Tax Client Questionnaire
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1
2NEW CLIENT DATA SHEET
PERSONAL INFORMATION:
Name(s) ____________________________________________________________________________________________________
Social Security # ______________________________________Spouse Social Security #____________________________________
Birth Date____________________________________________ Spouse’s Birth Date_______________________________________
Address______________________________________________City______________________________Zip Code_______________
Home Phone #__________________________Work Phone #__________________________Cell Phone#______________________
Email Address_____________________________________ Would you like to receive Filak CPA’s Newsletters?
Yes
No
How did you hear about us? __________________________________________________
Marital Status:
Single
Married
Separated
Widowed
Dependents (if applicable):
Child’s Name _______________________________________________________ Social Security #____________________________
Birth Date_______________________ Relationship: ________________________________________________
Child’s Name _______________________________________________________ Social Security #____________________________
Birth Date_______________________ Relationship: ________________________________________________
Child’s Name _______________________________________________________ Social Security #____________________________
Birth Date_______________________ Relationship: ________________________________________________
Did children live with you?
Yes
No
How many months? ________
Are any full time students?
Yes
No
Did you have any other dependents that were not your children?
Yes
No
Name______________________________________Relationship___________________ Social Security #_____________________
SECTION II:
YES
NO
Did you make any estimated payments?
If yes: Amount Paid $_____________________
Did you purchase, sell or refinance your home or any property?
____
____
Did you buy or sell any stocks, bonds, or mutual funds?
____
____
Did you make any contributions to an IRA, SEP, or SIMPLE plan?
____
____
Did you receive a distribution from a retirement plan?
____
____
Did you, your spouse or a dependent incur any tuition expenses to attend a college,
university, or vocational school that you were not reimbursed for?
____
____
Did you receive or pay any child / alimony support payments? Amount $_____________ Paid or Received
Did you include the amount you paid for your license tabs?
____
____
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Parent category: Business