Tax Questionnaire – Rosen & Associates, LLP

Name*

First Last

Email*

Phone*

Questions

Please check the appropriate box. If any box is marked yes, please include all necessary details and documentation

Did you have a financial interest in or signature authority over a financial account such as a bank account, securities account, or brokerage account, located in aforeign country?*

Yes
No

Do you have any foreign financial accounts, foreign financial assets, or hold interest in a foreign entity?*

Yes
No

Did you have any sales or other exchanges of virtual currencies, or used virtual currencies to pay for goods or services, or you are holding virtual currencies as an investment? If yes, please include any details of any transactions.*

Yes
No

Virtual currencies transaction details

Drop files here or

Max. file size: 128 MB.

Did you receive correspondence from the State or the IRS?*

Yes
No

If yes, explain

Personal Information

Did your marital status change during the year?*

Yes
No

If yes, explain:

Did your address change from last year?*

Yes
No

Can you be claimed as a dependent by another taxpayer?*

Yes
No

Did you receive an Identity Protection PIN (IP PIN) from the IRS or have you beena victim of identity theft? If yes, attach the IRS letter*

Yes
No

IRS Identity Protection PIN Letter

Max. file size: 128 MB.

COVID-19 Information

Did you or any of your dependents receive an Economic Impact Payment (EIP, aka "Stimulus payment")?*

Yes
No

If yes, how much?

Did you receive a Paycheck Protection Program (PPP) loan? If yes, please enclose loan agreements, unless you previously sent them to us.*

Yes
No

Paycheck Protection Program Loan Agreements

Drop files here or

Max. file size: 128 MB.

If yes, did you apply for Paycheck Protection Program (PPP) loan forgiveness?

Yes
No

Are you a telecommuting employee that was required to "shelter in place" due tolocal COVID-19 protocols while working in a state that was not your home state?*

Yes
No

Did you receive any state grants or loans?*

Yes
No

Did you receive an EIDL grant or loan? If yes, please enclose documentation, unless you previously sent them to us.*

Yes
No

EIDL grant or loan documentation

Max. file size: 128 MB.

Did you receive any unemployment benefits? If yes, please include form 1099-G that is reporting the unemployment benefits-This is in addition to any 1099-G you may have received for a state tax refund*

Yes
No

Upload form 1099-G unemployment benefits

Max. file size: 128 MB.

If you are self-employed, were you unable to perform your self-employed activitiesdue to coronavirus related care you needed?*

Yes
No

If you are self-employed, were you unable to perform your self-employed activitiesdue to coronavirus related care you provided to your son or daughter under the age of 18?*

Yes
No

If you are self-employed, were you unable to perform your self-employed activitiesdue to coronavirus related care you provided to another?*

Yes
No

Step 1 of 3

Questions

Personal Information

COVID-19 Information

Dependent Information

Purchases, Sales and Debt Information

Income Information

Retirement Information

Education Information

Health Care Information

Miscellaneous Information