Individual Tax Packet

Thank you for taking the time to complete your 2023 client questionnaire. For new clients, this information is critical

to ensure we accurately file your tax return. For existing clients, we kindly request that you provide this information

again to ensure our records are 100% accurate and up-to-date.

IMPORTANT: UPON COMPLETION OF ALL APPLICABLE PARTS OF THIS FORM YOU MUST CLICK THE

"SUBMIT" BUTTON AT THE BOTTOM OF THE FORM TO SEND THIS INFO TO OUR OFFICE. CLOSING YOUR

BROWSER BEFORE CLICKING THE "SUBMIT" BUTTON WILL DELETE ALL INFO WITHOUT SENDING TO US.

IT SHOULD BE NOTED THAT UPON CLICKING THE SUBMIT BUTTON YOU WILL GET A CONFIRMATION

EMAIL THAT WE RECEIVED YOUR INFO.

Please also note that to comply with federal and state identity theft protection efforts our firm will ask for a valid state issued photo identification card during your engagement.

***The page is highly secure. We use industry-leading technology Secured Socket Layer (SSL) to keep your information safe. All sensitive information are securely transmitted and can not be compromised***

This questionnaire may take you up to 20 minutes to complete. Please be sure to organize all of your tax documents prior to completing the form.

2023 Dollars & Cents Tax and Accounting Services LLC Intake Form

Select Your Tax Professional

Are you a NEW or EXISTING Client? *

New

Existing

Did you file a 2022 Tax Return

Yes

Do you have a copy of your prior year (2022) tax return?

Yes

Please Upload Your 2022 Return

Taxpayer Name

First Name *

Last Name *

Suffix

Taxpayer Social Security Number *

Taxpayer Date of Birth *

Taxpayer Occupation *

Were you previously issued an Identity Protection PIN (IP PIN) by the IRS? *

Yes

Phone *

Email *

Address Line 1

Address Line 2

City

Postal code

Was the taxpayer affected by a natural disaster in 2023? *

Yes

Please indicate disaster designation *

Was your main home located in the federally declared disaster area and were you or your spouse displaced from your main home due to the disaster during its incident period?

Yes

Can another taxpayer claim you as a dependent on their tax return? *

Yes

Spouse Name *

Spouse MI

Spouse suffix

Spouse Date of Birth *

Spouse Social Security #. *

Spouse Occupation *

Spouse Phone Number *

Were you previously issued an Identity Protection PIN (IP PIN) by the IRS? (s)

Yes

Spouse E-mail *

Spouse Social Secuirty Card

Spouse Back and Front of Photo Identification *

Did the Spouse work last year?

Yes

Spouse Income Documents (W-2, 1099 etc)

Did you file taxes in the previous year?

Yes

If so please state which years need to be filed:

Upload Previous Tax Year Documents

If you are filing back taxes for 2020 or 2021, Did you receive Stimulus payments?

Yes

Stimulus Document from your IRS.gov account

Taxpayer Back and Front of Photo Identification *

Taxpayer Social Security Card

Did the taxpayer work last year?

Yes

Taxpayer Income Documents (W-2, 1099 etc)

Will you be filing a tax return with your Spouse? *

Yes

Do you have any dependents you will claim on your tax return? *

Yes

Have you ever been disallowed for EITC/AOTC/CTC?ACTC?

Yes

How many dependents will you claim on your tax return? *

1 dependent

2 dependent

3 dependent

4 dependent

DEPENDENT 1

Was Dependent (1) claimed on your tax return last year?

Yes

Can anyone else claim dependent (1) on their tax return?

Yes

Dependent (1) Name as it appears on social security card

Last

Suffix

Dependent (1) social security number *

Dependent (1) Date of Birth

Is Dependent (1) your biological child?

Yes

How many months did Dependent (1) live in your household last year?

Relationship

Is Dependent (1) disabled?

Yes

Dependent ( 1 ) social security card

Dependent (1) birth certificate

Did you pay any child care expenses for any dependents listed above? *

Yes

Upload child care expense receipt(s)

List Childcare Provider information if receipt isnt available.

Did you, your spouse or any dependents attend college last year? *

Yes

Name of person that attended college last year? *

Last *

Suffix

Did the student attend college at least half time?

Yes

Upload Form 1098-T from college.

Did you, your spouse or dependents receive health insurance through the Marketplace last year and receive Form 1095-A? *

Yes

Upload Form 1095-A Health Insurance Marketplace Statement

Did you or your spouse receive unemployment benefits last year? *

Yes

Upload Form 1099-G received for unemployment benefits

Did you receive government assistance last year? (ex: SNAP (food stamps), Medicaid or Section 8 housing assistance?

Yes

Do you rent or own your current residence? *

Yes

Did you make any home improvements last year?

Yes

If you own your home, have you received form 1098 from your mortgage lender? *

Yes

Upload Form 1098 from mortgage lender

Did you or your spouse make payments on your student loans last year? *

Yes

Upload Form 1098-E Student Loan Interest Statement(s)

Did you or your spouse pay any medical or dental expenses last year? (this does not include insurance premiums)

Yes

Do you or your spouse own a rental property?

Yes

Did you or your spouse have any gambling winnings last year? *

Yes

Upload Form W-2G from gambling winnings

Did you or your spouse receive any earnings from interest or dividends last year? *

Yes

Upload Forms 1099-DIV and 1099-INT for dividends and interest earned

Are you self-employed, own a full time or side business or 1099 contractor? *

Yes

Self Employed/Independent Contractor

Business Name

Business Type

Business Address If Different from Main

What year was business formed?

Do you have a EIN Number ?

Yes

Provide your EIN number

Business Income

Do You Have Supporting Documents For Your Expense Below? (Records, Receipts, Journal, Log, Etc.)

Yes

Do you have form 1099K from Cashapp, paypal, Venmo etc over $10,000?

Yes

1099 K

Do you or your spouse owe debt to any Government Agency; such as IRS, Student Loans, Child Support etc? *

Yes

Which goverment agency do you owe?

Do you plan to purchase a home within the next one or two years?

Yes

Are you interested in securing your family with a Life Insurance Policy ?

Yes

Would you like to see if you PRE-QUALIFY for a SAME DAY ADVANCE UP TO $6,000?

Yes

How would you like your ADVANCE disbursed?

How would you like to recieve your refund?

Would you like your tax refund direct deposited into your bank account? If so, please complete bank information below:

Yes

Bank Name

Routing Number

Account Number

Type Of Account

Would you like to receive a text message when your refund is funded? *

Yes

Select your cell phone provider

How did you hear about Dollars & Cents Tax and Accounting Services LLC?

Do you and your spouse understand and agree to the fees for Dollars & Cents Tax and Accounting Services LLC preparing your Federal/State Income tax return?

Yes

I acknowledge that all information provided to Dollars & Cents Tax and Accounting Services is true and accurate to the best of my knowledge. I understand that I am required to have any supporting documentation to validate the information provided. Furthermore, I understand that knowingly providing false information on my tax return and reporting it to the IRS, that I am taking part in a potentially criminal penalty situation and is punishable by law including but not limited to: facing court dates, restitution, and possible imprisonment. I waive Dollars & Cents Tax and Accounting Services and the preparer of any error due to incorrect information provided by me. By signing below, I authorize Dollars & Cents Tax and Accounting Services to file my tax return.

I acknowlege by signing this form if I and/or my spouse owes a federal/governement debt such as IRS, child support, student loans etc., I/we are still responsible for tax preparation fees due to Dollars & Cents Tax and Accounting Services at the time of service. Also, if the federal refund amount is mailed, I/we are still responsible for the tax preparation fees stated on the invoice. If the tax preparation fees are not paid, I understand Dollars & Cents Tax and Accounting Services will take legal action to collect the unpaid tax preparation fees

Taxpayer's Signature

Clear

Spouse's Signature (if applicable)

Clear

ENGAGEMENT LETTER

Dear Taxpayer,

Thank you for the opportunity to work with you in preparing your income tax returns. To foster a complete understanding of our relationship, take a moment to review the following information.

We will prepare your income tax returns based solely on the information you furnish to us. Upon completion of your tax returns we will return any original tax documents to you. From time to time our office may retain scanned copies of your documents for our records, however you should retain all documents, cancelled checks and other data that form the basis of income and deductions and other tax return forms, schedules, elections and disclosures. Such documents include but are not limited to, proper records to support deductions claimed for meals, entertainment, travel, business gifts, charitable contributions, and vehicle use (if applicable), as well as bank and credit card statements. These records will be necessary to prove the accuracy and completeness of the returns to taxing authorities, should your returns be selected for examination. We recommend keeping all documents and copies of your returns for a minimum of five years after you file your tax returns or after their due date, whichever is later.

Our work in connection with the preparation of your income tax returns cannot be relied upon to disclose errors, irregularities or illegal acts, including, without limitation, fraud that may exist within the documents or figures you provide. We will use our professional judgment in resolving questions where the tax law is unclear or where there may be conflicts between the tax authority’s interpretations of the tax law and other supportable positions. Unless instructed by you, we will take a tax position in your favor whenever reasonable. We cannot provide any assurance that tax positions taken will not be challenged or ensure the ultimate outcome of such a challenge. Moreover, we cannot be responsible for issues arising from any income, expenses or other information not provided to us at the time of tax preparation or prior to the filing of your returns.

Please note that this engagement, and this firm’s services, include but are not limited to general and annual income tax related services. Unless specifically requested by you, and agreed upon in writing we do not provide any services related to payroll tax, sales tax, excise tax, and personal or real property tax. Nor can we be relied upon to determine or report your compliance, or lack thereof, with any Federal, State, or Local business related laws, health care or human resources regulations, retirement plan compliance or any business, property, or professional permitting/licensing.

The charges for our services are on a “per form” basis with references to time spent by our professional staff to perform the work, and costs incurred for related supplies and expenses, including copy charges, long distance phone charges and computer processing charges. Our fee for the preparation of your tax returns will be due and payable upon presentation of your completed income tax filing. It is company policy not to release tax returns or any tax related reports, schedules, information, advice, or notes without payment in full. Should a situation arise where services have been rendered but payment is not received and our firm is forced to or elects to seek legal assistance to collect fees due to us, please note that you may be asked to reimburse our firm for the legal costs to collect any outstanding balance due. Because we understand that cost is an important issue for many clients, we will do our best to provide you with an estimate of our fees prior to completing your returns but please understand that circumstances arise which may raise or lower the estimated fee. We will contact you if such a situation arises after you receive an estimate.

Upon completion of your returns and after you have paid your tax preparation fees we will provide you with a copy of your returns as well as the e-file signature authorizations and any applicable payment vouchers to complete your tax filing. You should review the completed returns carefully. If you see anything that requires changing please bring it to our attention immediately and we will either explain the matter to you or correct it without delay and provide you with new, corrected copies. If you are satisfied with the returns and see no issues, please sign and date the e-file signature authorizations and return them to this office immediately. Please note that all taxing authorities prohibit us from transmitting your tax returns without signed authorization from you. Please also note that if your returns can not be e-filed we will provide you with paper copies to sign and mail to the taxing authorities.

By signing this engagement you are agreeing to compensate Dollars & Cents Tax and Accounting Services for services you have requested. In the event you terminate the engagement prior to the completion of your tax accounting work, Dollars & Cents Tax and Accounting Services reserves the right to invoice you for any out of pocket expenses, time at our hourly rate, or other expenses that were incurred during this engagement. If you sought in person consultation services, received advisory services by phone or email, sought representation work or received any tax accounting services, by signing this engagement letter you are agreeing to compensate Dollars & Cents Tax and Accounting Services for these services, even if you terminated the engagement prior to our firm completing the work requested or required.

Please be advised that if you receive any correspondence from a taxing authority that pertains to a tax return prepared by this firm we will be happy to address this matter on your behalf. Included in the cost of your tax preparation is 120 minutes of correspondence work per tax year at no additional charge. During that 120 minutes we will assess your situation and apprise you of the course of action we believe is best to take. If we can also compose and send off a reply to the appropriate taxing authority then we will certainly do so. If the matter or issue will involve more than 120 minutes of work, each additional hour (or fraction thereof) will be billed at a standard hourly rate of one hundred and fifty dollars ($99) per 60 minute hour. When possible, we will do our best to inform you if we believe your issue will require more than 120 minutes to handle, however there may be a situation when we are unable to inform you in advance. Even if we are unable to inform you, the standard hourly rate listed above will apply and is payable upon completion of this work. At any time in the process you may choose to have us cease our work in connection with your correspondence but we will require said request in writing with your name and signature included. If, during the course of this work, it becomes apparent the correspondence received was due to an error or omission by this office there will be no charge for handling the correspondence regardless of the time involved. Please note that except in cases where our office is deemed at fault, a flat $50 dollar handling charge will be assessed for all matters where our assistance is requested in handling any such correspondence from any taxing authority. This charge is not included in your annual tax preparation fees and is payable upon completion of our work in connection with said correspondence.

Please also note that audit/examination representation work is not included in the tax preparation fee and is considered a different engagement with a separate fee structure. If you have any questions regarding the specifics of audit/examination representation please feel free to ask any time before, during or after your appointment. Again if your returns are audited or examined by any taxing authority, for any reason, the fee you paid for their preparation does not include the costs to represent you with regard to any audit or examination unless you opt in for the Audit Maintenance Protection for $49.99 which will be added in with your tax preparation fees.

Dollars & Cents Tax and Accounting Services takes your privacy and personal information very seriously. We will take whatever steps are necessary to safe guard that information and will never sell or disclose said information to anyone outside the firm for any reason. Please note that while we will protect your confidential information, our firm, from time to time, will need to utilize some of your information for internal purposes not related directly to your current year tax preparation. An example of this usage would be mailing you a newsletter or holiday card to your confidential home address or perhaps a personal phone call to wish you or a member of your family greetings or a happy birthday. By signing this letter you agree to allow our staff limited access to your information for such informal, non-tax preparation related situations.

Please also note that in an effort to help combat the increasing threat of identity theft and to ensure the returns filed by our firm are accurate, true, and pertain to the proper client or taxpayer, Dollars & Cents Tax and Accounting Services reserves the right to request, as condition of our providing services, certain documents to verify your identity and the identity of others you may be listing on your tax returns. This is for your protection and for the protection of your spouse and/or dependents and these documents will be safeguarded to the best of our ability and in accordance with our document protection procedures. Such documents requested by our firm may include but are not limited to; government issued photo identification, Social Security Cards, birth certificates, or visa and immigration related documents.

If you agree with the terms of our engagement as described in this letter please sign below. Please be aware that by signing below and giving us your income tax information, you expressly agree to the terms of this engagement letter. We want to thank you for putting your trust in Dollars & Cents Tax and Accounting Services and look forward to a long and mutually satisfying relationship.

Warm Regards,

Dollars & Cents Tax and Accounting Services

(844) 515-1040

[email protected]

Taxpayer's Engagement Letter Signature *

Clear

Spouse's Engagement Letter Signature (if applicable)

Clear

CONSENT TO USE OF TAX RETURN INFORMATION

Federal law requires this consent form be provided to you. Unless authorized by law, we cannot use, without your consent, your tax return information for purposes other than the preparation and filing of your tax return. However, federal law also prohibits us from revealing any personal or financial information to any third party. Therefore as a matter of fact, we will never reveal your financial or personal information in any way, to anyone, unless you specifically request we do so, and provide in writing to us the specific person or persons to whom you wish that disclose to be made, which is done on a wholly separate consent form from this. For the purposes of this consent form please note we are seeking consent only to satisfy requirements set forth by federal law so we may speak with you on the phone, send you email correspondences of any kind, send you mailings, newsletters, email reminders, holiday and occasional cards and greetings, and reminders of upcoming deadlines, etc.

You are not required to complete this form. If we obtain your signature on this form by conditioning our service on your consent, your consent will not be valid. Your consent is valid for the amount of time that you specify. If you do not specify the duration of your consent, your consent is valid for a period of three years from the date you have signed the consent.

The undersigned hereby consents to the use; by Dollars & Cents Tax and Accounting Services, its owner, employees, and staff; of any and all tax return information pertaining to

Direct questions, inquiries or requests you make regarding your tax returns, situation, or issues.
Requests you make for copies of your documents, figures, numbers, or information.
Upon your direct request in order to connect you with another professional in another field or profession so you may gain further information on a certain topic not available or in the realm of expertise of this firm.
Notification of important tax law changes.
Notification of changes or information that will impact our engagement, such as a change of firm website address, email address, physical location, or other such contact, biographical or geographical information.
Other reasonable business purposes including but not limited to: appointment reminders, holiday mailings, birthday greetings and other informational mailings.

The tax information may not be disclosed or used by Dollars & Cents Tax and Accounting Services its owner, employees, or staff, for any purpose other than that which is permitted by this consent document.

If you believe your tax return information has been disclosed or used improperly in a manner unauthorized by law or without your permission, you may contact the Treasury Inspector General for Tax Administration (TIGTA) by telephone at 1-800-366-4484 by email at [email protected].

Taxpayer's Consent to use of Tax Return Signature *

Clear

Spouse's consent to use of tax return information signature (if applicable)

Clear

CONSENT FOR PAYMENT

We here at Dollars & Cents Tax and Accounting Services value the relationship we have with all of our clients. We are in the business to provide you with the absolute best service you can have. With saying that, we would like to remind you that we are providing you a service NOT a refund. You as a taxpayer have the choice to pay your tax preparation fees by one of the following: cash, check, money order, credit card, or directly from your refund*.

*If you choose to have the tax preparation fees taken from your refund and for whatever reason your taxes are intercepted, YOU ARE STILL RESPONSIBLE FOR THE TAX PREPARATION FEES! Please contact us immediately at our office for payment or payment arrangements. By signing your return you are agreeing to pay the preparation fees regardless if your refund was received or not. After 90 days from the date the refund was scheduled to arrive if no payment or payment arrangement is made, we will be forced to put your account into collections and/or debit your bank account. We hope we never have to go this route, so please keep open communication with us so we can work with you!

Taxpayer's Consent for Payment Signature *

Clear

Spouse's Consent for Payment Signature (if applicable)

Clear

I agree to terms and conditions provided by the company. I agree to receive notification and/or marketing messaging from Dollars & Cents Tax and Accounting Services at the phone number provided above. I understand I will receive up to 10 messages a month, data rates may apply, reply STOP to opt out.