Fort Leavenworth Tax Questionnaire Form PDF Details

When you move to a new state, you may have to file a tax return in that state. If you are stationed at Fort Leavenworth, there is a specific form you will need to fill out. The Fort Leavenworth Tax Questionnaire Form is for Active Duty military personnel and their families who are residents of Kansas and are required to file a Kansas income tax return. This form helps determine your residency status for tax purposes. Here's what you need to know about the Fort Leavenworth Tax Questionnaire Form.

QuestionAnswer
Form NameFort Leavenworth Tax Questionnaire Form
Form Length5 pages
Fillable?No
Fillable fields0
Avg. time to fill out1 min 15 sec
Other namesfort leavenworth tax intake questionnaire, fort leavenworth tax office, tax center fort leavenworth, fort leavenworth tax questionnaire

Form Preview Example

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 (M-VITA) program. M-VITA is co-sponsored by the IRS and the Department of Defense and provides free tax assistance and preparation to all eligible Legal Assistance beneficiaries. Eligible beneficiaries normally include active duty, activated Reserve Component (on active duty at time of service for more than 20 days), retired military (bluish green ID), divorced beneficiaries (salmon colored ID) and family members of each category (salmon colored ID). For more eligibility details, refer to AR 27-3, Chapter 2-5. We cannot provide tax services to “gray area” retired, reservists (red ID), nor prior Servicemembers on Transitional Assistance (TA). We welcome all ranks and income levels.

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 340-18-4.

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 1-877-330-1205 or email wi.voltax@irs.gov.

1

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

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Taxpayer

 

 

 

 

 

 

 

 

 

Spouse

First:

 

 

MI:

Last:

 

 

First:

 

 

MI:

 

Last:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

SSN:

 

 

 

Date of Birth:

 

 

SSN:

 

 

 

 

 

Date of Birth:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Occupation:

 

 

 

 

 

 

 

 

 

Occupation:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

US Citizen

Legally Blind

 

Total Permanent Disabled

US Citizen

 

Legally Blind

 

Total Permanent Disabled

□

 

□

 

 

 

□

 

□

 

□

 

□

Current Mailing Address:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Unit:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

City:

 

 

 

 

 

State:

 

Zip:

 

 

State of Legal Residence:

 

 

 

 

 

 

 

 

 

 

 

 

Taxpayer -

 

Spouse -

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Daytime phone

 

Evening phone

 

 

Cell phone

 

 

Email address

Taxpayer

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Spouse

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

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 non-custodial parent to claim a dependency exemption. Custodial parent is defined as the parent with whom the child lives with the longer period of time. Only Form 8332 or a statement of equivalent content will be accepted by the IRS.

2

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

.

 

 

 

Relation-

# of

US citizen,

 

 

Received

 

Date of

 

months

resident of

 

 

more

 

 

ship to

Married as of

Full time

Full Name

SSN

lived in

US,

than

Birth

you (e.g.

12/31/10?

student?

 

 

your

Canada, or

$3650 in

 

 

 

son)

 

 

 

 

 

home

Mexico?

 

 

income?

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Y / N

Y / N

Y / N

Y / N

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Y / N

Y / N

Y / N

Y / N

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Y / N

Y / N

Y / N

Y / N

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Y / N

Y / N

Y / N

Y / N

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Y / N

Y / N

Y / N

Y / N

 

 

 

 

 

 

 

 

 

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

Have a Health Savings Account? (Forms 5498-SA, 1099SA)

Have debt from a mortgage or credit card cancelled/forgiven by a commercial lender? (Form 1099-C)

Buy a home? If yes, closing date _________________

Have Earned Income Credit (EIC) disallowed in a prior year? If yes, for which tax year ___________

Purchase and install energy efficient home items? (such as windows, furnace, insulation, etc.)

Live in an area affected by a natural disaster? If yes, where? _____________?

Receive the First Time Homebuyers Credit in previous years? If yes, closing date _____________

Pay any student loan interest?

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:

3

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 - W-2G Tip Income

Royalties – 1099Misc

Self Employment income Unemployment - 1099G State refund – 1099G IRA distribution – 1099R Partnership or Trust – K-1 Farm Income

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 $

 

Traditional IRA- Self $

 

 

 

 

 

 

Roth IRA- Spouse$

 

Traditional IRA- Spouse $

 

 

 

 

 

 

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)

Non-reimbursed Moving Exp.

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 Non-reimbursed Job Exp Paid Foreign Income Taxes Prior Yr State Balance Due

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 # ___________________

4

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

 

 

dependent on their return? If yes, which ones: N/A

 

 

___________________________________________________

Yes

No

2.

Were any of the persons listed in the “Family” section totally and permanently

 

 

disabled? If yes, which ones: N/A

 

 

__________________________________________________

Yes

No

3.

Did any of the persons listed in the “Family” section provide more than half of

 

 

their own support? If yes, which ones: N/A

 

 

___________________________________________________

Yes

No

4.

Did the taxpayer provide more than half the support for each of the persons l

 

 

listed in the “Family” section? If no, which ones: N/A

 

 

____________________________________________________

Yes

No

5.

Did the taxpayer pay over half the cost of maintaining a home for any of the

 

 

persons listed in the “Family” section? If yes, which ones: N/A

 

 

___________________________________________________

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

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