Client Name (Preferred Contact if multiple taxpayers) *
Email Address: *
Phone Number *
Please indicate your preferred means of communication. *EmailPhone
Taxpayer Occupation: *
Spouse Occupation:
Did your address change? If yes, provide your new address and move date below. *NoYes
Move date:
New address:
Did you receive an Identity Protection PIN from the IRS? If yes, please upload the PIN letter to your client portal. *NoYes; letter uploaded to the portal
Have you received any other letters from the state or IRS? If so, please upload these letters to your client portal. *NoYes; letter(s) uploaded to the portal
Is your banking information the same as last year? *No; I will call to provide the required details.Yes; I will confirm that information below.
Bank Name:
Last 4 digits of the Account Number:
Do you own or have signing authority over a foreign bank, brokerage or trust
account? *NoYes; I will call to provide the required details
If you are not itemizing, you may still deduct some cash donations. Provide
the total of your cash donations: *
Did you buy, sell, or exchange virtual currency (Bitcoin, etc.)? *NoYes; I will provide details at the end of this form
Did you make any gifts of more than $16,000 to any individual? *NoYes
Did you purchase a qualified plug-in electric vehicle? *NoYes
Did you make energy efficient improvements to your main home? Lifetime limits are still in effect through 2022 - If you have received a credit in the past, check “no”. *NoYes
Did you pay for child care? If yes, we will need the amount paid. For new
caregivers, provide their name, address and tax ID number. *NoYes; details provided at the end of this form
Changes to Personal Information Have there been any changes to your personal information? *No; skip to the next sectionYes
Do you have a new dependent?def_rad_optNoYes; will contact the office to give additional needed info
Should we remove a spouse or dependent? Contact us with any questions. def_rad_optNoYes; will contact the office to give additional needed info
If you are divorced or separated with child(ren), are you the custodial parent?def_rad_optNo, I am not the custodial parentYes, I am the custodial parentNA
Do you have dependents who must file a tax return? If they filed a return,
forward a copy so we can verify that they did not claim themselves. def_rad_optNoYes; a copy of the return is uploaded to the portal.
Self-Employed Credits and Deductions Are you self employed? *No; skip to the next sectionYes
Did you pay health insurance for your employees this year? def_rad_optNoYes
Did you pay for your own health insurance premiums?def_rad_optNoYes
How much were your annual premiums?
Are you eligible for health insurance coverage through your spouse's
employer? def_rad_optNoYes
Did you receive forgiveness of a Paycheck Protection Program (PPP) loan in 2022? If so, please provide details. def_rad_optNoYes
Did you use an area of your home solely and exclusively for business?def_rad_optNoYes
Did you pay any unincorporated entity $600 or more in cash or checks? def_rad_optNoYes
Do you want us to compute your maximum SEP or Solo 401K contribution? def_rad_optNoYes
List the amount, if any, of SEP or Solo 401(k) retirement contributions made
in 2022 or the 2022 tax year:
Education and Education Savings Plans Is this section applicable to you? *No; skip to the next sectionYes
Did you, your spouse, and/or your child(ren) attend post-secondary school? If yes, provide Form 1098-T from the college. def_rad_optNoYes; form uploaded to the portal
Did you make any withdrawals from an education savings or 529 Plan account?
If yes, please provide Form 1099-Q. def_rad_optNoYes; form uploaded to the portal
Did you make contributions to your resident state's education savings or 529
plan? If yes, provide account number and amount.def_rad_optNoYes; I will provide details at the end of this form
Did you pay student loan interest? If yes, provide Form 1098-E.def_rad_optNoYes; form uploaded to the portal
Itemized Deduction Information Which option applies to your situation? *Married, with deductions less than $25,900; skip to the next sectionSingle, with deductions less than $12,950; skip to the next sectionHead of Household, with deductions less than $19,400; skip to the next sectionNone of the above; continue to fill out this section
Did you pay real estate taxes on your primary and/or secondary home? If yes,
provide details. def_rad_optNoYes; I will provide details at the end of this form
Did you pay mortgage interest on your primary and/or secondary home? If yes,
provide Form 1098. def_rad_optNoYes; form uploaded to the portal
Did you refinance your home or take out a home equity loan? If so, provide
the settlement statement. def_rad_optNoYes; statement uploaded to the portal
Did you pay out-of-pocket medical expenses (including health insurance
premiums) that may exceed 7.5% of your income? If yes, provide details at the end of this form. Keep all receipts for your records. def_rad_optNoYes; details provided at the end of the form
Did you make cash charitable contributions? Provide letters from charities
for donations over $250. Keep all receipts or cancelled checks for your records. def_rad_optNoYes; details provided at the end of the form
Did you make non-cash charitable contributions? Provide lists of items and
their thrift-shop values. For donated vehicles, provide Form 1098-C. def_rad_optNoYes; details provided at the end of the form
Retirement and Retirement Accounts Is this section applicable to you? *No; skip to the next sectionYes
Did you receive Social Security or Retirement income this year? For Social
Security, provide Form 1099-SA. For other retirement plans, provide 1099-R. def_rad_optNoYes; form uploaded to the portal
Did you make any contributions to retirement accounts that are not included
in a W-2 from an employer? If so, provide details. def_rad_optNoYes; details provided at the end of the form
Did you contribute to charity directly through an IRA? Provide details.def_rad_optNoYes; details provided at the end of the form
Do you want us to compute your maximum Regular or Roth IRA contribution?def_rad_optNoYes
Healthcare and Healthcare Accounts Is this section applicable to you? *No; skip to the next sectionYes
Did you obtain Marketplace health insurance through healthcare.gov? If yes,
provide Form 1095-A. def_rad_optNoYes; form uploaded to the portal
Did you or did you employer make contributions to your Health Savings
Account (HSA)? If so, provide Form 5498-SA. (This does not apply to Flexible
Savings Accounts, or FSAs, which must be spent during the year.)def_rad_optNoYes; form uploaded to the portal
Did you use funds from your Health Savings? If so, provide Form 1099-SA.
(This does not apply to Flexible Savings Accounts.) def_rad_optNoYes; form uploaded to the portal
Are you a Maryland resident who purchased a new Long-Term Care policy this
year? Please provide details. (Maryland credit is only for the first year of
the policy.)def_rad_optNoYes; details provided at the end of this form
Head of Household, Child Tax Credit, or Earned Income Credit. If you have no dependents, check "no" and skip to the next section. *No; skip to the next sectionYes
Have any of the above credits been denied in a previous year? def_rad_optNoYes
Can anyone else (other than your spouse) claim your child as a dependent?def_rad_optNoYes
Did your child live with you for over half the year?def_rad_optNoYes
Are you single and claiming Head of Household in 2022? Contact us with
questions regarding eligibility.def_rad_optNoYes
Looking Forward to Next Year Do you expect a large fluctuation in income, deductions or withholding next year? If so, please explain below. *NoYes; details provided at the end of this form.
Do you need quarterly estimated tax payment vouchers for 2023? *NoYes
Will you be taking out a Required Minimum Distribution in 2023? *NoYes; details in the following questions
If you will be taking out a Required Minimum Distribution in 2023,
please provide the estimated amount:
If you will be taking out a Required Minimum Distribution in 2023,
please provide the percentage of Federal tax withholding:
If you will be taking out a Required Minimum Distribution in 2023,
please provide the percentage of State tax withholding:
Will 2023 be the first year you will start collecting social security
benefits? *NoYes; details in the following questions
If 2023 will be the first year you will start collecting social security
benefits, please provide estimated date to start:
If 2023 will be the first year you will start collecting social security
benefits, please provide estimated monthly amount:
If 2023 will be the first year you will start collecting social security
benefits, please provide estimated Federal withholding:
If you are entitled to a refund, would you like to have some or all of it
applied to your 2023 estimated tax liability? *NoYes
2022 Quarterly Estimates Is this section applicable to you? *No; skip to the next sectionYes; details in the following questions
Federal; 1st Quarter Date:
1st Quarter Amount:
2nd Quarter Date:
2nd Quarter Amount:
3rd Quarter Date:
3rd Quarter Amount:
4th Quarter Date:
4th Quarter Amount:
Your State of Residence; 1st Quarter Date:
1st Quarter Amount:
2nd Quarter Date:
2nd Quarter Amount:
3rd Quarter Date:
3rd Quarter Amount:
4th Quarter Date:
4th Quarter Amount:
Additional State, if any; State Name & 1st Quarter Date:
1st Quarter Amount:
2nd Quarter Date:
2nd Quarter Amount:
3rd Quarter Date:
3rd Quarter Amount:
4th Quarter Date:
4th Quarter Amount:
When we have completed your 2022 returns: Choose a method to receive your copy of your 2022 tax returns: *Pick upMailElectronic copy
Choose a method to have your original
documents returned: *Pick upMailElectronic copy
Please list any unusual tax events for this or the upcoming year, or include any details required in previous questions. *
For our scheduling purposes for 2023 returns, please choose the earliest week that
you will be ready for return preparation: *Week 6 - 2/3/2023Week 7 - 2/10/2023Week 8 - 2/17/2023Week 9 - 2/24/2023Week 10 - 3/3/2023Week 11 - 3/10/2023Week 12 - 3/17/2023Week 13 - 3/24/2023Week 14 - 3/31/2023Week 15 - 4/7/2023
Electronic Signature Agreement *I agree that my electronic signature below is the legal equivalent of my manual signature on this form. Leaving the following field blank is a refusal to sign this form.
Electronic Signature

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