The Fort Leavenworth Tax Questionnaire form is a comprehensive document designed to streamline the process of tax preparation for individuals eligible under the Military Volunteer Income Tax Assistance (M-VITA) program. This initiative, a collaboration between the IRS and the Department of Defense, offers free tax help to a broad spectrum of the military community, including active duty personnel, certain reservists, retired members, and their families. The form emphasizes the taxpayer's responsibility for the accuracy of the return, irrespective of who prepares it, and underlines the policy of mandatory electronic filing for both federal and state returns to comply with governmental mandates. It includes sections on personal and biographical data, family and dependent information, income details, and deductions, ensuring a thorough collection of all relevant tax information. By providing details on eligibility, required documentation, and legal provisions such as the Military Spouses Residency Relief Act, the form serves as a crucial tool in the accurate and efficient preparation of tax returns. Additionally, it addresses special situations with potential tax implications, like changes in family status, moving expenses, and disaster losses, and outlines the privacy acts that protect the client's information, thus encapsulating the essential elements needed for diligent tax filing.
| Question | Answer |
|---|---|
| Form Name | Fort Leavenworth Tax Questionnaire Form |
| Form Length | 5 pages |
| Fillable? | No |
| Fillable fields | 0 |
| Avg. time to fill out | 1 min 15 sec |
| Other names | fort leavenworth tax intake questionnaire, fort leavenworth tax office, tax center fort leavenworth, fort leavenworth tax questionnaire |
FORT LEAVENWORTH TAX CENTER
TAX YEAR 2010 CLIENT QUESTIONNAIRE (version 01/12/2011)
PLEASE READ THE FOLLOWING BEFORE SIGNING THE PRIVACY ACT STATEMENT
AND ANSWERING THE QUESTIONNAIRE.
1. Welcome! We are here to provide you timely, accurate, courteous, and free tax preparation services.
2. Tax Service Eligibility: The Fort Leavenworth Tax Center participates in the Military Volunteer Income Tax Assistance
3.It is Your Return: Whether prepared by yourself, friends, commercially, or with free public assistance, the content of your tax return is ultimately your responsibility. Please view our services as tax assistance – not tax advice you might receive from a paid preparer. Review your return and sign only if you are confident in the accuracy of figures you have provided, and the tax positions you have taken on it.
4.Electronic Filing: To reduce administrative burdens and adhere to Federal and State electronic filing mandates, our policy is to electronically file all eligible federal and state returns. We appreciate your cooperation and understanding in this matter.
5.Military Spouses Residency Relief Act: Federal legislation passed in 2009 may impact the tax jurisdiction of income earned for services performed by military spouses. For certain spouses, income earned in a state where the military spouse is stationed with their servicemember spouse may be deemed to have been earned in the legal state of residency or domicile. Please be careful when listing your state of residency or domicile on this questionnaire, as that state will have tax jurisdiction over all income placed on your Federal return. Your state of domicile is generally your permanent home to which you intend to return to following military service. Legitimate domicile also requires physical presence in that location prior to establishing legal residency. Please ask your tax preparer for a domicile information handout and consult with a Legal Assistance attorney for advice on your particular residency concerns or questions.
DATA REQUIRED BY THE PRIVACY ACT OF 1974
PRIVACY ACT STATEMENT (5 USC 522a)
AUTHORITY: 10 USC 3013, AR
PRINCIPAL PURPOSES: To assist in preparation of federal/state income tax returns.
ROUTINE USES: To provide the basic information necessary to prepare the client’s federal/state income tax return.
DISCLOSURE: Voluntary disclosure. Nondisclosure precludes preparation and filing of the federal/state income tax return.
Date: ________ Printed Name: ______________________ Signature: _____________________________
Volunteers assisting with preparing your return are trained to provide high quality service and uphold the highest ethical standards. To report any concerns to the IRS on site operating issues please call toll free
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For tax assistance, you (and spouse) will need:
•Active duty, retired, and/or family member ID Card (activation orders for RC)
•Copies of all W2, 1098, and 1099 forms
•SSN or ITIN for all individuals to be listed on the return (copy of Social Security card preferred)
•Form 8332 or divorce decree releasing exemption (Form 8332 required for divorcees after 12/31/2008
•Prior year federal & state return if available
•Child care provider’s identification number
•Voided check or myPay account information for Direct Deposit
•Amounts and dates of estimated tax payments made
•Amounts of other income, adjustments, and deductions
•Power of Attorney if spouse is not available
•This completed questionnaire
BIOGRAPHICAL & CONTACT INFORMATION
Please write your name as it appears on your Social Security Card even if different from your Military ID. Your full name and SSN must match what is on your Social Security Card exactly or your return will be rejected.
On December 31, 2010 were you?
Single
Legally Married: Did you live with your spouse during any part of the last six months of 2010? Yes No
Divorced or Legally Separated: Date of final decree or separate maintenance agreement: ____________
Widowed: Year of spouse’s death: ________________________
Can a parent or someone else claim you (or spouse) as a dependent on his or her tax return? Yes No Other than English, what language is spoken in your home? ______________________________
Are you or a member of your household considered disabled? Yes |
No |
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Note – effective for divorces after 12/31/2008, the IRS will no longer accept a divorce decree or court ordered separation as proof of eligibility of the
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FAMILY AND DEPENDENT INFORMATION – Do not include yourself or your spouse
List everyone who lived in your home and outside your home that you supported during 2010
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Relation- |
# of |
US citizen, |
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ship to |
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your |
Canada, or |
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son) |
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Dependent Care Expenses
Did you or your spouse pay any childcare expenses that allowed you to work or look for work? If yes, list each child below.
Child’s Name
Provider’s Name & Address
SSN or Fed EIN #
Amount
Special “Life Event” questions - during 2010- did you (or your spouse if filing a joint return):
Yes No Unsure
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Have a Health Savings Account? (Forms |
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Have debt from a mortgage or credit card cancelled/forgiven by a commercial lender? (Form |
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Buy a home? If yes, closing date _________________ |
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Have Earned Income Credit (EIC) disallowed in a prior year? If yes, for which tax year ___________ |
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Purchase and install energy efficient home items? (such as windows, furnace, insulation, etc.) |
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Live in an area affected by a natural disaster? If yes, where? _____________? |
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Receive the First Time Homebuyers Credit in previous years? If yes, closing date _____________ |
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Pay any student loan interest? |
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Make estimated tax payments or apply last year’s refund to your 2010 tax? If so, how much _________ |
Additional Information your tax preparer should know about:
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Income
Please check all boxes that apply - put a question mark if unsure.
Wages – W2 Interest – 1099Int
Sale of Stock/Bonds – 1099B Pension or Annuity – 1099R Received Alimony $_________
Scholarships - 1098T or W2 Disability Income (SSA, VA, Ins.) Sale of Real Estate - 1099S
DITY Move - W2
Dividends – 1099Div/1099OID Cost basis of investment sale Social Security – SSA 1099 Rental Property
Gambling Winnings -
Royalties – 1099Misc
Self Employment income Unemployment - 1099G State refund – 1099G IRA distribution – 1099R Partnership or Trust –
Awards, Prizes, Jury Duty Other: _______________
Did you itemize deductions in 2009 and also receive a State tax refund? Yes No
If yes, in 2009 did you itemize : State Income taxes |
General Sales taxes |
Did any of your dependent children receive 1099INTs, 1099DIVs, 1099B and/or 1099MISCs (for Alaska Permanent Fund dividends) listing in total, over $950 in income? Yes No
If yes, please discuss with your preparer the option to reporting this income on your own return.
Adjustments and Deductions
Did you made any Contributions to an IRA in 2010? If so for whom and how much?
Roth IRA- Self $ |
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Traditional IRA- Self $ |
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Roth IRA- Spouse$ |
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Please check all boxes that apply - put a question mark if unsure
Reservist Travel Expenses Student Loan Interest – 1098E Pension, 401K, Keogh, KPERS Paid Alimony $_____________
Home Mortgage Interest (1098) Charitable Contributions Home used for Business Purpose
Educator Expenses
Tuition and Fees (1098T)
Medical Savings Account
Real Estate Taxes Paid
Medical Expenses
Child Adoption Expenses
Self Employment Tax Vehicle Sales Tax
Loss due to flood/ fire/ theft Personal Property Taxes
Refunds and Balances Due
Yes No If you are due a refund, would you like a direct deposit or split of your refund (up to three accounts)?
Yes No If you are due a refund, would you like information on how to purchase US Savings Bonds?
Yes No If you have a balance due, would you like information about your payment options (direct debit, money order, credit/debit card or payment plan)?
We recommend direct deposit for all Federal and State refunds as well as direct debit of balance due. Direct debits can be scheduled for any day between the date of filing and April 18. Federal refunds may be split between a maximum of three accounts. Please attach proof of account(s). ENSURE this information is correct.
DIRECT
DEPOSIT
INFO
ATTACH VOIDED CHECK OR “MYPAY” DIRECT DEPOSIT PRINTOUT
Routing # __________________ Account # ___________________
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CERTIFIED TAX PREPARER USE ONLY BELOW THIS LINE!
You are the link between the taxpayer’s information and a correct tax return. Verify the taxpayer’s information on pages 2, 3 & 4 is complete. Any question marked “unsure” or with a “question mark” must be discussed with the taxpayer.
Yes |
No |
1. |
Can anyone claim any of the persons listed in the “Family” section as a |
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dependent on their return? If yes, which ones: N/A |
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___________________________________________________ |
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Yes |
No |
2. |
Were any of the persons listed in the “Family” section totally and permanently |
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disabled? If yes, which ones: N/A |
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__________________________________________________ |
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Yes |
No |
3. |
Did any of the persons listed in the “Family” section provide more than half of |
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their own support? If yes, which ones: N/A |
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___________________________________________________ |
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Yes |
No |
4. |
Did the taxpayer provide more than half the support for each of the persons l |
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listed in the “Family” section? If no, which ones: N/A |
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____________________________________________________ |
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Yes |
No |
5. |
Did the taxpayer pay over half the cost of maintaining a home for any of the |
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persons listed in the “Family” section? If yes, which ones: N/A |
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Tax Preparer Reminder – Use Publication 17, Your Federal Income Tax For Individuals, and Publication 4012, Volunteer Resource Guide (aka ‘the spiral”) in making tax law determinations.
Additional Tax Preparer Notes:
5