Client Name(s): __________________________________________

Primary Phone: __________________________________________

Primary Email: __________________________________________

Best way to reach you: ☐ Email ☐ Phone ☐ Text

Today’s Date: ____ / ____ / _______

Please complete the sections that apply to you. If you’re unsure about an item or questions, write “Unsure” and we’ll follow up.

Important: For security, do not email bank account numbers, full SSNs, or other sensitive personal data unless you are using a secure portal or encrypted method approved by our firm.

Any change to your marital status in 2025?

☐ Yes

☐ No

If yes:

☐ Married

☐ Married Filing Separately

☐ Single

☐ Widow(er)

☐ Head of Household

Spouse Information

Spouse Date of Birth: ____ / ____ / _______

Spouse SSN: __________________

Spouse Occupation: __________________

State of spouse employment: __________________

Do you have any W-2s this year from new employers?

☐ Yes

☐ No

If yes:

New employer names:

Did you work out of state requiring additional W-2 information?

☐ Yes

☐ No

If yes:

State of residence: __________________

California

Select all that apply:

☐ Paid unreimbursed work expenses

☐ Paid rent in California more than half the year

☐ Paid accounting or legal fees

☐ Paid safe deposit box fees

☐ Did not have health insurance

☐ None of these

Idaho

Did you pay out-of-pocket health insurance premiums?

☐ Yes

☐ No

☐ Unsure

If yes:

Total premium paid: __________________

Indiana

Please select any items that apply to you during 2025:

☐ You adopted a child in 2025

☐ You contributed to an Indiana CollegeChoice 529 Plan in 2025

☐ You paid income taxes to another state in 2025

☐ You made a foster care support donation in 2025

☐ Your child attended a home school or private school in 2025

☐ You participated in a cost-sharing medical coverage plan (such as Medi-Share, Samaritan Ministries, etc.)

☐ You donated to Habitat for Humanity in 2025

☐ None of the above apply

Do you rent or own?

☐ Rent

☐ Own

If renting:

Address of Rental: ________________________

Number of months living there: ________________________

Landlord name: ________________________

Landlord address: _____________________

Total rent paid for the year: $_____________________

Iowa

Did you make donations to:

☐ Fish & Wildlife Fund

☐ State Fair Fund

☐ Firefighters / Veterans Fund

☐ Child Abuse Prevention Fund

☐ None

Maine

529 Contributions - Please provide beneficiary name(s) and contribution amounts:

Beneficiary Name: ______________________

Amount Contributed: $__________________

Beneficiary Name: ______________________

Amount Contributed: $__________________

Beneficiary Name: ______________________

Amount Contributed: $__________________

Minnesota

Do you rent or own your residence?

☐ Rent

☐ Own

Oklahoma

Select any that apply:

☐ Contribution to an Oklahoma 529 plan

☐ Received payments from the Parental Choice Tax Credit

☐ Expenses as a caregiver to a family member

☐ Contribution to Oklahoma Child Abuse Prevention Fund

☐ None of these apply

Oregon

Select all that apply:

☐ Political contributions

☐ Disability of taxpayer or child

☐ 529 plan contributions

☐ None of these

Wisconsin

Do you rent or own?

☐ Rent

☐ Own

If renting:

Address of Rental: ________________________

Number of months living there: ________________________

Landlord name: ________________________

Landlord address: _____________________

Total rent paid for the year: $_____________________

☐ Are you claiming any dependents on your tax return?

☐ Yes

☐ No

If yes:

Dependent Names:

Can another person qualify to claim any of your dependents?

☐ Yes

☐ No

If yes:

Name of the person: __________________

Did any dependent receive more than $1,350 of unearned income?

☐ Yes

☐ No

Did the dependent live with you more than half the year?

☐ Yes

☐ No

Did you pay more than half of their living expenses?

☐ Yes

☐ No

Did you have any childcare providers?

☐ Yes

☐ No

If yes:

Provider Name: __________________

Address: __________________

Tax ID / EIN: __________________

Amount Paid: __________________

Did you have adoption expenses last year?

☐ Yes

☐ No

Did you move or change addresses?

☐ Yes

☐ No

If yes:

New Address:

Date moved: ____ / ____ / _______

Did you purchase a home?

☐ Yes

☐ No

Did you sell your primary residence?

☐ Yes

☐ No

If you sold a home:

☐ Received Form 1099-S

☐ Owned and occupied the home 2 of the last 5 years

☐ Property was rented out at any point

☐ Sold another primary residence within the last 2 years

☐ Move due to military service

Moving expenses (if any): __________________

Overtime pay received?

☐ Yes

☐ No

Do you have a job where tips are customary?

☐ Yes

☐ No

Did anyone in your household have Marketplace (Obamacare) coverage?

☐ Yes

☐ No

Did you pay long-term care premiums?

☐ Yes

☐ No

Do you have an HSA account?

☐ Yes

☐ No

Did you make contributions outside of payroll?

☐ Yes

☐ No

Did you receive distributions from an HSA / MSA?

☐ Yes

☐ No

Were any funds used for non-medical purchases?

☐ Yes

☐ No

Did you have foreign income, accounts, gifts, or residence?

☐ Yes

☐ No

Did you have a financial interest or signature authority over a foreign account?

☐ Yes

☐ No

If yes:

Account Number: __________________

Highest value during the year: __________________

Did you receive a foreign gift or trust distribution?

☐ Yes

☐ No

Were you or anyone in your household a citizen of or living in another country?

☐ Yes

☐ No

If yes:

Country: __________________

Did you pay taxes to a foreign country?

☐ Yes

☐ No

Did you buy, sell, or exchange any digital assets (cryptocurrency)?

☐ Yes

☐ No

If yes:

Exchange(s) used:

☐ Coinbase

☐ Coinbase Pro

☐ Binance

☐ Bitfinex

☐ Bittrex

☐ BlockFi

☐ Cash App

☐ Celsius

☐ Crypto.com

☐ FTX

☐ Gemini

☐ Kraken

☐ KuCoin

☐ OKEx

☐ Poloniex

☐ Voyager

☐ Other: __________________

Did you purchase or sell NFTs?

☐ Yes

☐ No

Did you have gambling income or losses?

☐ Yes

☐ No

Did you receive any other income?

☐ Yes

☐ No

If yes, source of income:

Did you start or purchase a new business?

☐ Yes

☐ No

If yes:

Business name: __________________

Did you acquire an interest in a partnership or S-Corp?

☐ Yes

☐ No

If yes:

Name(s): _________________________________

_________________________________________

_________________________________________

Did you sell any businesses?

☐ Yes

☐ No

Sold any real estate?

☐ Yes

☐ No

Purchased real estate?

☐ Yes

☐ No

Bought/sold/exchanged real estate other than residence or rentals?

☐ Yes

☐ No

Refinance or home equity loan?

☐ Yes

☐ No

Rent out your home (Airbnb, VRBO, etc.)?

☐ Yes

☐ No

Use your home for business (home office)?

☐ Yes

☐ No

Did you purchase a vehicle during the year?

☐ Yes

☐ No

Did you purchase a fully electric vehicle?

☐ Yes

☐ No

Did you make any energy-efficient home improvements during the year?

☐ Yes

☐ No

Examples include:

☐ Solar panels

☐ Energy-efficient windows or doors

☐ Energy-efficient HVAC systems

☐ Insulation improvements

☐ Electric heat pumps

☐ Other: __________________

Did you receive any distributions or rollovers from retirement accounts?

☐ Yes

☐ No

Did you make any contributions to a retirement account outside of an employer plan?

☐ Yes

☐ No

If yes:

Type of account:

☐ Traditional IRA

☐ Roth IRA

☐ SEP IRA

☐ SIMPLE IRA

☐ Other: __________________

Amount contributed: __________________

Did you convert any traditional, SEP, or SIMPLE IRA to a Roth IRA?

☐ Yes

☐ No

Did you receive Social Security or disability benefits?

☐ Yes

☐ No

Did you pay large out-of-pocket medical or dental expenses?

☐ Yes

☐ No

Did you pay sales tax on major purchases (vehicle, boat, etc.)?

☐ Yes

☐ No

Did you pay mortgage interest during the year?

☐ Yes

☐ No

Real Estate Taxes Paid:

Personal Property Taxes Paid:

Charitable Donations:

Did you make charitable donations?

☐ Yes

☐ No

Did you pay tuition expenses?

☐ Yes

☐ No

Did you pay student loan interest?

☐ Yes

☐ No

Any contributions or distributions from a 529 plan or Qualified Tuition Program?

☐ Yes

☐ No

If yes:

State of the plan: __________________

Account number(s): __________________

Select all that apply:

☐ Room and board

☐ Books

☐ Supplies

☐ Computer

☐ Software

☐ Internet access

☐ Special needs services

☐ Apprenticeship program

☐ K-12 tuition

☐ Student loan repayment

☐ None

Total eligible expenses: __________________

Has the student ever been convicted of a felony related to possession or distribution of a controlled substance?

☐ Yes

☐ No

Did anyone receive a scholarship?

☐ Yes

☐ No

If yes:

Were scholarship funds used for expenses other than tuition (ex: room & board)?

☐ Yes

☐ No

Does anyone owe you money that has become uncollectible?

☐ Yes

☐ No

Did you incur a loss due to damage, theft, or casualty?

☐ Yes

☐ No

If yes, describe:

Did anyone in your household attend post-secondary school during the year?

☐ Yes

☐ No

It yes:

Student name(s) and school(s):

Did you make large gifts to any individual during the year?

☐ Yes

☐ No

If yes:

Recipient name: __________________

Amount gifted: __________________

If a refund is due:

☐ Direct deposit

☐ Apply to next year’s taxes

Note: The IRS is phasing out paper refund checks starting with 2025 returns. No bank info = major refund delays. Please make sure you have provided your current banking info.

If balance due:

☐ Withdraw from bank account

☐ Pay manually

Note: A recent executive order is pushing all federal agencies toward electronic payments. Direct withdrawal ensures faster, hassle-free processing if you owe a balance.

Would you like to set up an automatic draft for estimated payments?

☐ Yes

☐ No

Bank Name: __________________

Account Type:

☐ Checking

☐ Savings

☐ Other

Routing Number: __________________

Account Number: __________________

Has your bank account information changed since last year?

☐ Yes

☐ No

☐ Unsure

Did you pay any estimated tax payments directly to the IRS or state?

☐ Yes

☐ No

Did you receive any notices from the IRS or state tax authorities?

☐ Yes

☐ No

Do you have an IRS Identity Protection PIN (IP PIN)?

☐ Yes

☐ No

Do you have an IRS online account through ID.me?

☐ Yes

☐ No

☐ Not sure

Is there anything else we should know or documents we should have?

I confirm that the information provided is complete and accurate to the best of my knowledge.

Signature: __________________

Date: ____ / ____ / _______