Bruce R. Ashton, CPA
Tax Questionnaire 2013
PERSONAL TAX INFORMATION (BRING SOCIAL SECURITY CARD, to verify name)
TAXPAYER
SPOUSE/RDP
NAME
TAX ADDRESS
CITY, STATE & ZIP CODE
OCCUPATION
SOCIAL SECURITY NO.
DATE OF BIRTH
TELEPHONE: HOME
BUSINESS
e-Mail Address
/
/
/
/
DEPENDENT TAX INFORMATION
FULL NAME
DATE OF
BIRTH
SOC. SEC. NO.
[SEE NOTE]
RELATIONSHIP
MONTHS
IN HOME
CHILD
CARE EXP
NOTE: SOCIAL SECURITY NUMBER REQUIRED FOR ALL DEPENDENTS (even babies)
ESTIMATED INCOME TAX DATA
FEDERAL
DATE PAID
AMOUNT
STATE
DATE PD
AMOUNT
2012 Overpayment
credited to 2013
Due 15 April 2013
Due 15 June 2013
Due 15 September 2013
Due 15 January 2014
Amounts from Backup
Withholding
OTHER INCOME TYPES AND REPORTING REQUIREMENTS
TYPE OF INCOME
Wages and Salaries
Pensions
Partnerships, Estates and Trusts
PAPERWORK REQUIREMENTS
Provide actual W-2's [do not recap]
Provide actual 1099's [do not recap]
Sole Proprietorship or Farm Businesses
PLEASE, provide copies of the K-1's for me to keep.
[The tax laws are too complicated for summaries or
recaps]
I need a listing of income and expenses separated into
meaningful line items or categories, not just totals for
money-in and money-out. If you need any help or
forms to complete the task, please call my office.
Royalties
Other Income
All paperwork provided
Bring provided paperwork
IF YOU WANT YOUR REFUND SENT DIRECTLY SENT TO YOUR BANK, EITHER BRING IN A
BLANK CHECK (NOT A DEPOSIT SLIP) OR FILL IN THE FOLLOWING ------------Routing number (9 digits)
Account Number
REMEMBER - USE LAST YEARS TAX RETURN AS A
GUIDE AND REFERENCE
INTEREST & DIVIDEND INCOME [RECEIVED]
FROM BANKS, SAVINGS AND LOANS, CREDIT UNIONS, ETC.
Source
Amount
Source
Amount
FOREIGN BANK ACCOUNTS (this is a hot button issue with the IRS) – Please provide names,
balances and country of holding for all foreign bank accounts.
.
Total Amount of Penalties for Early Withdrawals
Amount of back-up withholding
$ ___________________________
$ ___________________________
SELLER-FINANCED MORTGAGE INTEREST RECEIVED
Payer's Name
Face Amount of
Note
Payer’s Soc. Security
Number —
Required by IRS(!)
Principle
Received
Interest
Income
Received
DIVIDEND INCOME (Please bring all broker’s statements)
Source or Payer
Ordinary
Dividends
Capital Gain
Distributions
Non-Taxable
Other Items
NONTAXABLE AND / OR OTHER TYPES OF INTEREST OR DIVIDENDS RECEIVED
Source
Amount
Source
Amount
OTHER INCOME ITEMS AND ADJUSTMENTS TO INCOME
OTHER INCOME

Social Security Benefits Received
Taxpayer
Spouse

Unemployment Benefits or Compensation
Received
Received
$
Paid

Alimony
Received
Paid
Tax rebate check received in 2013
Other Cash Receipts or Income Items:


see below

(if any)
Notes
1.
2.
3.
4.
INCOME ADJUSTMENTS [Items That Reduce Income]

Alimony Paid

Payments to

Self-Employed
Health Insurance
Premiums:
IRA
Contributions:

Recipient's Last Name:
Soc. Sec. #:
KEOGH
SEP or SEP-IRA
Taxpayer
Spouse
Covered by an Employer
Plan
Amounts of Contribution
Dates of Contribution

1.
2.
3.
4.
5.
Other Items:
COBRA subsidy
Comments or Notes
Total per your records
Sales or Exchanges of Assets (BRING IN ALL 1099-BROKER STATEMENTS)
Property type &/or
Description
Date
Acquired
Date Sold
(2013
Assumed)
Gross Sales
Price
Cost of Asset
+
Improvements
Costs
Involved in
Sale
ITEMIZED DEDUCTIONS
MEDICAL EXPENSES
[effective only if total is over 10.0% of AGI]
Total of Prescription Medicines and Drugs
Medical Insurance Premiums
Medicare Insurance Premiums
Doctors and Hospitals: ALL doctors or hospitals where TOTAL
amount is less then $100
Doctors & Hospitals: List all where individual amounts are > $100
1.
2.
3.
Glasses, Hearing Aids, Laboratories
Total Medical Mileage
Other items:
Amount of Insurance Reimbursement - if not netted above
miles
TAXES PAID [note: sales taxes are not deductible]
State Income Taxes
Additional Paid with 2012 Return
January 2013 Estimate Paid for the 2013
Return
Amounts Paid to Other States / Other /
Miscellaneous
Even if you don’t itemize
1.
2.
1.
Even if you don’t itemize
Real Estate Taxes
Auto Licenses
Other Taxes Paid:
Sales Tax for new vehicles
Sales Tax for major purchases
CONTRIBUTIONS (100% Receipts REQUIRED)
Religious Institutions
Cancer, Heart Societies
Other Charities
Goodwill, Salvation Army
Other Non-Cash Contribution
[note: non-cash contr. in excess
of $500 must be itemized and
listed separately]
1.
2.
1.
2.
1.
2.
3
4.
1.
2.
3.
4.
MISCELLANEOUS DEDUCTIONS [effective only if total is over 2% of AGI]
Accounting Fees
Safe Deposit Box Fees
Professional Dues
Work Tools
Seminars
Telephone
Uniforms
Other business items: 1
2
3
4
5
6
7
NOTE: for automobile or truck expenses - see “business automobile” page
INTEREST EXPENSE [PAID]
LOAN PAYABLE TO {NOTE: if paid to
an individual, social security
number
must be included}
YEAR OF
LOAN
PURPOSE OF LOAN
& LOAN AMOUNT -OTHER COMMENTS
INTEREST PAID
DURING YEAR
HOME MORTGAGE
1.
2.
3.
EQUITY MORTGAGE
1.
2.
POINTS PAID - REFINANCE
1.
INVESTMENT OR PASSIVE INTEREST
EXPENSE / OTHER ITEMS OF NOTE
1.
2.
3.
MISCELLANEOUS QUESTIONS & ITEMS OF INTEREST
DESCRIPTIONS, AMOUNTS,
OTHER COMMENTS
Any rollover of pension plans, Keogh’s or IRA's?
Any loans or notes that became uncollectible during the
year?
Did you move during the year?
Do you own/have any foreign assets?
Did you incur a loss because of damaged or stolen
property, or other casualty-type loss? If so, provide
details on a continuation sheet, Include date of loss,
type of property, type of loss, fair market value
before and after, and date the property was acquired.
Do you have a dependent, under 18 years of age, who
received over $850 in any type of earnings?
Did you pay for the care on one or more dependents
during the year? If so--- Number of dependents
 Provider name [as requested on Form SS-10]

address

social security or federal id. Number
Did you make a nondeductible contribution to an IRA?
If so, form 8606 requires the following:
 Amount of contribution and to whom.
 Total amount of previous years contributions,
where being held in trust, 31 December value, and
breakdown of basis of those contributions.

If you made any large purchases for your rental or
business property, provide copies of the purchase
agreements or invoices.
IF YES – we need to talk
YES
NO
IF WE DID NOT PREPARE YOUR INCOME TAX RETURNS IN THE PAST, PLEASE BRING
YOUR 2011 FEDERAL AND STATE RETURNS WITH YOU - THANK YOU
BUSINESS AUTOMOBILE
NOTE: must be completed for every vehicle that is used for business. Actual expenses are NOT required
if you are using the government’s “standard mileage rate”. However, this section must be completed if you
are using the Actual Expense Method, if you are leasing the vehicle, or if you ever depreciated the vehicle
under the ACRS/MACRS method.
Do not complete this or any other auto section if your auto is only
used for commuting to and from work and for personal travel
Description of Vehicle (Make and Model)
Date Originally Purchased
Total miles auto driven in current year
Business miles driven:
for employer
for professional meetings
between 1st and 2nd jobs
job seeking
investment miles (including tax preparation)
self-employed business
other: ___________________________________
Total Automobile Costs
Gasoline, Oil
Repairs & Maintenance
Tires, Batteries, Etc.
Insurance
License and/or taxes (do not duplicate elsewhere)
Interest (do not duplicate elsewhere)
Washes and Waxes
Lease Payments
Other: ___________________________________
VEHICLE 1
Taxpayer
Spouse
VEHICLE 2
Taxpayer
Spouse
Miles
Miles
Miles
Miles
Miles
Miles
Miles
$
miles
miles
miles
miles
miles
miles
miles
$
RENTAL INCOME AND EXPENSES
Property Number
1
2
3
Property (NOTE- use 100% amounts]
Income
Advertising
Auto and Travel
Cleaning and maintenance
Commissions
Insurance
Legal and other professional fees
Management fees
Mortgage interest paid - 1st trust deed
Other amounts
Repairs
Supplies
Taxes
Utilities
Yard maintenance
Other Expenses:
Address
1
% Ownership
2
3