Wheeler Tax & Accounting LLC Individual/Small Business Intake Survey 2025 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 2025 filing status?

Single (15,750 SD)

Head of Household (23,625 SD)

Married Filing Joint (31,500 SD)

Married Filing Separately (15,750 SD)

Qualifying Widow(er) (31,500 SD)

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4. How do you want to receive your 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 2025?

Yes

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6. Did your receive an IRS Identity PIN for 2025?

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. Select all of the following choices that apply to your situation for 2025:

Earned tips on your W2 job

Worked overtime on your W2 job

Purchased a new vehicle for personal use

Had a baby/ Adopted a baby

Wheeler Tax & Accounting LLC Individual/Small Business Intake Survey 2025 Tax Year

2025 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 2025 filing status?

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

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* 5. Did your receive a 1095-A tax form from the Healthcare Marketplace for 2025?

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* 6. Did your receive an IRS Identity PIN for 2025?

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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. Select all of the following choices that apply to your situation for 2025:

1. Please enter the following information about yourself:

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

3. What is your 2025 filing status?

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

5. Did your receive a 1095-A tax form from the Healthcare Marketplace for 2025?

6. Did your receive an IRS Identity PIN for 2025?

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

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)?

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

10. Select all of the following choices that apply to your situation for 2025: