Client Information Form Accountants
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2DELANEY’S TAX & ACCOUNTING SERVICE
1157-B STATE ROUTE 131
MILFORD, OHIO 45150
TELEPHONE (513) 248-2829
FAX LINE (513) 248-4747
CLIENT INFORMATION FORM
DEAR________________________________:
YOUR APPOINTMENT IS SCHEDULED FOR:
DAY:___________________DATE:_________________________TIME:__________________
At my office. Please mark this date on your calendar NOW.
By completing this form you will expedite the completion of your tax return, help avoid missing important deductions and help keep tax
preparation fees down.
Please answer the following questions by circling yes or no. If you circle no to any questions, please enter the revised information as
applicable in the space provided.
1.
Is your address the same as entered on last year’s return?
Yes
No
.
.
NEW STREET
NEW CITY
NEW STATE
NEW ZIP
2.
Do you have the same dependents as listed on last year’s tax return?
Yes
No
Add New Ones _________________________________________ Please Delete _______________________________________
3.
Did you have a change in marital status as compared to last year?
Yes
No
4.
Do you have the same occupation as entered on last year’s return?
Yes
No
Spouse Yes
No
Your New Occupation_____________________________
Spouse’s New Occupation______________________________
5.
Was either you or spouse 65 or older on December 31 of the year just ended?
Yes
No
6.
Did you pay any estimated tax payments?
Yes
No
(If yes have the information at hand.)
7.
Were you claimed as a dependent on another taxpayer’s return?
Yes
No
PLEASE CIRCLE YES IF YOU OR YOUR SPOUSE RECEIVED ANY INCOME FROM THE FOLLOWING SOURCES:
Wages or Salary
Yes
Pension Income
Yes
Interest Received
Yes
Pension Rollover
Yes
Tax-exempt Income
Yes
Partnership or Royalty Income
Yes
Dividend Income
Yes
Income from Rental Income
Yes
State or Local Tax Refund
Yes
Estate or Trust Income
Yes
Did You Itemized Your Deductions on Last Year’s
Farm Income
Yes
Tax Return
Yes
Unemployment Income
Yes
Alimony Received
Yes
Social Security Benefits
Yes
Business Income & Deductions
Yes
Gambling Winnings
Yes
Sale of Stock, Bonds, or Other Assets
Yes
Gifts, Prizes, Awards or Bonuses
Yes
Sale of Real estate
Yes
Independent Contractor 1099 Income
Yes
Sale of Principal Residence
Yes
Income from any other source
Yes
If you circled YES to any of the above income items, please bring W-2(s), bank statement or other available records that indicated amounts
received.
.
PLEASE COMPLETE THE BACK OF THIS PAGE SO WE CAN DETERMINE IF YOU QUALIFY TO ITEMIZE YOUR DEDUCTIONS
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