Questionnaire — Gianni Logan, accountant & Business Consultant

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Occupation (self)

Occupation (spouse)

Dependent (1) - Social Security No.

*Please upload via client portal

Dependent (1) - Relationship to You

Dependent (1) - No. of months lived with you

Dependent (2)

First, Middle Initial, and Last Name

Dependent (2) - Social Security No.

*Please upload via client portal

Dependent (2) - Relationship to You

Dependent (2) - No. of months lived with you

Dependent (3)

First, Middle Initial, and Last Name

Dependent (3) - Social Security No.

*Please upload via client portal

Dependent (3) - Relationship to You

Dependent (3) - No. of months lived with you

Dependent (4)

First, Middle Initial, and Last Name

Dependent (4) - Social Security No.

*Please upload via client portal

Dependent (4) - Relationship to You

Dependent (4) - No. of months lived with you

Is there a special arrangement that allows the non-custodial parent to claim a dependent as their qualifying child?

If there is such an arrangement, please provide documentation.

Did you and each member of your tax family have health care coverage during the tax year?

Please list any member of your tax family who did not have health care coverage?

Was health care coverage provided by a government marketplace (exchange)?

If health care coverage was provided by a government marketplace (exchange), please provide a copy of Form 1095-A.

Was health care coverage provided by an employer?

*If health care coverage was provided by an employer, please provide a copy of form 1095-B or 1095-C.

Did you receive a distribution from a retirement account during the tax year?

If a distribution was received, please provide a copy of 1099-R or any other relevant documents.

Child and Dependent Care Expenses

List the name (first, middle initial, last) of each qualifying individual for whom you paid child and dependent care expenses on behalf of.

Child and Dependent Care Provider & Tax ID

List the name, address, and tax identification number of each child and dependent care provider. *If the provider was an individual - please list the provider's name, address, and social security no. ~ Support should be provided for payment of expenses~

Adoption - Were expenses paid in connection with an Adoption?

*If expenses were incurred - please provide supporting documentation for expenses.

Adoption - Was the adoption for a child with special needs?

Qualified Higher Education - Tuition and Fees

Were expenses paid for qualified higher education (tuition and fees?)

Qualified Higher Education - Please provide supporting documentationi of all expenses paid relative to qualified higher education?

*Books, supplies, equipment (i.e. computer/laptop)

Earned Income Tax Credit (EITC)

Has the IRS disallowed you the EITC in prior years?

EITC - Please provide the year in which the EITC was disallowed.

Estimated Tax Payments

Please indicate the type ( Federal or State) and the total amount of estimated tax payments for each made during the tax year.

Itemized Deductions

*Please provide the total amount of expenses paid for each category of itemized deductions. Note: If your itemized deductions do not exceed $12,400 there is likely no benefit to itemizing. ~ Supporting documentation should also be provided.

Itemized Deductions - Medical and Dental

Out of Pocket cost (not reimbursed by medical insurance)

Medical Insurance Premiums (not paid with pre-tax dollars)

Doctor and Dentist Cost

Prescription Medicines

Nurse Care, Nursing Home or Long Term Care Facility Cost

*Nursing Home or Long Term Care cost must be primarily due to medical care provided by facility.

Medical treatment cost (hospitals/lab work)

Medical aids (glasses, contacts, hearing aids, wheel chairs)

Transportation (medical)

*Transportation must either be "actual" cost paid (i.e. gas, parking, etc.) or "standard mileage". Please specify.

Lodging (medical)

Capital Expenditures (medical)

*Ex.) Improvements made to home for medical reasons

Itemized Deductions - Taxes Paid during tax year

*Please provide total amount paid for each category and supporting documentation

State and local income taxes

*Not listed elsewhere

Real estate taxes

*Not listed elsewhere

Personal property taxes

*Includes owners tax on auto registration

Itemized Deduction - Interest

*Please provide total amount paid for each category and supporting documentation.

Home mortgage interest - Paid to financial institutions

Home mortgage interest - Paid to individuals

* List the name and address of individual(s)

Mortgage Points

*Please identify if points paid relative to Purchase or Re-finance

Investment Interest (expense)

Student Loan Interest

*This deduction is available whether taxpayer itemizes or not.

Itemized Deductions

*Did you incur expenses during the tax year to be itemized?

Itemized Deductions - Contributions

*Please provide total amount paid for each category and supporting documentation from organization.

Cash Contributions

Non-cash Contributions

Itemized Deductions - Casualty and Theft Losses

*Please provide loss amounts relative to federally declared disasters only.

Income Adjustments

*Please provide total amount paid for each category and supporting documentation.

Alimony Paid

*List name & social security number of individual paid

IRA Contributions (Self)

*Please indicate the total amount contributed

IRA Contributions (Spouse)

*Please indicate the total amount contributed

Self-employed Health Insurance Premiums

SEP (simplified employee pension) Contributions

*Please indicate whether contributions were to a Keogh SEP

Rent & Royalty Income and Expense

*Please provide supporting documentation for each amount.

Property Address

Proprety Type

Property Ownership Percentage

*Please provide percentage of ownership. If owned by more than one person, please provide percentage split

Did you live in the rental property at any time during the tax year?

Number of Days Rented

*Note: This typically applies in the case of a vacation home; however, may apply if renting for a partial year.

Rental Income

$

Royalties

$

Rental Expenses

*Please provide the total amount for each expense paid during the tax year.

Advertising

$

Allocated Tax Preparation Fees

*Please provide portion of tax preparation fees only related to rental property.

$

Association Dues

$

Auto Mileage

$

Cleaning and Maintenance

$

Insurance

$

Legal and Professional Fees

$

Licenses and Permits

$

Management Fees

$

Mortgage Interest (Form 1098)

$

Other Interest

$

Property Taxes

$

Repairs

$

Supplies

$

Utilities

$

Other Expenses

*Please provide a description

$

Business Income & Expenses

Principal Business or Profession

Business Name

Employer Identification Number (EIN)

Did you materially participate in the business?

Is this the first year of the business?

Did your business earn a profit in the last three out of five years?

Gross Receipts or Sales Income

*Please provide supporting documentation.

$

Business Expenses

*Please upload supporting documentation via secure client portal.

Advertising

$

Commissions and Fees

$

Consulting

$

Client Gifts

*Limited to $25 each

$

Education and Seminars

$

Employee Benefits

*Employers to report amounts

$

Employee Vehicle Expense

*Employers to report amounts (i.e. stipend paid to employee)

$

Health Insurance

$

Insurance [other]

$

Legal and Accounting Fees

$

Licenses

$

Management Fees

$

Meals [client & self]

*Meals for self are deductible only when traveling away for business.

$

Mortgage Interest

$

Interest [other]

$

Lodging

$

Office Supplies

$

Other Office Expenses

$

Payroll Service

$

Payroll Taxes

$

Pension and Profit Sharing Plans

$

Rent (building)

$

Rent (equipment)

$

Rent (vehicles)

$

Repairs & Maintenance (building)

$

Repairs & Maintenance (equipment)

$

Repairs & Maintenance (Vehicle Type)

*Provide the year, make, and model of the vehicle.

Repairs & Maintenance (vehicle)

*Please provide repairs to vehicle relative to business.

$

Tax Preparation Fees

*Please provide portion of tax preparation fees only related to business.

$

Utilities

$

Wages (employees/independent contractors)

*Provide amounts paid to employees and/or independent contractors

$

Transportation Expense Method

*Please select the transportation expense method used during 2018.

Transportation - What expense method was used on last year's tax return?

Transportation - Miles Driven

*Please provide total business miles driven during 2018. ~ Commuting miles should be deducted from mileage ~ Please provide supporting documentation (i.e. mileage log)

Other Business Expenses

$

Other Business Expenses

$

Business Use of Home

Do you use any part of your home regularly and exclusively for business?

Please provide the estimated percentage of time spent in home office .

Provide a brief description of the type of work done in home office.

Provide total area (square feet) of home

Provide total area (square feet) of home used regularly for business

Business Expenses - Home Office

*Please provide the total amount for each expense. ~ The actual expense will be based on the percentage of business use.

Do you use any part of your home regularly and exclusively for business?

Please provide the estimated percentage of time spent on business activity in the home office?

Please provide the total area (square feet) of home.

Please provide the total square feet of the area in the home used regularly for business?

Business Expenses - Home Office

*The total amount provided for each expense will be allocated based on the business percentage.

Home Insurance

$

Utilities

$

Rent

$

Mortgage Interest

$

Other

$

Did you pay cash wages to a household employee of $2,100 or more?

Did you receive an Identity Protection Pin (IPIN) from the IRS?

*IPIN's are issued to taxpayers to help prevent fraudulent use of social security numbers on fraudulent income tax returns.

Prior Year Tax Returns - Required

*Please provide a copy of your prior year income tax return

Other Important Information

*Please provide other important tax data and circumstances I should be aware of to properly prepare your tax return. ~ If there are none, please indicate by inputting "N/A".

First Time Home Buyer Credit Repayment

Are you under obligation to repay the First Time Home Buyer Credit?

Tax Questionnaire