Please review and answer the following questions.

Has your address changed in the past year?
Yes/No

Did your marital status change before December 31st of the tax year?
Yes/No

Were there any changes in the number of dependents you want to claim?
Yes/No

Did you have any child or dependent care expenses?
Yes/No
If Yes, please list below and include care provider’s name, address, ssn, and amount.

Did you buy or sell stocks, bonds, mutual funds or other investment properties?
Yes/No

Did you buy, sell or refinance your home?
Yes/No

Did you donate money, household goods, cars or stock?
Yes/No

Did you incur any tuition or continuing education expenses?
Yes/No

Did you and your dependents have health care coverage for the full-year?
Yes/No

Did you receive any of the following IRS documents? Form 1095-A, 1095-B, or Form 1095-C? If so, please send a copy.
Yes/No

Do you own or have a controlling interest in foreign financial institutions, businesses or investment funds?
Yes/No

Do you want to file your tax return electronically?
Yes/No

For direct deposit, please provide your bank name, routing number, and account number.

If you are entitled to a REFUND, do you want a PAPER check?
Yes/No

If you should OWE the IRS or State, do you want to PAY IN FULL at filing; REQUEST PAYMENT PLAN (how much per month) ?

Please list any questions or other concerns you might have.
Yes/No

Record your e-mail address.

Record your cell phone number.