Musselman Tax Questionnaire

Name *

First

Last

Spouse

First

Last

Main Contact *

Phone *

Can We Text You At This Number? *

Yes
No

Alternate Phone

Address *

Address Line 1

Address Line 2

City

State

Zip Code

Email

If you provide an email please monitor it for questions.

Is this your first year at Musselman Tax and Bookkeeping? *

Yes
No

New clients, please provide previous 2 years tax returns as well

How did you hear about Musselman Tax and Bookkeeping?

If you referred by a current client, please list their name.

Are all W2’s & 1099’s provided? *

Yes
No

Did anyone receive any RETIREMENT DISTRIBUTIONS/PENSIONS and are all 1099-R’s provided? *

A 1099-R tax form reports distributions from a retirement plan — income you might have to pay federal income tax on. But the form isn’t just for retirees drawing on their nest eggs. There are other situations when you might get a 1099-R before you retire. If you took a distribution, you should have a form for each account.

Are you claiming dependents this year? *

Yes
No

If you claimed a dependent(s) last year and are not this year please provide their name.

We need a copy of each dependents social security card. If not able to do so, please provide reason, if you are supplying them via the upload at the bottom of the form, just type "enclosed" *

Name of dependent *

First

Last

Relationship to taxpayer

Date of Birth

Do you have another dependent you are claiming? *

Yes
No

Name of dependent 2 *

First

Last

Relationship to taxpayer

Date of Birth of dependent 2

Do you have a third dependent you are claiming? *

Yes
No

Name of dependent 3 *

First

Last

Relationship to taxpayer

Date of Birth of dependent 3

Do you have a fourth dependent you are claiming? *

Yes
No

Name of dependent 4 *

First

Last

Relationship to taxpayer

Date of Birth of dependent 4

Do you have a fifth dependent you are claiming? *

Yes
No

Name of dependent 5 *

First

Last

Relationship to taxpayer

Date of Birth of dependent 5

Do you have a sixth dependent you are claiming? *

Yes
No

Name of dependent 6 *

First

Last

Relationship to taxpayer

Date of Birth of dependent 6

Have you included any of your Dependent’s W2s? *

If your dependent worked and has a w2, please include their name and an additional phone number in case of questions.

Do you have childcare expenses? *

Yes
No

Name of Daycare

Tax ID Number of Daycare

Amount per month paid and number of months

Address of Daycare

Address Line 1

Address Line 2

City

State

Zip Code

Are you REMOVING a prior dependent, if so, please type their name(s)

Did you receive CHILD SUPPORT or - ALIMONY (What year was Alimony started?)? If so, total received for the year:

Please state if it was child support or alimony.

Name and Social Security Numbers of who received and who paid if payments started before 2019 *

DIGITAL CURRENCY: At any time during the tax year did you receive, sell, send, exchange, or acquire, any digital currency such as bitcoin or property? *

Yes
No

If YES we will need a transaction report/1099B (Composite).

Do you rent? (Rent Credit) *

Yes
No

Name(s) on the lease (Your NAME MUST be on the lease in order to receive the rent credit)

Who did you pay rent to and what is their address:

How much is your rent per month?

How many months did you pay this?

Is heat included in your rent? *

Yes
No

Is heat bill in your name? *

Yes
No

FOR HOMEOWNERS:

Please provide copies of both summer and winter property tax bills. The tax bills do not need to have been paid. Verify bills are for the correct year. The summer tax bill comes during the tax year, and the winter tax bill comes the following year even though it is for the tax year being prepared.

Do you itemize usually? *

Yes
No
I don't know

ITEMIZED ITEMS: (Only include if you usually itemize) Medical Expenses (out of pocket) & Medical Mileage, license tabs, Property taxes, Mortgage Interest (1098 Statement), Charitable Contributions

HEALTH CARE COVERAGE: Did you purchase your health care through the Marketplace? *

Yes
No

Did you receive a 1095-A? *

Yes
No

Michigan Credits:

If you paid health insurance premiums during the tax year, please provide the amount paid, this helps calculate the credits.

Did you purchase an ELECTRIC CAR? *

Yes
No

Please provide the make and model of vehicle, vehicle year, purchased new or used, and the date of purchase below. *

If you are getting a refund, and you would like to have your refund direct deposited into your account, we need your routing number and account number of the account it is to be deposited to. If you do not give us the information here, or wish not to, we will need you to call us at (810) 736 1667 (Burton) or (989) 724 3277 (Harrisville) to provide us with that information before we can transmit your taxes. Would you like to give us that information now? *

Yes
No

Direct Deposit (choose one) *

Savings
Checking

Bank Name *

Routing Number *

This form is secure, and no information is shared with anyone.

Account Number *

This form is secure, and no information is shared with anyone.

Debit Account to PAY when E-filing tax return for tax owed instead of mailing a check

Bank Name

Routing Number *

This form is secure, and no information is shared with anyone.

Account Number

This form is secure, and no information is shared with anyone.

Would you like your Tax Preparation bill taken out of your refund? **Please note the bank charges $72.95 on top of your preparation fee. If you do not get a refund or if you owe back taxes, you will not qualify. If the bank does not approve, YOU will be responsible for the tax preparation fee. *

Yes
No

Did you have any of the following Residential Energy Credits? • Qualified Solar Electric, Water, Wind or Geothermal property costs • Insulation • Exterior doors or windows • Metal or asphalt roof installed (Not patched) • Natural gas, propane or oil furnace or hot water boiler • Advanced main air circulating fan If so, please include receipts for said purchases or installations. NO APPLIANCES *

You may upload receipts at the end of the form along with other information needed.

Are you self employed and require a Schedule C? *

Yes
No

If YES:

Please be sure to provide Total Income and Itemized Expenses/Deductions.

If this is your first year, please fill out a Schedule C Due Diligence form located here or at our front desk.

There are a variety of worksheets located here.

How long have you owned your business?

Brief Description of business:

Where do you conduct business?

What Services do you perform?

How much do you charge for them?

Approximately how many clients do you have:

How often do you provide services for each client?

What type of items do you need to operate?

How often are they replenished?

Do you travel for business? If so, how often?

How do you keep track of mileage?

When and where do you have to travel for business:

Can you provide any documentation to substantiate your business?

Like: a. Business Cards b. Business Stationery c. Receipts or receipt book (with company header) d. Business/Occupational License (if required) e. Other tax returns (sales/excise, employment, etc.) f. Advertisements (newspaper, flier, yellow pages, etc.) g. Other:

Who maintains the business records?

Do you maintain separate banking accounts for personal and business transactions:

If “No”, how do you differentiate between personal and business transactions and monetary assets?

Please provide Income & Expense records (totals):

Please provide totals for the following: Accounting records b. Paid invoices/receipts c. Computer Records d. Car/truck expenses e. Logbooks f. Ledgers g. Business bank accounts h. Other:

If no expenses or low expenses, why are expenses so low?

If high expenses or overall loss, why are expenses so high?

If high expenses or loss, how are you able to pay these expenses and keep this business open?

Did you receive any Covid-19 related Grants or Loans? If so, include the verification paperwork with amount received and dates. *

ADDITIONAL Information that will help us with your taxes, or questions? *

Please upload your documents here.

Click or drag files to this area to upload. You can upload up to 20 files.

Secured file upload. No information will be shared outside Musselman Tax and Bookkeeping. By uploading these documents you understand that they are solely for the benefit of completing your taxes, accounting or bookkeeping.