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C&R Tax Service: Tax Interview Form
Tax Preparation Information
Name
*
First
Last
*Your name as it appears on your Social Security Card
Social Security Number
*
Filing Status
*
Please Choose One
Single
Married-Jointly
Married-Separate
Head of Household
Date of Birth
*
Phone Number
*
###
-
###
-
####
Occupation
*
Address
*
Street Address
Address Line 2
City
State / Province / Region
Postal / Zip Code
Antigua and Barbuda
Aruba
Bahamas
Barbados
Belize
Canada
Cayman Islands
Cook Islands
Costa Rica
Cuba
Dominica
Dominican Republic
El Salvador
Grenada
Guatemala
Haiti
Honduras
Jamaica
Mexico
Netherlands Antilles
Nicaragua
Panama
Puerto Rico
Saint Kitts and Nevis
Saint Lucia
Saint Vincent and the Grenadines
Trinidad and Tobago
United States
Argentina
Bolivia
Brazil
Chile
Colombia
Ecuador
Guyana
Paraguay
Peru
Suriname
Uruguay
Venezuela
Albania
Andorra
Armenia
Austria
Azerbaijan
Belarus
Belgium
Bosnia and Herzegovina
Bulgaria
Croatia
Cyprus
Czech Republic
Denmark
Estonia
Faroe Islands
Finland
France
Georgia
Germany
Greece
Hungary
Iceland
Ireland
Italy
Kosovo
Latvia
Liechtenstein
Lithuania
Luxembourg
Macedonia
Malta
Moldova
Monaco
Montenegro
Netherlands
Norway
Poland
Portugal
Romania
San Marino
Serbia
Slovakia
Slovenia
Spain
Sweden
Switzerland
Ukraine
United Kingdom
Vatican City
Afghanistan
Bahrain
Bangladesh
Bhutan
Brunei Darussalam
Myanmar
Cambodia
China
East Timor
Hong Kong
India
Indonesia
Iran
Iraq
Israel
Japan
Jordan
Kazakhstan
North Korea
South Korea
Kuwait
Kyrgyzstan
Laos
Lebanon
Malaysia
Maldives
Mongolia
Nepal
Oman
Pakistan
Palestine
Philippines
Qatar
Russia
Saudi Arabia
Singapore
Sri Lanka
Syria
Taiwan
Tajikistan
Thailand
Turkey
Turkmenistan
United Arab Emirates
Uzbekistan
Vietnam
Yemen
Australia
Fiji
Kiribati
Marshall Islands
Micronesia
Nauru
New Zealand
Palau
Papua New Guinea
Samoa
Solomon Islands
Tonga
Tuvalu
Vanuatu
Algeria
Angola
Benin
Botswana
Burkina Faso
Burundi
Cameroon
Cape Verde
Central African Republic
Chad
Comoros
Democratic Republic of the Congo
Republic of the Congo
Djibouti
Egypt
Equatorial Guinea
Eritrea
Ethiopia
Gabon
Gambia
Ghana
Gibraltar
Guinea
Guinea-Bissau
Cote d'Ivoire
Kenya
Lesotho
Liberia
Libya
Madagascar
Malawi
Mali
Mauritania
Mauritius
Morocco
Mozambique
Namibia
Niger
Nigeria
Rwanda
Sao Tome and Principe
Senegal
Seychelles
Sierra Leone
Somalia
South Africa
Sudan
Swaziland
United Republic of Tanzania
Togo
Tunisia
Uganda
Zambia
Zimbabwe
Country / Region
Email
*
Amount of Last Tax Refund
*
Spouse Name
Spouse Social Sec #
Spouse Date of Birth
Spouse Occupation
Dependent Information
Please list your dependents and their information:
Dependent Name #1
Dep. Social Sec #
Dep. Date of Birth
Your Relationship
Upload Dependent 1 SS#
2nd Dependent
If this dependent's relationship is anything other than son or daughter, please explain how you have the authority to claim this dependent.
Check all that applies:
*
I can provide school records with my address for this child
I can provide medical records with my address for this child
I have leasing information with my address for this child
I have birth certificate for this child
I have a letter from my religious organization verifying my care for this child
Check this box ONLY IF YOU ARE NOT CLAIMING ANY DEPENDENTS
Dependent Name # 2
Dep. Social Sec #
Dep. Date of Birth
Your Relationship
Upload Dependent 2 SS#
If this dependent's relationship is anything other than son or daughter, please explain how you have the authority to claim this dependent.
Check all that applies:
*
I can provide school records with my address for this child
I can provide medical records with my address for this child
I have leasing information with my address for this child
I have birth certificate for this child
I have a letter from my religious organization verifying my care for this child
Check this box ONLY IF YOU ARE NOT CLAIMING ANY DEPENDENTS
Dependent Name #3
Dep. Social Sec #
Dep. Date of Birth
Your Relationship
Upload Dependent 3 SS#
If this dependent's relationship is anything other than son or daughter, please explain how you have the authority to claim this dependent.
Check all that applies:
*
I can provide school records with my address for this child
I can provide medical records with my address for this child
I have leasing information with my address for this child
I have birth certificate for this child
I have a letter from my religious organization verifying my care for this child
Check this box ONLY IF YOU ARE NOT CLAIMING ANY DEPENDENTS
1099 SSA BENEFITS IN 2012
Complete this form ONLY IF THE TAXPAYER OR THE SPOUSE (if filing joint) received SOCIAL SECURITY "RETIREMENT" benefits.
DO NOT COMPLETE THIS FORM IF TAXPAYER HAS RECEIVED SSA BENEFITS FOR DISABLITY! DISABILITY BENEFITS ARE NOT TAXABLE!
1099 SSA
Recipient's Name
Total Gross Benefits in 2012
Taxable Benefits
Federal Taxes Withheld
Upload form 1099 SSA
W-2 Information
Please use your current W-2 form(s) to complete the following or simply attach a copy of your W-2
Employer Name
Employer Address
Employer ID# (EIN)
Total Gross Wages in 2012
Federal Taxes Withheld
State Taxes Withheld
State ID# (if applicable)
Employer Name
Employer Address
Employer ID# (EIN)
Total Gross Wages in 2012
Federal Taxes Withheld
State Taxes Withheld
State ID# (if applicable)
Employer Name
Employer Address
Employer ID# (EIN)
Total Gross Wages in 2012
Total Taxes Withheld
State Taxes Withheld
State ID# (if applicable)
Upload W-2
Upload W-2
Upload W-2
Upload W-2
Self-Employed Information
If you are filing Self-Employed please complete the following:
Self-Employment filing Disclaimer
If you are filing Self-Employed, you need to open and read this 5 page document, and you must have a income log / expense log for proper records. https://www.mcssl.com/content/152803/2012_SE_PACKET.pdf
If a client needs a copy of a blank income log, send them this link: https://www.mcssl.com/content/152803/SE_JOURNAL.pdf
If you WORK FOR ONE STOP you must copy the above link and send this packet to all SELF EMPLOYED TAX CLIENTS and bcc theonestopllc@gmail.com for verification.
We must inform you that it is a requirement to keep good records for the income and expenses you are claiming on your tax return. For us to stay in compliance with all rules and regulations of the IRS we must ask additional questions about you and your business practice and record keeping for us to successfully prepare your tax return.
Do you have documentation of the income you are claiming for your business?
Did you know, if you did not earn more than $600 as an INDEPENDENT CONTRACTOR, the company you provided a service for is not required to issue you a 1099, but YOU ARE REQUIRED TO REPORT YOUR ANY INCOME EARNED.
*
Yes
No
N/A
Do you have an income log for the INCOME you are claiming for your business?
The IRS requires that you keep an income log for all income received. One Stop offers a low priced bookkeeping service, that leaves all the hard work of record keeping to us.
Just visit www.onestopllc.com/shoebox for more info.
*
Yes
No
N/A
Do you have receipts for the expenses you are claiming for your business?
The IRS requires that you keep an expense log for all expenses you have for your business. One Stop offers a low priced bookkeeping service, that leaves all the hard work of record keeping to us.
Just visit www.onestopllc.com/shoebox for more info.
*
Yes
No
N/A
If you are filing self employed, it is highly recommended that you keep good income/expense records. One Stop offers a bookkeeping service that allows you to easily use your smart phone to take pictures of every receipt, type how it benefits your business and send it to us and we will do the rest to keep you organized for a low monthly price of just $12.99 per month. Visit www.onestopllc.com/shoebox for more info. Are you interested in receiving this much needed service, to help stay in compliance with the LAWS OF THE IRS.
*
Yes, www.onestopllc.com/shoebox
No, I keep my own income/expense logs
N/A
Did you earn Extra Income with any of the following? (you may select more than one)
N/A
Actor
Administrative Assistant
Auto Mechanic
Barber
Bookkeeper
Carpet/Floor/Tile Installer
Car Detailer
Chef/Cook
Child Care
Computer Tech
Exotic Dancer
Entertainment
Fisherman
Fitness Instructor/Trainer
Gambling (Professional)
Graphic Artist/Design
Hairstylist
Handyman
House Cleaner
House Painter
Interior Design
Inventor
Jewelry Maker/Repair
Landscaper/Groundskeeper
Musician
Online Business
Party/ Event Planner or Promoter
Restaurant Server
Roofer
Singer
Sound Engineer
Talent Manager
Umpire/Coach/Referee
Video Game Tester
Real Estate
Misc
Business Name
Service(s) Provided
Prices charged for Service(s)
Average Monthly Income
Prices charged for Service(s)
Please list your MONTHLY expenses for your business below
Office Rent/Lease
Business Line/Cellular Bill
Supplies
Advertising
Travel
Dining
Additional Information
Please complete where applicable:
Did you pay Tuition for you/your dependents?
Yes
No
If Yes, how much Tuition was paid in 2012?
Are you paying on Student Loans?
Yes
No
If Yes, how much?
Did you receive Unemployment Income? How much?
Did you have any Casualty or Theft Losses in 2012?
Do you pay Church Tithes/Offerings? How much?
Do you owe Student Loans?
*
Yes
No
Do you owe Back Child Support?
*
Yes
No
Not Sure
Do you owe the IRS for past returns?
*
Yes
No
Not Sure
Document Submission
If you have electronic copies of the following, please upload the file for quicker service:
Upload Driver's License
Upload Soc Sec Card
License/ID# & State
*
Complete the following information if you would like to have your TAX REFUND DIRECT DEPOSITED into your bank account. Type your Bank Name here:
Bank Routing #
Bank Account #
Upload a picture of a voided check for bank account info verification:
Notes about this client:
Terms and Conditions
Please read and agree to terms and conditions below
I acknowledge that the information provided is true and correct and that it in no way reflects the One Stop Tax Shop entity. I also grant the approval of One Stop Tax Shop to submit my tax return based on this knowledge.
Do You Agree to the Terms and Conditions?
*
Yes, I Agree
Signature/Full Name
*
Date
*
MM
/
DD
/
YYYY
How did you hear about us? (Google, Craigslist, Facebook, etc?)
*
List 5 Referrals to Qualify for a FREE CRUISE to the Bahamas! (include Name & Phone#)
*
RRO Name/ID
RRO Phone #
ONE STOP Store #
Did you receive this 5 page SELF EMPLOYMENT PACKET, explaining the requirements of tax payers that file SELF EMPLOYMENT.
Copy this link and email this packet to all clients that are filing self employed
https://www.mcssl.com/content/152803/2012_SE_PACKET.pdf
Yes, I received the packet via email
No
N/A, I am not filing self employed
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