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THOMPSON FLAHERTY2019 INDIVIDUAL TAX PREPARATION QUESTIONNAIREThe purpose for this questionnaire is to gather information needed in preparing an accurate income tax return, which may avoid lost deductions, IRS audits, interest, and penalties. We are updating our database. Please provide us with contact information.Please provide the following items: FORMCHECKBOX Copies of all W-2’s, 1098, 1099, 1095-A FORMCHECKBOX Copy of prior year’s tax returns (2018) Forms and the amount of other income received by you and your spouse. (New clients only). FORMCHECKBOX Copies of all K-1 Forms received by you or your spouse Email address:________________________________________ From any Partnerships, S-Corporations, Trusts or Estates FORMCHECKBOX I would like to receive the Thompson Flaherty monthly newsletter Please complete all Blocked information due to IRS Revenue Procedure ChangesFirst Name:M.I. Last Name:SS#Spouse’s First Name:M.I.Last Name (if different)SS#Address:City:State:Zip:Telephone No. Daytime:Evening:Cell:Your Date of Birth: (mm/dd/yy)Spouse’s Date of Birth: (mm/dd/yy)Check if legally blind: FORMCHECKBOX Taxpayer FORMCHECKBOX SpouseCheck if Permanently Disabled FORMCHECKBOX Taxpayer FORMCHECKBOX SpouseAs of December 31st were you: FORMCHECKBOX Single FORMCHECKBOX Legally married FORMCHECKBOX Separated FORMCHECKBOX Divorced FORMCHECKBOX Same sex Civil Union FORMCHECKBOX Qualifying Widow(er) FORMCHECKBOX Head of HouseholdCan your parents or someone else claim you or your spouse as a dependent on their tax return? FORMCHECKBOX Yes FORMCHECKBOX NoYour Occupation:Spouse’s Occupation:Family and Dependent InformationList dependents who lived in your home and anyone living outside your home that you or your spouse supported during the tax year. For example: son, daughter, step child, foster child, adopted child, brother, sister, stepbrother, stepsister, or a descendant of any of them, also mother or father. First Name Last Name SS# Dateof birthmm/dd/yyRelationshipto youLived with you more than 6 months?Did dependent file a joint tax return?Is childa full time student orpermanentlyand totallydisabled?Did you provide more than 50% of their support?Did the person have gross income over $4200?Special Rules for parents who are divorced or legally separated or lived apart at all times during the last 6 months of the year. If the child lived in your home for less than half of the calendar year:Did one or both parents provide over half of the child’s total support? FORMCHECKBOX Yes FORMCHECKBOX NoIs the child in custody of one or both parents for more than half the year? FORMCHECKBOX Yes FORMCHECKBOX NoDid the custodial parent sign Form 8332 or similar statement releasing the exemption? FORMCHECKBOX Yes FORMCHECKBOX No If yes, please provide Form 8332 – or copy of divorce decree for non-custodial parent claiming child.During the tax year did you, your spouse, or anyone in your household: During the tax year did you, your spouse, or anyone in you household: Receive any investment income? FORMCHECKBOX Yes FORMCHECKBOX No Were you a resident of, or did you earn income in FORMCHECKBOX Yes FORMCHECKBOX No (For example: interest or dividends?) more than one state in 2019?Receive a distribution from an IRA or FORMCHECKBOX Yes FORMCHECKBOX No Receive any gambling winnings? If yes, please FORMCHECKBOX Yes FORMCHECKBOX Noretirement plan? Separate your gambling winnings and losses by each day of gambling activity.Receive Social Security or FORMCHECKBOX Yes FORMCHECKBOX No Purchase/sell your principal home or second FORMCHECKBOX Yes FORMCHECKBOX NoDisability Income or Benefits? Home in 2019? If yes, provide a copy of closing statements.Receive unemployment compensation? FORMCHECKBOX Yes FORMCHECKBOX No Did you claim the First-Time Homebuyer Credit FORMCHECKBOX Yes FORMCHECKBOX No Receive any income which is exempt from FORMCHECKBOX Yes FORMCHECKBOX No on a prior year tax return? Federal taxes? (ie., Municipal Bond Interest) Did you pay any interest on the purchase of a boat FORMCHECKBOX Yes FORMCHECKBOX No Did you have any debts cancelled or RV/Camper that has living quarters? Or forgiven? FORMCHECKBOX Yes FORMCHECKBOX No Do you or your spouse wish to have $3.00 FORMCHECKBOX Yes FORMCHECKBOX No of your taxes applied to the Presidential Campaign Fund and/or contribute to any Refinance your principal and/or second home FORMCHECKBOX Yes FORMCHECKBOX NoIllinois Nonprofit organization? or take a home equity loan in 2019? Pay over $250 in private education FORMCHECKBOX Yes FORMCHECKBOX No expenses at an Illinois (K-12) or homeActively participate in the operations of any FORMCHECKBOX Yes FORMCHECKBOX Noschool program?Trust, Partnerships, or S Corporations for which you arereporting an income or loss on your 2019 tax return?Are you an elementary or high school FORMCHECKBOX Yes FORMCHECKBOX No S-Corporation Shareholders; please provide copy of teacher, aide, principal, or counselor? last paycheck stub for 2019. If yes, please indicate the amount of unreimbursed classroom expenses you paid in 2019. $_________ Actively participate in the operations of any rental FORMCHECKBOX Yes FORMCHECKBOX No activity for which you are reporting an income or Did you receive money from any other source FORMCHECKBOX Yes FORMCHECKBOX No loss on your 2019 return?that has not previously been mentioned on this form (a side job, Online sales, “Kickstarter”, GoFundMe”)? Receive or pay alimony this year? FORMCHECKBOX Yes FORMCHECKBOX No Have any foreign income, foreign financial assets, FORMCHECKBOX Yes FORMCHECKBOX NoReceive a refund from a state tax return FORMCHECKBOX Yes FORMCHECKBOX Nointerest in foreign companies or held foreign bank filed last year?accounts individually or jointly during 2019? If yes, did you pay foreign taxes? FORMCHECKBOX Yes FORMCHECKBOX No Did you purchase or dispose of any business FORMCHECKBOX Yes FORMCHECKBOX NoSell any stocks, bonds, or real estate FORMCHECKBOX Yes FORMCHECKBOX No assets (furniture, equipment, vehicles, real estate,held for investment purposes? etc.), or convert any personal assets to business use?Have any worthless stock or any loans FORMCHECKBOX Yes FORMCHECKBOX No that became uncollectible in 2019? Have you, or your spouse received an Identity Protection Yes No Personal Identification Number (IP PIN) from the IRS? Pay student loan interest? FORMCHECKBOX Yes FORMCHECKBOX No If so, please provide the number__________________ Receive any prizes, awards, court awards, FORMCHECKBOX Yes FORMCHECKBOX No Did you pay any expenses related to adopting a child? Yes NoScholarships or bartered any goods during the year. If so, please provide details.Attend, or pay tuition for college or FORMCHECKBOX Yes FORMCHECKBOX No Did you make any charitable contributions? FORMCHECKBOX Yes FORMCHECKBOX No Vocational School? If yes, please provide (Please provide documentation). Form 1098-T.Pay for child/dependent care (including a FORMCHECKBOX Yes FORMCHECKBOX No Make gifts during 2019 directly or in a trust FORMCHECKBOX Yes FORMCHECKBOX Nonanny) that allowed you to work?totaling over $15,000 per person? If yes, please list the provider’s name, address, Tax ID number, and amount paid. Pay any of your medical or long-term healthcare FORMCHECKBOX Yes FORMCHECKBOX NoDid you have any children under age 19 insurance premiums, deductibles, co-pays or any or full-time students under age 24 at the other out-of-pocket medical expenses for you or end of 2019 with interest,dividend and FORMCHECKBOX Yes FORMCHECKBOX No your dependents in 2019 in excess of 10% of capital gain income in excess of $1,100.00? your income? Pay any state and local sales tax on any major purchases (motor vehicles, boats, or home building materials)Receive a distribution from or make a FORMCHECKBOX Yes FORMCHECKBOX No in 2019? If yes, please provide the sales tax paid. FORMCHECKBOX Yes FORMCHECKBOX Nocontribution to an educational savings account or qualified tuition program?Were you or your spouse an active FORMCHECKBOX Yes FORMCHECKBOX No Do you want any overpayment of 2019 taxes FORMCHECKBOX Yes FORMCHECKBOX Noparticipant in an employer or self-employed applied to your 2020 taxes?pension, profit sharing, or tax-sheltered annuity at any time during 2019? Do you expect a large fluctuation in your income FORMCHECKBOX Yes FORMCHECKBOX NoContributions to/or Distributions from FORMCHECKBOX Yes FORMCHECKBOX No or withholding in 2020?a Health Savings Account or Flexible Savings Account in 2019? If so, were all distributions used for FORMCHECKBOX Yes FORMCHECKBOX No Do you expect to receive a lump sum distribution FORMCHECKBOX Yes FORMCHECKBOX No Qualified Medical Expenses? from a pension or profit sharing plan in 2020? Did you incur a loss to your property related to a FORMCHECKBOX Yes FORMCHECKBOX No Federally declared disaster?Did you add any energy efficient propertyto your home in 2019? Examples include FORMCHECKBOX Yes FORMCHECKBOX No Do you anticipate having significant Investment FORMCHECKBOX Yes FORMCHECKBOX No solar, wind, geothermal, and fuel cell property Income in 2020? Do you anticipate having wages or self-employment FORMCHECKBOX Yes FORMCHECKBOX No Income in excess of $125,000 in 2020? Did you purchase a plug-in Electric Drive FORMCHECKBOX Yes FORMCHECKBOX No Did you receive, sell, exchange, or otherwise acquire Motor Vehicle or qualified fuel cell vehicle? Any financial interest in any virtual currency in 2019? Yes No Did you receive any notices from the IRS or Did you obtain health insurance through the governmentsa state taxing authority? FORMCHECKBOX Yes FORMCHECKBOX No sponsored exchange “The Marketplace” in 2019? Yes No If yes, please provide Form 1095A ROTH IRA REGULAR IRA HSA Taxpayer Spouse Taxpayer Spouse Taxpayer SpouseContributions paid for 2019 prior to 12/31/2019 ________ ________ ________ ________ _______ _______Contributions for 2019 to bepaid on or before 4/15/2020 ________ ________ ________ ________ _______ _______Did you convert a Traditional IRA to a Roth IRA in 2019? FORMCHECKBOX Yes FORMCHECKBOX No Did you transfer or rollover any amounts from one retirement plan to another retirement plan? FORMCHECKBOX Yes FORMCHECKBOX NoDid you pay any federal and state estimated taxes for 2019? FORMCHECKBOX Yes FORMCHECKBOX NoIf yes, please list: Federal State DueDate paidAmount Date paidAmount4/15________________________________6/15________________________________9/15________________________________1/15________________________________ Do you want to electronically file your tax return? FORMCHECKBOX Yes FORMCHECKBOX NoDo you want your income tax refund directly deposited to your bank account? FORMCHECKBOX Yes FORMCHECKBOX NoIf yes, please provide:Bank Name:_________________________ FORMCHECKBOX Checking FORMCHECKBOX SavingsBank Routing No.:_________________________Bank Account No.:_________________________May the IRS discuss this return with the preparer? FORMCHECKBOX Yes FORMCHECKBOX No Would you like a copy of your tax return emailed to you as a PDF file instead of receiving a paper copy? FORMCHECKBOX Yes FORMCHECKBOX NoAmount of purchases in 2019 for which Sales Tax has not been paid, (i.e. internet purchases) please provide the dollar amount of those purchases. $_______________ This tax can be paid for on the Illinois income tax return.Note: The IRS may require documentation for any listed data. By completing this questionnaire, youAcknowledge that the information is factual and that you will furnish substantiation if requested.Signature Printed Name Date Thompson FlahertyCertified Public Accountants Tax Return Preparation, Consulting and Accounting ServicesENGAGEMENT POLICY STATEMENTDear Client:We appreciate the opportunity of serving you and advising you regarding your income taxes and/or accounting needs. To ensure a complete understanding between us, we are setting forth the pertinent information about the services that we propose to provide for you.Tax Work:We will prepare your federal and state income tax returns based on information you furnish to us. We will not audit or otherwise verify the data you submit to us, although we may ask you to clarify some of it. In order to timely file your tax returns, we need all required information no later than 20 days prior to the tax filing deadline. You may be required to request an extension if we do not receive all required information by the above date. We will use our judgment in resolving questions where the tax law is unclear, or where there may be conflicts between the taxing authorities’ interpretation of the law and other supportable positions. Unless otherwise instructed by you, we will resolve such questions in your favor whenever possible.It is your responsibility to provide all the information required for the preparation of complete and accurate returns. You represent that there is adequate substantiation to support deductions for any expenses claimed on the return. You are ultimately responsible for the accuracy of your return and should review it carefully before signing it. You should retain all the documents, canceled checks, and other data which form the basis of income and deductions. These may be necessary to prove the accuracy and completeness of the returns to a taxing authority.Your returns may be selected for review by the taxing authorities. Any proposed adjustments by the examining agent are subject to certain rights of appeal. In the event of such government tax examination, we will be available upon request to represent you and will request a retainer before performing such services.If there is an error on the return resulting from incorrect information supplied by you, or due to your subsequent receipt of amended or corrected tax forms (W-2’s, 1099’s, K-1’s), you are responsible for the payment of any additional taxes which would have been properly due on the original return(s), along with any interest and penalties charged by the IRS. Accounting and Consulting:Our services come in the form of a tax return, financial statement, letter, report preparation, along with consultations, meetings or phone calls. Our fees are based upon several factors. We have spent many years becoming very knowledgeable and educated in tax and accounting matters. In addition, we are required to continue our education annually to maintain our licenses. When you contact us it is because you need our knowledge and assistance with something, this is when our time becomes billable. If you call our office with a “general” question that we can quickly answer, we consider this a courtesy service and you will not be billed for our time. Phone calls requiring research, business or personal planning, tax compliance, etc. will be billed in accordance with our billing policy.Billings: Any estimate we give is based upon information you initially provide to us. Actual fees may vary as circumstances change and/or new corrected information is made available. All fees and costs incurred to prepare your income tax returns are due and payable before the returns are released from our office. You will receive a full paper or pdf of your return. Any additional copies will incur a service charge of $45.00 for digital and $60.00 for returns in storage. We reserve the right to hold the completed returns until your account is paid in full. An E-file authorization signature and payment in full is required before any tax return can be electronically filed or released.If your return is for a closely held corporation, partnership, limited liability company, or other entity, the person signing that return agrees to be personally liable for our fees if the entity does not pay. Finance Charges will accrue at 1.5% per month after 30 days of the invoice date. Uncollected invoices will be subject to submittal with collections and incur a collection fee, all collection costs and Finance Charges.Payments:We reserve the right to require retainers at our discretion. New clients will be requested to remit a retainer. New client status will remain in effect for the first twenty-four (24) months of service. The retainer is an estimate of work to be performed; and additional amounts may be due.Accounts unpaid for 60 days will require that we cease rendering service until your account is brought current. In the event we stop work or withdraw from this engagement as a result of your failure to pay on a timely basis for services rendered, we shall not be liable for any damages/penalties incurred as a result of our ceasing to render services.The client has ten (10) days from the invoice date, to voice any objections or questions regarding the invoice or any portion or element thereof. After the ten (10) day period all invoices shall constitute acceptance of the invoice as submitted and payment in full will be expected within the required time frame. Any courtesy billing adjustments given are honored for fourteen (14) days. After fourteen (14) days, the invoice must be paid at the full rate and the courtesy adjustment shall be null and void. Any Non-Sufficient Funds check will be charged an additional $50 fee.Either party may terminate this agreement upon giving a (10) days written notice. Should this agreement be terminated prior to completion of services, we will prepare a final bill showing the total fees incurred for services rendered. This amount will be due and payable upon presentation.Please be advised that certain communications involving tax advice between you and our firm may be privileged and not subject to disclosure to the IRS. If you disclose the contents of those communications to anyone, or turn over information about those communications to the government, you may be waiving this privilege. To protect your rights, please consult with us or your attorney prior to disclosing any information about our tax advice.If, after reading this letter, you agree to the terms and conditions set forth herein, please sign below and return this letter in the enclosed envelope.We again would like to express our appreciation for this opportunity to serve you.Yours very truly,Thompson FlahertyACKNOWLEDGEMENT Having read and fully understood the engagement letter, I/we agree to engage Thompson Flaherty in accordance with the terms indicated. I/we understand the returns and/or Accounting services are to be prepared from information I/we provide and that the final responsibility for a complete and accurate return/services rests with me/us. It is also my/our responsibility to review and understand the information on the returns prior to signing and filing them.Date__________________________________________________________________Company Name (if applicable)________________________________________________________________Print Name (Taxpayer) Signature________________________________________________________________Printed Name (Spouse) Signature We must have a signed Engagement Policy Statement signed and in our records before we can commence on work requested.We may terminate our representation of you if you insist that we pursue objectives that we consider imprudent, unprofessional, or unethical or if we feel further representation is not warranted for personal reasons. Regardless of the reason for termination, you are obligated to pay for services provided and costs incurred through the date of termination. ................
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