| Do you have wage income? | Yes No |
| Do you have more than $1,000 in bank interest or stock/mutual fund dividend earnings? | Yes No |
| Do you have income from self-employment? | Yes No |
| If Yes, please describe the type of self-employment and the estimated gross income. | |
| If Yes, do you have buildings, equipment and/or furniture that you use in self-employment? | Yes No |
| If Yes, do you use vehicles in self-employment? | Yes No |
| Did you sell, exchange, redeem, or trade any stocks, bonds, or real estate? | Yes No |
| Do you own rental real estate? | Yes No |
| If Yes, how many properties/units? | |
| Did you receive any distributions from IRAs or retirement plans before age 59-1/2? | Yes No |
| Do you generally itemize deductions for medical expenses, real estate tax, mortgage interest and charitable contributions? | Yes No |
| Do you have un-reimbursed work related expenses in your work as an employee? | Yes No |
| Did you pay for dependent care while you work? | Yes No |
| Did you pay any college tuition for yourself or a dependent? | Yes No |
| Do you pay federal quarterly estimated tax payments? | Yes No |
| Which states are you required to file personal income taxes in? | |
| Do you pay state quarterly estimated taxes payments? | Yes No |
Do you want your tax preparation fee deducted from your refund?
(Note: extra fee applies; cash, personal checks and Mastercard and VISA accepted) | Yes No |
| Describe any other special situations that apply to your tax return preparation | |
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