Client Name(s): ___________________________________________________________________
2014 TAX QUESTIONNAIRE
COMPLETE TO THE BEST OF YOUR ABILITY
In order that we may accurately report all necessary tax events for this tax year, please complete the
following questionnaire.  If answers to specific questions are left blank, we will assume a "No" answer.
Please return ALL pages of this questionnaire.
YOUR SIGNATURE(S) IS (ARE) REQUIRED ON THE LAST PAGE
RETURN WITH YOUR OTHER TAX MATERIALS
MANDATORY FOR THE COMPLETION OF YOUR 2014 TAX RETURN
Please provide the following tax support documents when delivering your tax information to us for the
preparation of your 2014 Individual Income Tax returns.  Please indicate with an "X" below which forms
have been provided:
W-2 ____ 1099 R ____ 1099 B Brokerage Statements ____
1099 INT ____ 1099 G ____ 1099 MISC ____
1099 DIV ____ 1099SSA ____ 1098 Mortgage Interest ____
1099 T (Tuition) ____ 1099 LTC ____ 1098 E ____
1099 Q (529 w/d)   ____ 1099 A ____ 1099 C (Debt Cancelation) ____
1041 K-1 ____ 1065 K-1 ____ 1099 S (Sale of Real Estate) ____
1099 SA (HSA) ____ 1120S K-1 1099 K (Merchant and 3rd Party Pay) ____
5498-SA ____
1099 HC (Massachusetts Health Care Form provided by Insurance Carrier) - Required ____
Also, please provide any additional tax documentation so that we may accurately include all taxable 
events you may have incurred throughout the year.  If you are uncertain, provide the information and we
will determine the tax impact.
NOTE:  Please be advised that, if requested by the Internal Revenue Service or any other
federal, state or local taxing authority, that you are required to have proof to substantiate 
all information presented.
ELECTRONIC FILING AND PAYMENT
We will prepare your tax returns for Electronic Filing, unless advised otherwise, or certain schedules
preclude us from doing so.
YES NO
If you have a tax refund, would you like it to be Direct Deposited into your bank account ?
If so, please attach a VOIDED CHECK to the Questionnaire unless that information 
is unchanged from the prior year. ____ ____
If you have a tax balance due, would you like it to be automatically withdrawn from your  ____ ____
bank account?  If so, please attach a VOIDED CHECK to the Questionnaire unless we
have that information previously.
YES NO
PERSONAL INFORMATION
Did your marital status change during the year? ____ ____
If married, do you and your spouse want to file separate returns? ____ ____
Can you or your spouse be claimed as a dependent by another taxpayer? ____ ____
Did your address change since our last filing? ____ ____
If so, please provide new address, phone, cell phone and e-mail:__________________
_______________________________________________________________________
_______________________________________________________________________
Did you pay or receive alimony during 2014? ____ ____
If yes, did you reside with your former spouse at any time during the year? ____ ____
DEPENDENTS
Were there any changes in dependents from the prior year? ____ ____
If adding a dependent, please provide Name, Social Security Number, and Date of Birth:
_______________________________________________________________________
If losing a dependent, please identify ________________________________________
Did you pay for childcare while you worked or looked for work? ____ ____
**If so, please provide the Provider's name, address, SSN/EIN and the amounts paid during
this tax year for each child. ____________________________________________________
______________________________________________________________________
Do you have any children with wages, interest, dividend or sales of securities income ____ ____
totaling over $1,000 in 2014?  If yes, please contact our office.
Did you adopt a child or begin adoption proceedings during 2014? ____ ____
If yes, please provide expenses incurred in 2014 and whether a foreign adoption.
SCHEDULE A - ITEMIZED DEDUCTIONS INFORMATION
Please provide all 1098 Mortgage Interest statements and the total Real Estate tax payments made during 2014.
Are you claiming a deduction for mortgage interest paid to a financial institution for ____ ____
which someone else received the Form 1098?  If so, please specify. ______________
______________________________________________________________________
Did you pay any mortgage interest to someone other than a financial institution?  If so, ____ ____
please provide name, address, social security number and amount paid in 2014.
Did you refinance your mortgage?  If so, please provide the HUD Settlement Statement. ____ ____
YES NO
Charitable Contributions:
Cash, Checks and Credit Cards: Total             $  ________________
* Please supply a list summarizing all charitable contributions showing the name of each
charity and the amount contributed.  At the time of filing, IRS requirements are as follows:
* For contribution less than $250 - proof of payment:  cancelled check, credit card receipt,  or in
the case of cash contributions, a receipt from the charity.  Records must be contemporaneous;
* For contribution of $250 or more, you must have either a cancelled check or credit card
receipt AND a letter acknowledging the contribution and if any adjustment for goods and 
services received.  Records must be contemporaneousFor these contributions, please list 
the net contribution and provide a copy of the letter from the charity.
Clothing and Household Goods: Total             $  ________________
* Per IRS instruction, these contributions must be in GOOD OR BETTER CONDITION.  Only list
the amount that you can substantiate.  
If the total exceeds $500, then please provide receipts which clearly indicates the following: 
   - name and address of the charity:
   - the fair market value of the donated item:
   - your cost and how acquired (purchase, inheritance, etc.):
   - and the method used to calculate the fair market value.
Records must be contemporaneous.
For guidance on fair market value, we suggest viewing the list of suggested values per websites
such as:  www.salvationarmyusa.org (look under:  ways to give/valuation guide); or
www.goodwill.org (look under:  get involved/donate).  These can be accessed through our website.
Other Contributions - please describe and attach support or contact our office for guidance.
* For items over $5,000, other than securities, a signed appraisal is required.  Please contact
our office.
_________________________________________________________________________
Did you make any large purchase, such as a motor vehicle or boat in 2014? ____ ____
If so, the sales tax MAY be deductible.  Please contact our office.
This deduction generally benefits taxpayers in states without state income tax (i.e. NH, FL, etc.)
Did you incur any casualty or theft losses during the year, including losses from ____ ____
"Ponzi Schemes" or are in a Federally Declared Disaster area?  If so, provide details.
Did you pay union or professional dues, incur uniform, un-reimbursed auto or certain ____ ____
investment expenses or have gambling losses (to the extent of winnings).  If so,
please provide details:____________________________________________________
___________________________________________________________________________________________
YES NO
SCHEDULE B - INTEREST AND DIVIDEND INCOME
Did you receive any interest or dividend income?  If so, please provide Forms 1099-INT, ____ ____
1099-DIV or any other information showing the amount of income you received.
Did you have any Tax-Exempt income?  If so, please provide statements. ____ ____
SCHEDULE C -  (SELF EMPLOYMENT)  -  BUSINESS INCOME AND EXPENSES
Did you start or dispose of a business during the past year?
If so, please discuss the matter with us. ____ ____
If you are a Schedule C filer, please provide the amount you paid in health insurance $___________
and long term care premiums for yourself and your dependents.
If you or your spouse are self-employed, are you or your spouse eligible to be covered ____ ____
under an employer's health plan at another job?  If yes, how many months were you
covered? Months:_____________
Business vehicle expenses must be substantiated with mileage logs and trip sheets for each trip.  You 
are required to maintain these records and provide in the event of an audit.  Please provide us with 
summary information.  (Note that commuting miles between your home and a fixed work location is
not considered deductible business miles).  Please provide:
Business Miles    1/1/13-12/31/13       ($.56.5/mile) ______________________
Total Miles Driven    1/1/13-12/31/13 ______________________
Automobile:  Date of Purchase, make, model and year ______________________
During the past tax year, did you make payments to others of $600 or more for services
that would require you to issue Forms 1099 ?   ____ ____
If "yes" have you filed the required Forms 1099 and 1096 ? ____ ____
If "Yes" please provide copies.  If required to file these forms and have not done so,
please contact our office.
Please provide us with a list of your related business income and expenses, any
newly acquired business assets, business-related car expenses and business use
of home expenses;  the client organizer can be used.