security and ½ of Railroad Tier 1 income)? Visit www.papropertytaxrelief.com or
call 888-222-9190 to obtain your PA Property Tax/Rent Rebate claim form
and for free assistance. Various
resources are available to prepare this form FOR FREE. Call for more information… PA Dept of Aging
783-1549; PA Dept of Revenue District Office 783-1405; various senior
centers, and state Legislator’s offices.
If you need my help, our office prepares this form for a fee of
$99. But I suggest that you instead
take advantage of one of the FREE options.
You will need paid property tax receipts (or cancelled check copies
and bill copies), all income source documents (W-2’s, 1099’s), 2009 Federal
or PA tax returns, signed Landlord statement, any existing lease agreement
as applicable. The filing deadline is 06/30/10 but is usually extended to
12/31 each year by the governor. If
you qualify, your rebate of $250-$650 will be issued after 07/01/10. Itemized Deductions: ___ ___ Did you have a loan secured by a
boat, camper, or R.V. with living, bathroom, cooking, and sleeping quarters? ___ ___ Did you refinance a mortgage or obtain a home equity loan in 2009? Please bring the HUD-1 settlement sheet whether you paid points or not since many times additional deductible property taxes are listed on the HUD-1. Also note that some home equity loans don’t have a HUD-1 settlement sheet. When in doubt, bring your entire folder of loan papers.
___ ___ Did you pay Private Mortgage Insurance (PMI)? (mortgages originating after 2006)(AGI phaseout 100-110k)(valid 2007-2010) ___ ___ Did
you own a vacation time-share and pay related loan interest or real estate
taxes? You can deduct the real estate
portion of the maintenance fees, but only if your time-share reports this
amount to you in writing each year. If
necessary, call your time-share company before your tax appointment. ___ ___ Did
you pay the $10 or $52 occupation tax… referred to as either LST, EMST, or
OPT? ___ ___ Did
you pay other personal or per capita taxes? (usually $5-$20 and paid by
check) Please bring receipts. ___ ___ Did
you keep a detailed record of 2009 sales tax paid? If not, we will use IRS tables to
calculate. However, still provide the
sales tax paid on significant 2009 purchases of motor vehicles,
aircraft, boats, mobile homes, or home building materials for do-it-yourself
projects. $_______. This amount
can be added to the IRS table amount. ___ ___ Did
you have a large property loss due to a sudden and unexpected event (storm,
fire, or theft) that was not reimbursed by insurance/lawsuit which resulted
in a loss exceeding 10% of your income?
___ ___ Did
you pay significant medical expenses including dental, vision, hearing, &
insurance? Must exceed 7.5% of your
income. Ask about including medical
payments for others not claimed as dependents on your tax return… a) children
of divorce b) elderly family, domestic
partners, or others living in your home where you provided more than 50% of their financial
support. Medical miles driven: ________. (dependent
other than AGI rule) ___ ___ Do
you have proof of your charitable contributions? New… even the smallest monetary donation
requires a detailed receipt or bank statement or credit card
statement or paystub.
Unsubstantiated cash donations are NO LONGER ALLOWED. Also, donated clothing and household items
must be in at least “good” used condition in order to deduct. ___ ___ Did
you have charitable contributions?
Only use those that satisfy the above rules. Qualified cash and check donations
for 2009 (requires records) $_________. Clothing & household donations
for 2009 (requires good condition & records) $_________. Charity miles driven: _________. ___ ___ Did
you make a cash donation 01/12/2010 to 02/28/2010 for Haiti earthquake
victims? $________ ___ ___ Did
you inherit an IRA or annuity from an estate that has already paid Federal
estate tax on the same? Generally,
this only applies to large estates over $2 million. W-2 Employee Expenses (not in business for
yourself): ___ ___ Did
you have job related mileage (other than to and from work) not reimbursed in
full by your employer... errands, between buildings, overnight travel, from
main job to 2nd job (Federal deduction only), from home to temporary work
locations? Provide # miles: ______. ___ ___ Did
you have un-reimbursed employee education or seminar expenses? Please indicate whether the education was
a) to maintain & improve your current job skills (2106) or b) to prepare
you for a new profession (lifetime learning credit). Provide Tuition:$______
Books & supplies:$______ # miles:
______. ___ ___ Did
you have other job related expenses that were not reimbursed in full by your
employer? Circle: union dues, uniforms
purchased, uniforms laundry & maintenance, safety clothing &
equipment, work supplies, reference materials, dues & subscriptions,
tools, insurance, license, tolls & parking, computer & related
toner/paper/disks, telephone, meals, overnight travel, luggage, business
gifts, office decor, job hunting, expenses to overcome work impairments for
the disabled, legal fees to protect your income. ___ ___ Did
you maintain a home office for the convenience of your employer and as the
only office available to conduct substantial administrative activities? To qualify, your employer cannot have a
local office available to you. Please
complete the Business Use of Home section later in this questionnaire. ___ ___ Are
you a kindergarten through 12th grade teacher, instructor, counselor,
principal, or classroom aide who works at least 900 hours per school
year? ___ ___ Are
you in the transportation industry and subject to the Dept. of
Transportation's hours of service rules (trucking, rail, airlines =
80%)? New… tax court ruled that truck
drivers must actually stop for sleep break in order to deduct standard
meals allowance. ___ ___ Are
you a performing artist employee that receives a W-2… musician, dancer, juggler? (2+ w-2’s, agi < 16k) ___ ___ Are
you State or Local government official paid on a fee basis rather than
salary… such as a tax collector? ___ ___ National
Guard / Reserves… Did you have
unreimbursed travel expenses while traveling more than 100 miles away from
home? (test=100 miles one way). Provide # miles: ______ Meals $_______ Hotel $______. ___ ___ Military/National
Guard / Reserves… Did you have active
duty pay while working/training out-of-state? Or did you have PA active duty pay related
to a PA declared emergency? Please
bring orders with dates and locations. Education: ___ ___ Did
you cash U.S. Savings Bonds (series EE or I) in parent’s name issued after
1989 and use the money for college expenses for yourself or your dependents? ___ ___ Did
you pay student loan interest?
(60-75k/120-150k agi) ___ ___ Did
you make contributions to a Sec 529 Qualified Tuition Program such as PA’s
TAP? Please provide information
below. Skip social security numbers
for children listed on your tax return. ($13k max per child, per spouse, by
12/31) T / S Student Beneficiary
______________________ SS#
______________ 2009 contributions
$________ T / S student Beneficiary
______________________ SS#
______________ 2009 contributions
$________ T / S student Beneficiary
______________________ SS#
______________ 2009 contributions
$________ ___ ___ Did you pay for higher education (post high school) tuition & fees for yourself or your dependents? Include amounts paid by student loans. Include amounts paid by the student. Please bring form 1098-T (IRS tuition statement) for each school attended. Please provide… Tuition paid: $____________* Books, supplies, computers:
$____________ If yes, please answer
the following 3 questions: ___ ___ ……..Was
student at least 1/2 time for at least one academic period? ___ ___ ……..Had
student completed 4 years of undergraduate credits at 01/01/10? (American
Opportunity Ed. Credit) ___ ___ ……..Has
student already claimed the Hope credit on 2 tax returns? * a. Reduce
amounts by reimbursements from financial aid, employers, military, etc. b. Limitations apply for students convicted
of a drug felony before 01/01/10. Business & Rental Property Owners: Corporate clients can skip this entire section if you have already given me 2009 income, expenses, mileage, etc. at your corporate tax appointment earlier this year. ___ ___ Are you a home improvement contractor? PA requires you to register. 888-520-6680 for more info. ___ ___ Do you offer a health insurance plan to your employees? PA businesses with 2-20 employees are subject to mini-COBRA and must offer continuation of benefits to laid off employees. Contact your health insurance provider.
___ ___ Did you participate in the 2009 65% COBRA subsidy for any of your employees? If yes, the payroll tax credits on your 941 payroll tax forms need to reduce your company paid health insurance premiums. ___ ___ Did your business receive more than $10,000 in cash for a single transaction (or group of related transactions)? Cash = cash, cashier’s check, bank draft, wire transfer, traveler’s check, money order. Form 8300 within 15 days.
___ ___ Did you operate a vacation rental property with an average rental period of 7 days or less? (motel rules) ___ ___ Did
you operate a rental property which you used personally for the greater of…
more than 14 days; or more than 10% of the total days rented? Don’t include
maintenance, cleaning, condition inspections, administrative as personal use
days. ___ ___ Did
you receive rent payments for use of your home for 14 days or less (tax-free
loophole)? ___ ___ Are
you using Quickbooks? Please bring
your Quickbooks backup file and do not input again until I return the
file. Do not use Accountants Review Copy. Do not use Portable Company File. I will need to know your password and
Quickbooks version such as Quickbooks Pro 2009 (found by pressing F2 in most
versions). ___ ___ Did
you have rental mileage? Provide #
rental miles: ______ Provide total miles
driven in 2009 (all miles including personal miles): ________ ___ ___ Did
you have business mileage? Provide #
business miles: ______ Provide total miles
driven in 2009 (all miles including personal miles): ________ ___ ___ Does
your business manufacture, grow, extract, install, develop, improve,
process/change products in the U.S?
Includes manufacturing, new construction contractors (not
landscapers), engineering, architects, equipment rentals of self-created or
self-processed property, film & audio production, software design except
databases, graphic design, etc.
Does not include retail sale of food & beverages. ___ ___ Did
you pay interest on a vehicle loan for a vehicle used partly for business or
rentals? Please call your bank
before your tax appointment, etc. for the amount of 2009 interest expense
paid $________. The amount is not
found in your coupon book and changes each year. If you want to deduct, you must call your
lender. ___ ___ Did
you pay 2009 interest on business credit card charges? Please call your credit card companies and
provide $_______. Note: Don’t
include 2009 credit card payments in your 2009 expenses. Instead only include the new 2009 credit
card charges. This amount may be
higher or lower than the actual payments.
___ ___ Did
you pay health, long-term care, or cancer insurance premiums for yourself
& dependents? Don’t include months
you were eligible to participate in an employer’s subsidized plan for same
type of insurance. $_______. ___ ___ Did
you purchase at least 50 gallons of un-dyed fuel for generators, tractors,
chain saws, backhoes, or other off-road equipment? _____ gallons unleaded.
_____ gallons diesel. (NOT for autos
& trucks, NOT for rental properties) ___ ___ Did
you pay rent to lease commercial space (office, storage, etc.) and pay for
building improvements? (15 yrs) ___ ___ Did
you own a restaurant property and pay for building improvements? (15 yrs) ___ ___ Was
the business owner under age 65 and collecting social security? ___ ___ Are
you a farmer receiving Conservation Reserve Program (CRP) payments and also
receiving Social Security? (No se tax
on CRP) ___ ___ Did
you pay startup & admin. costs to establish a new retirement plan during
2009? (form 8881=$500) ___ ___ Do
you own a food & beverage business with tipped employees? (form 8846) ___ ___ Are
you a self-employed musician selling self-created compositions? (capital gain treatment) ___ ___ Does
your 2009 business income include notary fees? (no se tax) ___ ___ Did
your business increase accessibility for disabled employees or customers by
removing barriers, modifying equipment, modifying walkways, etc.? (form 8826) ___ ___ New… Heroes Earnings Assistance Tax Act… Did
your business voluntarily pay an employee differential wages while they were
away on active military duty? (form
8932, 20% credit)(06/18/08-2009) ___ ___ Are
you in the business of building highly energy efficient residential homes
that are certified to save 50% in heating/cooling costs via formulas provided
by Residential Services Network (RESNET) publications 05-001 and 06-001? ($2k/$1k)
___ ___ Have
you installed highly energy efficient improvements to a commercial building
or rental property as part of a certified plan to save 50% in total annual
energy costs? (max expense $1.80 per sq foot) ___ ___ Did
you use biodiesel fuel in the operation of your business or farm? ($1/gallon
credit form 8864) ___ ___ Did
you file a PA Use Tax return during 2009 (form PA-1)? Use tax is another word for sales tax that
a vendor did not charge you due to internet purchase, mail-order purchase, or
vendor error. PA has sent letters to
most business regarding this issue.
Non-business persons are also subject to this tax. No license is required. ___ ___ Has
your business reported losses for more than 3 consecutive years? (Local issue) ___ ___ Are
you subject to the Harrisburg Mercantile tax (i.e. ___ ___ Business Use of Home.
Did you use part of your home exclusively for business either
to 1) meet with clients on a regular basis, or 2) store inventory, or 3) as a
paperwork base when no substantial administrative or managerial
activities were performed by you at another fixed location? Use actual amount of bills paid during the
period your home was used for business.
In other words, you don’t have to do any percentage calculations. Just use the full amounts that you paid. 1) home utilities...
don’t include phone, cable, or internet here… $__________ these
expenses are deductible, but elsewhere. (electric,
gas, oil, water, sewer, trash, coal, firewood) 2) home
repairs & improvements: 1.
to the office/storage/business area $__________ 2.
to remainder of home including personal areas $__________ 3) home
insurance $__________ (homeowners, fire, flood, renters, pmi - private mortgage insurance) 4) miscellaneous $__________ (home rent, homeowners association dues, cleaning, security) 5) Wait… you can skip this question 5) if you
claimed home office deduction in the prior year. a.
# rooms used for business __________. b.
total # of rooms __________. (Room
count should use average size rooms.
For example a small bathroom counts as 1/2 room and a large finished
basement counts as 2 rooms. Count all
finished rooms that use heat & electric.
Exclude garage.) c.
Amount you paid for your home plus home improvements over the years (don’t include your own
labor)(appraised value is not relevant).
$__________. Home Purchases and Sales: ___ ___ Did
you purchase a home in 2009? Please
bring HUD-1 settlement sheet. If yes, please answer the following 2 questions: ___ ___ ……..First-Time
Homebuyer Credit… Did you buy a primary residence during 2009… and did
you (and your spouse if married) not own any other primary residence during
the 3-year period ending on the purchase date? Please bring a copy of your purchase HUD-1
settlement sheet with signatures of all parties. Newly constructed homes require a copy of
the certificate of occupancy if no HUD-1 is available. Mobile home purchases require a copy of the
retail sales contract signed by all parties if no HUD-1 is available (must
include all info usually on HUD-1). To
qualify… home must be your primary residence located in the U.S.,
purchase date must be during 01/01/09-04/30/10 (military abroad have 1 extra
year)(use move-in date for new construction), you cannot have owned a primary
residence during the 3 years prior to purchase, income must be under $95k for
singles and under $170k for married couples for purchases before 11/07/09,
income must be under $145k for singles and under $245k for married couples
for purchases 11/07/09-04/30/10, must use newly purchased home as principal
residence for 3 years, cannot be a
non-resident alien, property cannot be acquired by gift or inheritance,
property cannot be acquired from a related party, primary mortgage financing
cannot be from tax-exempt mortgage revenue bonds. Effective for homes purchased after
11/06/09… purchase price can not exceed $800k, filer can not be claimed as a
dependent on another person’s tax return, taxpayer and spouse must be at
least age 18, no electronic
filing of your tax return is allowed--
ask Dave about the amended method.
For Dave only…(lesser of 10% of purchase or S/MFJ=$8,000,
MFS=$4,000)(Form 5405)(Phaseouts… S/MFS/HH 75-95k (125-145k), MFJ 150-170k
(225-245k)). ___ ___ ……..Long-Time
Resident Homebuyer Credit… Did you buy a primary residence on or after Nov.
7, 2009… and did you (and your spouse if married) reside in your old
home for 5 consecutive years during the 8-year period ending on the purchase
date? Please bring a copy of your
purchase HUD-1 settlement sheet with signatures of all parties. Also bring form 1098 mortgage interest form
or tax records or insurance records for each of the 5 years of
residency. Newly constructed homes
require a copy of the certificate of occupancy if no HUD-1 is available. Mobile home purchases require a copy of the
retail sales contract signed by all parties if no HUD-1 is available (must
include all info usually on HUD-1). No
electronic filing of your tax return is allowed-- ask Dave about the amended method. …(lesser of 10% of purchase or
S/MFJ=$6,500, MFS=$3,250)( ___ ___ Did
you sell a home in 2009? Please
bring HUD-1 settlement sheet. If yes, please answer the following 4 questions: ___ ___ ……..Did
you use the home sold as your principal residence for at least 2 of 5 years
before the sale? ___ ___ ……..Did
you sell another home within the 2 year period prior to sale? ___ ___ ……..Did
you sell a home that was used for business/rental? ___ ___ ……..First-Time
Homebuyer Credit recapture…Did you sell a home that you had previously used
to take the 2008 First-Time Homebuyer Credit ($7,500 re-payable loan). Early repayment required if property is
sold or no longer is used as primary residence, zero repayment required if
taxpayer dies, reduced repayment allowed if your outstanding balance exceeds
any gain on sale of the home, divorce results in the spouse living in the
home being fully responsible for repayment. Other Income: ___ ___ Did you collect unemployment during
2009? Please bring UC 1099-G tax
form. ($2,400 exclusion) ___ ___ Did
you receive non-taxable military combat zone pay? (EIC)(refundable child tax credit) ___ ___ Did
you receive alimony during 2009?
$________. Do not include
child support. ___ ___ Did
you receive other taxable income not reported to you on a tax form? Circle: jury duty, legal awards, unreported
tips exceeding $20/month, prizes, awards, gambling winnings, election volunteer
pay, non-taxable State/Local rebate to EMS workers, debt
cancellation/forgiveness (form 982). Other Deductions & Credits: ___ ___ Did
you purchase a new motor vehicle (not used) from 02/17/09-12/31/09?… passenger auto, light truck under 8,500 lbs,
motorcycle, or motor home Please
bring receipt showing sales tax. (49,500 max; S=125-135,
MFJ=250-260) ___ ___ Did
you pay property taxes in 2009? Even
minimal amounts are now deductible for those that don’t itemize
deductions. Up to $500 for single
filers. Up to $1,000 for married
filers. Please bring property tax
bills. ___ ___ Did
you pay alimony during 2009?
$________. Do not include
child support. Provide recipient’s
name and social security number unless we already have on file from previous
year. ___ ___ Did
you purchase a new hybrid gas/electric vehicle or alternate fuel
vehicle (hydrogen, methanol, natural gas) in 2009? Leased autos are no longer eligible. Please provide: Purchase date________ Year, make, & model _____________________ . ___ ___ Did
you make energy efficient improvements to your home that were installed in
2009? Please keep your purchase
receipts and the manufacturer’s certification that the product qualifies for
this tax credit. NONBUSINESS ENERGY PROPERTY CREDIT
(valid for 2009 and 2010) 1) 30% energy efficiency improvements: Circle: Insulation, exterior windows & skylights, exterior doors, coated metal roof, asphalt roof with cooling granules. This category excludes installation costs. 2)
30% qualified residential energy property: Circle: heat pumps,
central air conditioners, water heaters, newly added for 2009 is a stove
using biomass fuel such as wood to heat air or water (energy efficient
building property) Circle: gas furnace,
propane furnace, oil furnace, hot water boiler. Circle: advanced main
air circulating fan used in a gas or oil furnace. Note: overall max is $1,500
credit for all years 2009-2010;
manufacturer’s paperwork should indicate whether energy efficiency
qualifies for the tax credit; must be
principal residence; in USA. -------------------------------------------------------------------------------------------------------------------------------------- RESIDENTIAL ENERGY EFFICIENT
PROPERTY CREDIT (through-2016) 1) 30% improvements (include installation
costs for all): Circle solar energy electric generating property (main or 2nd home), solar water heating property (main or second home). Excludes swimming pool property. max = unlimited starting in 2009. Circle fuel cell property (main or 2nd home). max = $500 per half kilowatt of capacity. Circle geothermal heat pump property (main or 2nd home). max = unlimited starting in 2009. Circle small wind energy property (main or 2nd home). max = unlimited starting in 2009. ___ ___ Did
you contribute to an HSA health savings account? Not to be confused with the HRA
flexible spending accounts commonly available through most large employers. HSA’s require high deductibles of at least
$1,150 for self-only coverage and $2,300 for family coverage. Contribution deadline is 04/15/10. (Fed & PA)(must be <65)(max deduction = $3000/5950)(catchup = $1000 if age 55 at 12/31) ___ ___ Are
you on a bankruptcy payment plan & paying off deductible taxes, etc.? ___ ___ Did
you receive Trade Adj. Assistance (TAA) or Pension Benefit Guaranty (PBGC)
benefits and pay for your own health insurance? If these terms are unfamiliar, check
no. Please bring proof of eligibility
paperwork. (Form 8885) Miscellaneous: ___ ___ New small business penalty relief… Was more than 50% of your 2008 (not 2009) Federal gross income from a small business that you owned with less than 500 employees? (safe harbor is 90%) ___ ___ Did you elect to receive COBRA continuation health coverage (35% of premium) during 2009 as a result of an involuntary termination of employment? (S<125K, MFJ<250k) ___ ___ Were
you, your property, or your children attending college… located in a
Federally declared disaster area during any part of 2009? Which disaster?
________________________________ ___ ___ Did
you mail quarterly estimated tax payments for 2009? Please provide dates and amounts
below. Federal: Date Amount Date Amount Date Amount 1st
qtr-04/15/09 _______ _________ _______ ________ ________ ________ 2nd
qtr-06/15/09 _______ _________ _______ ________ ________ ________ 3rd
qtr-09/15/09 _______ _________ _______ ________ ________ ________ 4th
qtr-01/15/10 _______ _________ _______ ________ ________ ________ ___ ___ Did
you pay $1,700 or more to a household employee (e.g. live-in nanny, live-in
maid)? ___ ___ Did
you claim the 2008 (not 2009)First-Time Homebuyer Credit ($7,500
re-payable loan) on your 2008 tax return?
Repayments start on the 2010 tax return. ___ ___ Are
you behind in child support, taxes, student loans, etc. that may cause a
portion of your tax refund to be seized by the IRS? (Form 8379)
___ ___ Has
the IRS audited you and disallowed future Earned Income Credits? ___ ___ Did
you receive IRS notices, etc. concerning prior year tax returns? ___ ___ Are
you a new client for 2009 tax returns?
Who referred you? ______________________________________ NEW CLIENTS ONLY… You should also print
and complete the one page “New Client Basic Information Questionnaire” from
this same section of our web site UNLESS YOU HAVE PREVIOUSLY PROVIDED US A
COPY OF YOUR 2008 TAX RETURNS at a prior meeting with me. For Dave’s use only: _X_ ___ Allow
Fed penalty. 2008 total tax = _____________
2008 AGI = __________ _X_ ___ Allow
PA penalty. 2008 total tax =
_____________ 2008 AGI = __________ ___ ___ AMT:
certain home equity interest (if not for acquisition or improvements)
$_________. ___ ___ AMT:
exercise of incentive stock options? (new info return from employer) ___ ___ Travel
& entertainment deductions… client reports they have receipts/mileage
records. ___ ___ Inventory
other than incidental supplies. Client
reports they have records. ___ ___ Misclassified
worker given W-2… form 8919 to pay
fica tax, requires 1 of 7 criteria. ___ ___ New
joint Sole-proprietorship… 2 C’s, 2
SE’s, additional $69 fee ___ ___ M80’s
email list AGREEMENT
FOR TAX SERVICES
The below signed taxpayer (“TAXPAYER”) has engaged David S.
Baboian, CPA, PC (“DSB, CPA”) to prepare 2009 Federal, State, and
Local income tax returns. Fees are
calculated on a fixed price basis based upon complexity and required hours to
complete. PAYMENT IN FULL IS DUE AT TIME OF PICKUP. In the event of human or mechanical error, DSB,
CPA will correct the error at no charge and pay any resulting penalties. TAXPAYER
agrees that all information supplied for use in the preparation of 2009 income
tax returns is correct and complete. TAXPAYER agrees to review
completed tax returns to verify no omissions or misstatements of material
facts exist that understate TAXPAYER’s tax liability. Taxpayer or Spouse Signature:
__________________________________________ Date: _______ For DSB, CPA: __David S. Baboian, CPA___________________ Date: 01/19/10 |