Wheeler Tax & Accounting LLC Individual/Small Business Intake Survey 2022 Tax Year

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* 1. Please enter the following information about yourself:

FIRST NAME:

M.I.:

LAST NAME:

SUFFIX:

BIRTHDAY:

SOCIAL SECURITY# or ITIN#:

OCCUPATION:

PHONE NUMBER:

EMAIL ADDRESS:

ADDRESS USED ON RETURN:

CELL PHONE PROVIDER:

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* 2. Dependent Information (Name, SSN,Birth date, relationship)

Dependent #1:

Dependent #2:

Dependent #3:

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* 3. What is your 2022 filing status?

Single (12,950 SD)

Head of Household (19,400 SD)

Married Filing Joint (25,900 SD)

Married Filing Separately (12,950 SD)

Qualifying Widow(er) (25,900 SD)

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* 4. How do you want to receive you tax refund?

Direct Deposit

PrePaid Netspend Card

Check

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* 5. Did your receive a 1095-A tax form from the Healthcare Marketplace for 2022?

Yes

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* 6. Did your receive an IRS Identity PIN for 2022?

Yes

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* 7. Place an "X" next to all documents that you will be filing:

Self-Employment income/expenses

W-2s

1099-Misc, 1099 NEC, 1099 OID

1099-R PENSION/ANNUITY/IRA DISTRIBUTION

SSA- 1099 Social Security Income

HSA - Contributions

1099-G Certain Government Payments such Unemployment & State Tax Refunds

1098-Mortgage Interest - Main Home /2nd Mortgage/ Property Tax/Main Home

1099-INT Interest Income

1099-DIV Dividend Income

1099-B Capital Gains/Losses

1099-S Property Sale- PROVIDE CLOSING STATEMENTS

Sales Tax Paid (receipted)

Charity Receipts - Monetary

K-1 from (Form 1065 Partnership Return) PARTNER, S-CORPORATION, TRUST

Charity Receipts /Volunteer Mileage

1099-B SALE OF STOCK (Even if Losses)

Gambling Losses- Receipts/Logs

Alimony Received (Pre-2019 Decree)

IRA Contributions - Traditional (you have until 4/15)

Taxpayer HSA - Distributions

IRA Contributions - ROTH

1099-K MERCHANT SERVICES

1099-C CANCELED DEBT

Other IRA Contributions

1099-Q QUALIFIED EDUCATION PLANS

College/University - Form 1098-T *NEED PAYMENT SUMMARY FROM SCHOOL, RECEIPTS FOR BOOKS/FEES/SUPPLIES *For you or a dependent

1099-S REAL ESTATE SALES

W-2G GAMBLING WINNINGS

Student Loan Interest - 1098-E

Educator Expenses (Primary/Secondary Educators)

Rental Income/Expenses

Alimony Paid (Pre-2019 Decree)

Farm Income

Make EST. TAX PAYMENTS: QTR 1 QTR 2 QTR 3 QTR 4

Trade in cryptocurrency

Invest in QOF/QOZ property

Own foreign assets/accounts

Medical & Dental Expenses (Prescriptions, Doctors, Dentists, Hospitals, etc.)

Health Insurance Premiums

Mileage Expenses

Profit & Loss Statements

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* 8. If you are due a refund, are you expecting an offset due to an outstanding debt (back child support, IRS debt/state debt, student loans)?

Yes

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* 9. Can any other person claim you (or your spouse as a dependent on their own tax return?

Yes

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* 10. Has the IRS ever disallowed your claim for tax credits?

Yes

Wheeler Tax & Accounting LLC Individual/Small Business Intake Survey 2022 Tax Year

2022 INDIVIDUAL TAX INTAKE FORM

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* 1. Please enter the following information about yourself:

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* 2. Dependent Information (Name, SSN,Birth date, relationship)

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* 3. What is your 2022 filing status?

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* 4. How do you want to receive you tax refund?

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* 5. Did your receive a 1095-A tax form from the Healthcare Marketplace for 2022?

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* 6. Did your receive an IRS Identity PIN for 2022?

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* 7. Place an "X" next to all documents that you will be filing:

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* 8. If you are due a refund, are you expecting an offset due to an outstanding debt (back child support, IRS debt/state debt, student loans)?

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* 9. Can any other person claim you (or your spouse as a dependent on their own tax return?

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* 10. Has the IRS ever disallowed your claim for tax credits?