General Questions Please check if “yes” and provide documentation, if possible.
Name:
EMail Address:
	1. Did your marital status change?
	2. Were you notified by the IRS of changes to a prior year's return?
	3. Are you being claimed as a dependent by another person?
	4. Were there any changes in dependent information from the prior year?
	5. Did you have any children under the age of 14 who received more than $1400 in investment income?
	6. Do you have dependents who are neither U.S. citizens nor U.S. residents?
	7. Did you provide over half of the support for another person (or persons) during the year?
	8. Did you sell or purchase a principal residence?
	9. Did you receive payments from a pension or profit sharing plan?
	10. Did you receive any distributions from an IRA or other qualified plan?
	11. Did you receive any disability income?
	12. Did you receive any foreign income or pay any foreign taxes?
	13. Did you receive interest from a bank account or other financial account based in a foreign country?
	14. Did you pay nondeductible dues to an association that was involved in political lobbying?
	15. If you or your spouse are self-employed, are either of you covered under an employer's health plan at another job?
	16. Did you incur any non-business bad debts?
	17. Did you receive proceeds from an installment sale made to relatives?
	18. Did you make a loan at an interest rate below market rate?
	19. Did you make gifts of over $10,000 to an individual?
	20. Were there any changes in to a prior year's income, deductions, or credits that would require filing an amended return?
	21. Did your employer pay premiums on life insurance in excess of $50,000?
Business and Investment Questions
	1. Did you receive stock from a stock bonus plan with your employer?
	2. Did you buy or sell any bonds?
	3. Did you surrender any U.S. Savings bonds?
	4. Did you suffer a casualty, theft or condemnation?
	5. Did you start a business, purchase a rental property or farm, or acquire interests in partnerships or S-corporations?
	6. Did you own any investments for which you were not personally “at-risk?”
	7. Did you own any interest in a Real Estate Mortgage Investment Conduit (REMIC)?
	8. Did you sell any property or equipment on installment?
	9. Did you incur any business-related educational expenses?
	10. Did you incur any travel and entertainment expenses?
	11. Did you purchase any special fuels for non-highway use?
	12. Did you own a diesel-powered vehicle?