Client Portal

  • Tax organiser
  • Income
  • Deductions
  • Questions
  • Consent

Step 1 - 5

TAX ORGANISER

Taxpayer Information

Last name
First name
Middle initial
Suffix
SSN
Occupation
Work phone
Ext
Cell phone
E-mail address
Date of birth

Licence Driver Details

Issuing state
Licence number
Issue date
Expiration date
Does not expire
NY Doc number(first 3 chars)*

State Identification card detail

Issuing state
Identification number
Issue date
Expiration date
Does not expire
NY Doc number(first 3 chars)*

Spouse Information

Last name
First name
Middle initial
Suffix
SSN
Occupation
Work phone
Ext
Cell phone
E-mail address
Date of birth

Licence Driver Details

Issuing state
Licence number
Issue date
Expiration date
Does not expire
NY Doc number(first 3 chars)*

State Identification card detail

Issuing state
Identification number
Issue date
Expiration date
Does not expire
NY Doc number(first 3 chars)*

Address
Apartment number
City
State
ZIP code
Home phone
Fax number

Dependent Information

First name
Last name
MI
Suffix
Social security number
Relationship
Date of birth Months Lived with Taxpayer Child Care Expense










Child and Dependent Care Provider Expenses

Name Address ID number Amount Paid

Education Tuition and Fees

Attach all Form 1098-Ts and list of your qualified education expenses.

Student Loan Interest Paid

Enter total qualified student loan interest


Step 2 - 5

Income


Attach Form(s) W-2 - Wages, Salaries, Tips and Other Compensation

 Amount

Attach Form(s) 1099-R - Distributions from Pensions, Annuities, Retirement, Profit-Sharing, IRAs, etc

1099‑R Payer Name  Amount

Attach Form(s) SSA-1099 - Social Security/Railroad Benefits

Taxepayer Spouse
Sosial Security Benefits from Form SSA-1099
Railroad Retirement Benefits from Form RRB-1099
Medicare B premiums withheld
Medicare C premiums withheld
Medicare D premiums withheld

Attach Form(s) 1099-MISC - Miscellaneous Income

1099-MISC Payer Name

Attach Form(s) 1099-INT - Interest Income

1099-INT Payer Name Amount

Attach Form(s) 1099-DIV - Dividend Income

1099-DIV Payer Name Amount

Attach Form(s) 1099-B, 1099-S - Sales of Stocks, Bonds, Real Estate, etc

Attach all stock sale transaction information, including initial cost information.

Other Government Forms to attach:

Form(s) 1099-G - Certain Government Payments, Schedule K-1s - Partnership, S-Corporation, Trust or Estate In Income, Form(s) W-2G - Gambling or Lottery Winnings, Forms(s) 1099-Q - Payments from Qualified Education Programs.

Other Income:

Alimony, jury duty, unreported tips, disability income, etc. Business, rentals, farms: Attach income and expenses for any business, rental or farm you own. Include a list of all new equiment acquired this year, including date of purchased and cost.

Retirement Plan Contributions

Taxpayer Spouse
Traditional IRA contributions made for
Roth IRA contributions made for
SEP, Keogh, Individual 401(k) or SIMPLE Contributions


Step 3 - 5

Deductions


Medical and Dental Expenses

Amount Amount
Prescription medications
Health insurance premiuns
Doctors, dentists, etc
Hospitals, clinics, etc
Eyeglasses and contact lences
Miles driven for medical purposes
Other medical and dental expenses:

Taxes

Amount Amount
Real estate taxes paid on principal residence
Real estate taxes paid on additional homes or land
Auto licence registration fees based on the value of the vehicule
Other personal property taxes

Interest Expenses


Home mortgage interest paid - Attach Form(s) 1098
Lender's Name Amount Amount
Point paid on loan to buy, build or improve main home
Lender's Name
Amount

Cash/Check/Credit Contributions

Amount Amount

Noncash Charitable Contributions

Attach all reciepts with details listing the following information: Donee, donee address, description of donation, date acquired and date contributed, your cost, values at time of donation, and you acquired the property.

Miscellaneous Deductions

Amount Amount
Union and professional dues
Professional subscriptions, books, supplies
Uniforms and protective clothing (including cleaning)
Job search cost
Taxpayer educator expenses
Spouse educator expenses
Tax return preparation fees
Safe deposit box rental
Gambling losses (to the extent of gamblling income)
Other expenses (list):


Step 4 - 5

Questions

Yes

No

1.- Did a lender cancel any of your dept in (Attach any Form 1099-A or 1099-C)
2.- Did you make energy efficient improvements to your home or purchase any energy-saving property during ? If yes, please attach details
3.- Did you purchase a motor vehicle or boat during ?
If yes, attach documentation showing sales tax paid.
4.- Did you purchase a hybrid or electric vehicule in ? If yes, enter year, make, model, and date purchase
5.- Did you donate a vehicle in ? If yes, attach Form 1098C
6.- What was the sales tax rate in your locality in ?
%
7.- Did your marital status changes during ? If yes, explain
8.- Were you or your spouse permanently and totally disable in
9.- Do you have dependents who must file ?
10.- Do you have children who are under age 19 or a full time student under age 24 with investment income greater than $2,100?
11.- Did you provide over half the support for any other person during ?
12.- Did you incur adoption expenses during ?
13.- Did you receive a total distribution from IRA or other qualified plan that was partially or totally rolled over into another IRA r qualified plan within 60 days of the distribution?
14.- Did you receive any disability payments in ?
15.- Did you receive any tip income not reported to your employer?
16a.- Did you buy, sell, refinance, foreclose or abandon a pricipal residence or other real property in ? If yes, attach closing or escrow statements, 1099-C or 1099-A forms
16b.- If you sold a home, did you claim the First-Time Homebuyer Credit when you purchased it?
17.- Did you incur any casualty or theft losses during ?
18.- Did you incur any non-business bad bedts?
19.- Did you pay any individual for domestic sevices in ?
20.- Did you buy or sell any stocks on bonds in ?
21.- Did you use the proceeds from Series EE or | U.S. savings bonds purchased after 1989 to pay for higher education expenses?
22.- Did you incur any moving expenses? If yes, atach details
23.- Did you receive any income not included in this Tax Organizer? If yes, please attach information.
24.- Do you expect your income and deductions in to be the same as ? If no, attach explanation of changes expected.
25a.- Did you and your dependents have health insurance coverage for the full year?
25b.- Did you receive any of the following IRS documents ? Forms 1095-A (Health Insurance Marketplace Statement), Form 1095-B (Health Coverage) or Form 1095-C (Employer Provided Health Insurance Offer and Coverage)? Is so, please attach.
26.- If you paid any alimony, enter recipient's SSN ?
Alimony paid:
27.- Enter the state of residence

Electronic Filing and Direct Deposit of Refund

Yes

No

If your tax return is eligible for Electronic Filing, would you like to file electronically?
The Internal Revenue Service is able to deposit many refunds directly into taxpayers' account. If you receive a refund, would you like derect deposit? If yes, plaese provide a voided check (not a deposit slip) if your bank account information ahs changed.
What type of account is this?
Checking Savings

Estimated Tax Paid

Federal State Local
Date Amount Date Amount ID Date Amount ID

Additional Information

(Enter any additional information here and attach any documents.)


Step 5 - 5

Logo

9 Mott Avenue, Suite 210
Norwalk, CT 06850

Consent/Acknowledgement Form

  1. Name: Spouse Name: Tax Year:
    Business’Name: Federal Return?: State Return (s)?: State Name(s):
  1. I, (Print your name), hereby acknowledge that my identity has been verified satisfactorily, by use of my state or federal issued ID. I am the primary person on the attached tax return and have deemed myself in capacity to act on my own behalf. I also take full responsibility for the information and all supporting documents that I have provided for the preparation and filing of my tax return and I ascertain that they are accurate, valid, and true.

  2. I, , hereby acknowledge and agree that these services are not intended to determine whether I have filing requirements in other taxing jurisdictions than the one(s) I have listed above. The firm is available under the terms of a separate engagement letter to provide a nexus study that will enable us to determine whether any other state tax filings are required .

  3. I, , hereby acknowledge that I am in agreement with the preparation service fee $ quoted to me and understand that it is my obligation to pay (As instructed by the office) once my return is prepared based on the information I have provided, regardless of whether I opt not to file the return, for any reason. Should I fail to pay the full amount specified in any invoice before preparation and on the invoice’s date, a late fee of $35.00 shall be added to the amount due, and interest of 10% percent per annum shall accrue from the 3rd business day following the invoice’s date.

Should any tax authority, state(s) or IRS, decides or happens to audit the tax return in question as specified on this agreement, and should it NOT be any fault or error of the firm, or its representatives, an hourly rate of $95.00, at a minimum of two (2) hours , will be charged and payable to the firm to address the issue at hand. The term of this agreement would be still in place and enforce in addition to new fees.

  1. I, agree to reimburse Prestige ProServe, LLC (The firm) for all reasonable attorney's fees and costs i n the event legal action is required to enforce any provision of this Agreement; shall the firm prevail in these legal actions.

  2. I, , agree that regardless of where I am domiciled and regardless of where this Agreement is physically signed, it shall be deemed to have been entered into at Prestige ProServe’s office located at 9 Mott Avenue, Suite 210, Norwalk, CT 06850 , and Fairfield County, CT shall be the exclusive jurisdiction for resolving disputes related to this Agreement. This Agreement shall be interpreted and governed in accordance with the Laws of CT.

  3. For Business Returns – I declare that I agree to pay the fees associated with the work performed to render any accounting and/or bookkeeping services. I understand that this service will be limited to those tasks deemed necessary for the preparation of the above mentioned tax returns (State and Federal). I am the person duly authorized and take explicit and implicit responsibility for the information provided in connection to these returns.

  4. Tax Payer / Client’s Signature     Date :