Individual Tax - 2021 Client Update Form

Individual Tax - 2021 Client Update Form

Taxpayer Information
Name

First Name Last Name
Phone Number
Please enter a valid phone number.
Email
example@example.com
Filing Status

Single Head of Household Married Filing Separate Married Filing Joint Qualifying Widower

Tax Related Questions
Did your marital status change in the last year?

Yes No
Did your address change in the last year? If yes, please provide your new address.
Could you be claimed as a dependent on another person's tax return for 2021?

Yes No
Were there any changes in dependents? If new, please provide name, date of birth and social security number.
Did you have any children under age 19 or full-time students under age 24 at the end of 2021, with interest and dividend income in excess of $2,200?

Yes No
Is your bank account for direct deposit or direct withdrawal the same as last year?

Yes No
If you have a balance due/amount payable, would you like to use direct withdrawal?

Yes No
Did you and your dependents have healthcare coverage for the full-year? Did you receive Form 1095? If so, please attach or submit to our office.

Yes No
Form 1095

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Did you have any foreign income or pay any foreign taxes?

Yes No
Did you start a business or farm, purchase rental or royalty property, or acquire an interest in a partnership, S corporation, trust, or REMIC?

Yes No
Did you purchase or dispose of any business assets (furniture, equipment, vehicles, real estate, etc.), or convert any personal assets to business use?

Yes No
Did you buy or sell any stocks, bonds or other investment properties in 2021?

Yes No
Did you purchase, sell, or refinance your principal home or second home, or did you take a home equity loan? Please attach Final Settlement Statement or submit to our office.

Yes No
Final Settlement Statement

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Did you make any residential energy-efficient improvements or purchases involving solar, wind, geothermal or fuel cell energy sources?

Yes No
Did you make a contribution to a retirement plan (IRA, SEP, SIMPLE, Qualified Plan, etc.)?

Yes No
Did you transfer or rollover any amount from one retirement plan to another retirement plan?

Yes No
Did you convert part or all of your traditional, SEP, or SIMPLE IRA to a Roth IRA in 2021?

Yes No
Did you receive a distribution from an Education Savings Account or a Qualified Tuition Program?

Yes No
Did you, your spouse, or a dependent incur any tuition expenses that are required to attend a college, university, or vocational school?

Yes No
If you have an overpayment of 2021 taxes, do you want the excess applied to your 2022 estimated tax (instead of being refunded)?

Yes No
Do you want to allocate $3 to the Presidential Election Campaign Fund?

Yes No
Does your spouse want to allocate $3 to the Presidential Election Campaign Fund?

Yes No
Did you have an interest in or signature or other authority over a financial account in a foreign country, such as a bank account, securities account, or other financial account?

Yes No
Did you receive a distribution from, or were you the grantor of, or transferor to, a foreign trust or did you have an interest in any foreign assets or accounts?

Yes No
Was your home rented out or used for business?

Yes No
Were you notified or audited by either the Internal Revenue Service or the State taxing agency?

Yes No
Did you or your spouse make any gifts to an individual that total more than $15,000 or any gifts to a trust?

Yes No
Did you have virtual/crypto currency transactions in 2021?

Yes No
If you are a new client, how did you hear about us?
Would you like to receive weekly Tax Tips?

Yes No
Did you receive an Economic Impact Payment (EIP) during 2021? If so, please attach IRS Letter 6475 or submit to our office.

Yes No
IRS Letter 6475

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Did you receive the Advanced Child Tax Credit payments during 2021? If so, please attach IRS Letter 6419 or submit to our office.

Yes No
IRS Letter 6419

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Did you receive a Paycheck Protection Payment (PPP?)

Yes No
Did you receive an Economic Injury Disaster Loan (EIDL)?

Yes No
Did you receive unemployment benefits?

Yes No
Did you purchase an electric vehicle during 2021? If so, please provide purchase documentation or submit to our office.

Yes No
Electric Vehicle Documentation

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Acknowledgement & Signature
By signing below, you acknowledge and confirm that all information you entered here is true and correct and related to the tax year 2021 (January 1, 2021 to December 31, 2021). You also permit Tax Time Services Inc. to capture and collect the information you entered in this form.
Date Signed

Month Day Year
Date
Taxpayer Signature

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Date Signed

Month Day Year
Date
Spouse Signature (if applicable)

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