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Employer                Address:                                                Health Insurance thru the marketplace?Yes/No Who:                  \nDependents:  \nName  \nSocial Security\\#  \nDate of Birth  \nName  \nDate of Birth  \nSocial Security\\#  \nName  \nSocial Security\\#  \nDate of Birth  \nName  \nSocial Security\\#  \nDate of Birth  \nIncome:  \nW2/1099/K1  \nSelf/Spouse  \nCompany  \n(Circle one)  \n(Circle one)  \nW2/1099/K1  \nSelf/Spouse  \n(Circle one)  \nCompany  \n(Circle one)  \nSelf/Spouse  \nW2/1099/K1  \nTax Return Questionnaire-2021 Tax Year  \nPrint this form andfill itout.Bring it with you when you come to the office or fillit out online at jenniferyoungsbookkeeping.com/tax-preparation/.This will save you time and money and help us be more efficient.  \n## Tax Return Questionnaire-2021 Tax Year\n\n图图口图口图日图目图口图图图图口日照图图图l■■■  \nB田日  \n7aonanagonnon  \n\n| Taxpayer Name:   |  |\n| --- | --- |\n| Taxpayer Address:   |  |\n| Occupation:   |  |\n| Spouse Name:   |  |\n| Spouse Address:(if different)   |  |\n| Spouse Occupation:   |  |\n\n■口日  \n\n| Phone Numbers:   |  |\n| --- | --- |\n| Email Address(es):   |  |\n\n日日■[  \n日  \n图图图■图口  \n\n| Filing Status:  \u003Cbr>□Single  \u003Cbr>□Head of Household  \u003Cbr>□Married  \u003Cbr>□Qualifying Widow   |\n| --- |\n| Date of Birth:  Taxpayer:  //_____    Spouse:/_/____   |\n\nm口因口  \nIf you would like your tax refund(if any)deposited directly into your bank:  \n\n| Account Type:   | Account Number:   | Bank Routing Number:   |\n| --- | --- | --- |\n| □Checking  \u003Cbr>□Savings   |  |  |\n\nIf we have not previously prepared your return,please provide a copy of your2020 tax returns and driver's licenses.  \n## DEPENDENTS\n\nTax Return Questionnaire-2021 Tax Year  \n\n| Name:(First,Initial,Last)   | Income over  \u003Cbr>$2200?Y/N   | Date of Birth   | Relationship   | Months Lived  \u003Cbr>in Home   |\n| --- | --- | --- | --- | --- |\n|  |  |  |  |  |\n|  |  |  |  |  |\n|  |  |  |  |  |\n\n·Virtual Currency:At any time during 2021,did you receive,sell,send,exchange,or otherwise acquireany financial interest in any virtual currency?□Yes□No  \n● Health Insurance Coverage:Did you have health care coverage with a government marketplaceduring 2021?□Yes□No-  If yes,please provide form 1095-A issued by marketplace.  \n## INCOME\n\n### 1.Wages &Salaries-Include W-2s\n\n\n| Name of Payer   |  |\n| --- | --- |\n|  | □Taxpayer □ Spouse   |\n|  | □Taxpayer □ Spouse   |\n|  | □Taxpayer □ Spouse   |\n|  | □Taxpayer □Spouse   |\n|  | □Taxpayer □ Spouse   |\n\n### 2.Interest/Dividend Income-Include 1099s\n\n\n| Name of Payer   |  |\n| --- | --- |\n|  | □Taxpayer □ Spouse   |\n|  | □Taxpayer □ Spouse   |\n|  | □Taxpayer □ Spouse   |\n|  | □Taxpayer □ Spouse   |\n\n### 3.Capital Gains &Losses\n\n\n| Name of Payer   |  |\n| --- | --- |\n|  | □Taxpayer □ Spouse   |\n|  | □Taxpayer □ Spouse   |\n|  | □Taxpayer □ Spouse   |\n|  | □Taxpayer □ Spouse   |\n\n### 4.Other Gains &Losses\n\n\n| Name of Payer   |  |\n| --- | --- |\n|  | □Taxpayer □ Spouse   |\n\nTax Return Questionnaire-2021 Tax Year  \n\n|  | □Taxpayer □ Spouse   |\n| --- | --- |\n|  | □Taxpayer □ Spouse   |\n|  | □Taxpayer □Spouse   |\n\n### 5.Pensions,IRA Distributions,Annuities,and Rollovers-Include 1099 K\n\n\n| Name of Payer   |  |\n| --- | --- |\n|  | □Taxpayer □ Spouse   |\n|  | □Taxpayer □Spouse   |\n|  | □Taxpayer □Spouse   |\n|  | □Taxpayer □ Spouse   |\n\n### 6.Rents/Royalties,Partnerships,S Corporations,Estates,Trusts\n\n\n|  |\n| --- |\n\n### 7.Unemployment Compensation Received-Include 1099 G\n\n\n| Name of Payer   |  |\n| --- | --- |\n|  | □Taxpayer □ Spouse   |\n|  | □Taxpayer □ Spouse   |\n|  | □Taxpayer □ Spouse   |\n|  | □Taxpayer □ Spouse   |\n\n### 8.Social Security Benefits Received\n\n\n|  |\n| --- |\n\n### 9.Other Income\n\n\n| Description   |  |\n| --- | --- |\n|  | □Taxpayer □Spouse   |\n|  | □Taxpayer □ Spouse   |\n|  | □Taxpayer □Spouse   |\n|  | □Taxpayer □ Spouse","cbCaihbJr9aqYzSP","https://ap.wps.com/l/cbCaihbJr9aqYzSP","pdf",4430492,13,"English","# Tax Return Questionnaire-2021 Tax Year\n## Dependents\n## Income\n## Credits\n## 2021 Estimated Tax Payments\n## Itemized Deductions\n## Adjustments to Income","[{\"question\":\"What information does the questionnaire collect about the taxpayer and spouse?\",\"answer\":\"It collects taxpayer and spouse names, addresses, occupations, phone numbers, email addresses, Social Security numbers, and dates of birth, plus filing status and refund bank deposit details.\"},{\"question\":\"What types of income are covered in the questionnaire?\",\"answer\":\"It covers wages and salaries (W-2), interest/dividends (1099), capital gains and losses, other gains/losses, pensions/IRA distributions/annuities/rollovers (1099-K), rents/royalties, unemployment (1099-G), Social Security benefits, and other income.\"},{\"question\":\"Which deductions and tax payments categories are requested?\",\"answer\":\"It requests itemized deductions such as medical costs, transportation for medical care, and other medical-related expenses, plus adjustments to income like IRA deductions, Keogh SEP, early withdrawal penalties, alimony paid, and self-employed health insurance premiums, along with 2021 estimated tax payments and other payments/credits.\"}]","Tax Return Questionnaire-2021 Tax Year | PDF",1789811419]