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Securities, advisory services and certain variables insurance products are offered through World Equity Group, Inc. (WEG), member
FINRA/SIPC, a Registered Broker/Dealer, a Federally Registered Investment Advisor. Martin James CPA, PC and Martin James
Investment & Tax Management, LLC are not affiliated with World Equity Group, Inc. WEG does not provide tax advice. Martin
James is a registered Representative of World Equity Group, Inc.
Dear Client:
Enclosed you will find the following information related to the preparation of your 2016
income tax return.
1. Engagement letter – the purpose of this letter is to communicate our
understanding of the services we are to provide. Please read this document. If
you have any questions, please call.
2. 2016 Questionnaire
3. 2016 Disclosures policies
4. 2016 Consent to Use of Tax Information
5. Offer for the Audit Fee Protection Program
6. Bank Account Verification for Direct Deposit
It is very important that you complete the questionnaires in their entirety. The
complexity of our current tax system dictates the use of such a questionnaire. Tax law
gives us some real opportunities at times and without certain information those
opportunities can be missed. If we don’t receive information from you by February
15
th
for individuals needing to apply for student financial aid, March 23rd, for
individuals & March 1st, 2017 for businesses, it may be necessary to file an
extension for your 2016 tax return.
We look forward to a long relationship.
Sincerely,
Martin James, CPA/PFS
1
RE: 2016 Individual Tax Return Preparation Engagement Letter
Dear Client:
We are pleased to confirm and specify the terms of our engagement with you and to clarify the nature and extent of
the services we will provide regarding the preparation of the income tax return(s) and tax planning services. Please
review, sign, and return to us upon receipt.
We will prepare your 2016 federal income tax return, and applicable tax returns for the state and local taxing
authorities in which you deemed yourself a resident or have notified us of taxable activity in 2016 (collectively, the
"returns"). We will also prepare (if applicable) any separate federal, state and local tax filings required due to
taxable activity being generated from a single member LLC you owned in 2016, and those services will be covered
under the terms of this engagement letter. This engagement pertains only to the 2016 tax year and 2017 tax planning,
and our responsibilities do not include preparation of any other tax return years that may be due to any taxing
authority.
We will prepare the returns from information that you will furnish to us. It is your responsibility to provide all the
information required for the preparation of complete and accurate returns. We will not audit or otherwise verify
the information you submit. To the extent we render any services, it will be limited to those tasks we deem necessary
for the preparation of the returns only. Accordingly, our engagement cannot be relied upon to disclose errors, fraud,
or other illegal acts that may exist.
The timeliness of your cooperation is essential to our ability to complete this engagement. Specifically, we must
receive sufficient information from which to prepare the returns within a reasonable period of time prior to the
applicable filing deadline. Accordingly, if we do not receive this information from you, as noted above, by March
23, 2017, it may be necessary for us to pursue extensions of the due date of the returns. If the appropriate amount
of tax is not paid by the original due date of the returns, you may be subject to late filing penalties on your 2016
income tax returns, and, if applicable, underpayments of estimated tax penalties.
Throughout the year 2017, we may be called upon to provide tax planning advice or services. Our ability to provide
you with appropriate guidance will be entirely dependent on the timeliness, accuracy, and completeness of the
relevant information you provide to us. If such services are requested by you, all of the terms, conditions and
representations of this engagement letter shall apply.
We may encounter instances where the tax law is unclear, or where there may be conflicts between the taxing
authorities' interpretations of the law and other supportable positions. In those instances, we will outline in a written
communication each of the reasonable alternative courses of action, including the risks and consequences of each
such alternative. In the end, we will adopt, on your behalf, the alternative which you select after having considered
the information provided by us.
Our fees for this engagement are not contingent on the results of our service. Rather, our fees for this engagement
will be based on a number of factors, including but not limited to, the time spent as well as the complexity of the
2
services we will perform. In addition, you agree to reimburse us for any out-of-pocket costs incurred in connection
with the performance of our services.
Our fees and costs are payable upon receipt. We may bill monthly as work progresses. We reserve the right to
suspend our services or to withdraw from this engagement in the event that any of our invoices are deemed
delinquent. In the event that any collection action is required to collect unpaid balances due us, you agree to
reimburse us for the costs of collection including attorneys' fees.
If we do not receive this letter from you, in fully executed form, but we receive supporting documentation requested
therein, then such receipt by this office shall be deemed to evidence your acceptance of all of the terms set forth in
this letter and in the ADDITIONAL TERMS, CONDITIONS, AND REPRESENTATIONS attached hereto. If we
do not receive any response to this letter, we will not proceed to provide any professional services, and we will not
prepare the tax returns.
This engagement letter is contractual in nature, and includes all of the relevant terms and conditions that will govern
the engagement for which it has been prepared. The terms and conditions of this letter supersede any prior oral or
written representations or commitments by or between the parties. Any material changes or additions to the terms
and conditions set forth in this letter will only become effective if evidenced by a written amendment to this letter,
signed by all of the parties. If any provision of the letter and/or the ADDITIONAL TERMS, CONDITIONS, AND
REPRESENTATIONS attached hereto is declared invalid or unenforceable, the remaining provisions shall remain
in effect.
In the last section of this engagement letter, you will find an INDIVIDUAL TAX QUESTIONNAIRE. Please take
a moment to complete this document. Doing so will help ensure the most accurate tax filing possible. If any
question is left blank or the questionnaire is not returned, the answer is assumed to be “No.”
We look forward to providing our services to you. If you have any questions concerning the terms of this
engagement, please feel free to ask us. If you agree with the terms of this engagement letter and the ADDITIONAL
TERMS, CONDITIONS, AND REPRESENTATIONS, please sign below and return it to us. These engagement
terms will apply until either you or we cancel them.
Sincerely,
Martin James, CPA, PFS
Martin James, CPA, PC
ACCEPTED AND AGREED:
_______________________________________ ___________________________________
Taxpayer (or parent/guardian of dependent) Date
_______________________________________ ___________________________________
Spouse (if applicable) Date
3
ADDITIONAL TERMS, CONDITIONS, AND REPRESENTATIONS
1. We are responsible for preparing only the state and local returns which we have historically prepared and which
you authorize us to prepare. If you have taxable activity in a state or local municipality that has not historically
been recognized on a return filing, please discuss with us. We will assist you in determining whether or not a
filing requirement exists with the state or local municipality. If you have tax filing requirements in a given state
or local municipality but do not file that return, there could be possible adverse ramifications, such as an
unlimited statute of limitations, penalties, etc.
2. Our engagement will be fulfilled upon delivery of the completed returns to you. Therefore, you have the final
responsibility for the tax returns and should review them carefully before you sign and file the returns with the
appropriate taxing authorities and/or authorize us to e-file them on your behalf.
3. Pursuant to standards prescribed in IRS Circular 230 and IRC 6694, we are forbidden from signing a tax return
unless we have a reasonable belief that there is substantial authority for a tax position taken on the return or we
have a reasonable basis for a tax position taken on the return and we disclose this tax position on a separate
attachment to the tax return. Substantial authority is generally viewed by tax professionals as requiring at least
a 40% probability that the tax position taken will be sustained on its merits. However, under no circumstances
may we sign a tax return with a tax position that has no reasonable basis.
4. Your returns may be selected for review by the taxing authorities or you may receive a notice requesting a
response to certain issues on the tax returns. Any proposed adjustments by the examining agent are subject to
certain rights of appeal. In the event of such government tax examination or inquiry, we will be available upon
request to represent you or respond to such inquiry. If such services are requested by you, all of the terms,
conditions, and representations of this engagement letter shall apply and we will render additional invoices for
these services and any expenses incurred.
5. The law provides various penalties and interest that may be imposed when taxpayers understate their tax liability
and/or fail to pay the full amount of taxes owed by the original filing due date. Furthermore, additional penalties
and interest are imposed when taxpayers fail to remit the proper amount of subsequent year tax estimates. Based
on information you provide to us, we can assist you in determining the correct amount of taxes owed for the
current year and subsequent year tax estimates. You acknowledge that any such understated or underestimated
tax, and any imposed interest and penalty thereon, are your responsibility, and that we have no responsibility
in that regard. If you would like information on the amount or the circumstances of these interest and penalties,
please contact us.
6. To the best of your knowledge and belief, and unless specifically indicated to us that the representation below
cannot be made, you confirm that:
You have disclosed all reportable transactions. These include but are not limited to listed
transactions that the IRS has determined to be a tax avoidance transaction; transactions which
produce questionable tax shelters, tax deductions, losses, or credits; require confidentiality
by you or a related party and for which you or a related party paid an advisor a minimum fee;
a transaction for which fees are contingent on your realization of tax benefits from the
transaction or refundable if all or part of the intended tax consequences of the transaction are
not sustained; or a transaction that results in you claiming a significant loss of at least $2
million in any single year or $4 million in any combination of tax years (at least $50,000 for
a single year if the loss arose as a result of a foreign currency transaction).
4
You have disclosed the use of any mortgage proceeds for purposes other than to acquire,
construct, or substantially improve your main or second home.
You have disclosed any dividend income on shares of stock that you did not own for at least
61 days during the 121-day period beginning 61 days before the ex-dividend date.
You have disclosed if you materially participated in any pass-through entity (such as an S-
Corporation, LLC, or Partnership).
Note:
Any determination of material participation in a pass-through entity is complex and based on
certain facts and circumstances that may be particular to your personal situation. If you are
unsure as to whether you did materially participate in a pass-through entity, please contact
us.
You have disclosed if you have a financial interest in (direct or indirect), or signature or other
authority over, bank accounts, securities, or other financial accounts having an aggregate
value exceeding $10,000 at any time during the calendar year in a foreign country.
Note:
If you have a financial interest in any foreign accounts, you must electronically file the
FinCEN Report 114, Report of Foreign Bank and Financial Accounts (“FBAR”), as required
by the U.S. Department of the Treasury. Such filing requirements apply to taxpayers that
have direct or indirect control over a foreign or domestic entity with foreign financial
accounts, even if the taxpayer does not have foreign account(s). For example, a corporate-
owned foreign account would require filings by the corporation and by the individual
corporate officers with signature authority.
If you fail to disclose the required information to the U.S. Department of the Treasury, the
failure to disclose may result in substantial civil and/or criminal penalties. You are
responsible for providing our firm with all the information necessary to prepare the FBAR.
Failure to file can result in penalties ranging from $10,000 to the greater of $100,000 or
50% of account balances. If you do not provide our firm with information regarding any
interest you may have in a foreign account, we will not be able to prepare any of the required
disclosure statements.
You have disclosed if the total value of specified foreign financial assets you own are more
than $100,000 ($50,000 if unmarried or married filing separately) on the last day of the tax
year or more than $150,000 ($75,000 if unmarried or married filing separately) at any time
during the tax year.
Specified foreign financial assets are defined as accounts maintained by a foreign financial institution,
stocks and securities with a non-U.S. issuer, an interest in a foreign partnership, trust or estate, a
financial instrument or contract with a non-U.S. issuer or counterparty, etc.
Note:
If you have specified foreign financial assets above the threshold amounts provided above, you are
required to report this ownership on Form 8938 and include with your Form 1040.
5
If you fail to disclose the required information to the Internal Revenue Service, the failure to
disclose may result in substantial civil and/or criminal penalties. You are responsible for
providing our firm with all the information necessary to prepare Form 8938. Failure to file
can result in penalties ranging from $10,000 to $60,000. If you do not provide our firm
with information regarding any interest you may have in a specified foreign financial asset,
we will not be able to prepare the form, nor your tax returns.
You have disclosed all related party transactions between you, family members and/or a
business in which the business shareholders, partners or members have a related interest with
you. These types of transactions include borrowing and/or lending funds, paying and/or
receiving rents, buying and/or selling products or property, and performing and/or receiving
services.
7. Individuals are mandated to maintain qualified health insurance coverage under the “Shared Responsibility”
provisions of the Affordable Care Act (ACA). This responsibility requires you and each member of your family
to either have a qualified health insurance plan or have an exemption from the responsibility of having a
qualified health insurance plan. Absent such coverage or exemption, a “Shared Responsibility Payment” will
be assessed. The Shared Responsibility Payment is due at the same time your 2016 federal income taxes are
due, and is calculated as the greater of:
2.5% of your yearly household income that is above the tax return filing threshold for your tax filing
status, limited to the total yearly premium for the national average price of a Bronze plan sold through
the Marketplace; or
$695 per person for the year ($347.50 per child under 18), limited to a family maximum of $2,085.
For any given month, you are considered part of a qualified health insurance plan if that plan maintains
“minimum essential coverage” for at least one day during that month. Minimum essential coverage is defined
as the minimum health insurance coverage needed to satisfy the requirements of the ACA.
To the best of your knowledge and belief, and unless specifically indicated to us that the representation below
cannot be made, you confirm that you and/or your family have qualified health insurance coverage based upon
your enrollment in one of the following:
A health insurance plan provided by your employer;
A health insurance plan purchased through the Health Insurance Marketplace (www.healthcare.gov);
A health insurance plan provided under a government-sponsored program for which you are eligible
(including Medicare, Medicaid, and health care programs for veterans);
A health insurance plan purchased directly from an insurance company; or
Other health insurance coverage that is recognized by the Department of Health & Human Services
as minimum essential coverage.
If you and/or your family do not have a health insurance plan under one of the five categories listed above, then
you confirm that you and/or your family are exempt from this responsibility due to one of the following:
You have no affordable coverage options because the minimum amount you must pay for the
annual premiums is more than 8.13% of your household income;
You have a gap in coverage for less than three consecutive months; or
You qualify for an exemption for one of several other reasons, including having a hardship
that prevents you from obtaining coverage, or belonging to a group explicitly exempt from
the requirement.
6
Note:
Health insurance plan providers are required to provide documentation showing proof of
health insurance purchased through the health insurance Marketplace (Form 1095-A). If you
purchased health insurance through the health insurance Marketplace, it is mandatory that
you provide us with this Form.
8. You should retain all documents, canceled checks and other data that form the basis of income and deductions.
These may be necessary to prove the accuracy and completeness of the returns to a taxing authority, and as
such, you should retain and protect these records. You are responsible for substantiating any amount upon
which a deduction is taken on the return. The type of deduction taken will determine the specific substantiation
needed. The following is a list of common deductions taken on a tax return and the substantiation required for
each.
Automobile Expenses - Mileage logs and trip sheets for each trip. Commuting miles between
home and a fixed work location are not considered deductible business miles.
Meals and Entertainment Expenses (100% deductible) - Business meals for the benefit of
employees who are not highly compensated, such as holiday parties, lunches for staff
meetings, birthdays, and company outings if only the employees and their families attend (no
clients).
Meals and Entertainment Expenses (50% deductible) – Includes meals with an employee,
meals during travel, and meals with clients. Business meals with clients require
documentation substantiating who the client was and the business purpose of the meal. A
receipt is not required for expenses under $75, but documentation is still required.
Meals/entertaining clients at any event, such as a sporting event, etc., requires documentation
substantiating that there was a bona fide business discussion prior to, during, or following
the meal/entertainment event.
Charitable Cash Contributions (in any one day to any one organization):
o Less than $250 – A bank record (e.g. canceled check/ credit card statement) or a
written acknowledgement from the charity.
o $250 or more – Both a bank record and written acknowledgement from the charity.
Charitable Non-Cash Contributions (in any one day to any one organization):
o Deduction of less than $250 - A receipt or a written acknowledgement from the
charity.
o Deduction between $250 and $500 - A written acknowledgement by the charitable
organization.
o Deduction between $501 and $5,000 - Same records required as the $250 to $500
category. In addition, records must show how the property was acquired, the date
acquired, and the adjusted basis of the property.
o Deduction of more than $5,000 - Same records required as the $501 to $5,000
category. In addition, most contributions require a written appraisal.
Note:
7
The list above provides only general guidance on substantiating a limited number of deduction types.
There are many other types. If you are unsure as to whether or not the information you possess is
sufficient to substantiate a deduction, please contact us.
9. We reserve the right to suspend our services or withdraw from this engagement. If we elect to terminate our
services, our engagement will be deemed to have been completed upon written notification of termination, even
if we have not completed the return. You will be obligated, through the date of termination, to compensate us
for all outstanding invoices as well as our final invoice, and to reimburse us for all of our out-of-pocket costs.
For these purposes, any nonpayment, inability to sign the tax return, or non-response by you of information
requested (among other things) will constitute a basis for our election to terminate our services.
10. It is our policy to retain copies of engagement documentation for a period of seven years (five years for former
clients), after which time we will commence the process of destroying the contents of our engagement files.
Any work papers prepared in conjunction with this engagement are our property, constitute confidential
information, and will be retained by us in accordance with this record retention policy. To the extent we
accumulate any of your original records during the engagement, those documents will be returned to you
promptly upon completion of the engagement.
11. In the interest of facilitating our services to you, we may communicate with you by means of electronic
communications, such as fax, email, or via our client portal. While we will use our best efforts to keep such
communications secure in accordance with our obligations under applicable laws and professional standards,
you recognize and accept that we have no control over the unauthorized interception of these communications
once they have been sent and you consent to our use of these devices during this engagement. You agree that
we shall have no liability for any loss or damage to any person or entity resulting from the use of email
transmissions, including any consequential, incidental, direct, indirect, or special damages, such as loss of
revenues or anticipated profits, or disclosure or communication of confidential or proprietary information. It is
our belief that electronic communication provides the greatest privacy by eliminating paper trails of confidential
information. As such, and unless you tell us otherwise, the client’s copy of the prepared tax return will be
presented back to you in a PDF file format via our web-based client portal. If you would still like us to send
you a paper copy of the tax return, please contact our office.
12. IRS regulations require that we electronically file (e-file) all tax returns, and it is our belief that this type of
filing provides the greatest security. However, you do have the right to “opt-out” from e-filing by notifying us,
in writing, of this desire.
13. Although we may orally discuss tax issues with you from time to time, such discussions will not constitute
advice upon which we intend for you to rely on for any purpose. Rather, any advice upon which we intend for
you to rely, and upon which you will rely, will be embodied in a written report or correspondence from us to
you, and any such writing will supersede any prior oral representations between the parties on the issue.
14. In the event we are required to respond to a subpoena, court order or other legal process for the production of
documents, work papers and/or testimony relative to information we obtained and/or prepared during the course
of this engagement, you acknowledge our right to release this information and agree to compensate us for the
time we expend in connection with such response and to reimburse us for all of our out-of-pocket costs incurred
in that regard.
8
15. If the income tax returns we are to prepare in connection with this engagement are joint returns, and because
you will each sign those returns, each of you is our client. You each acknowledge that there is no expectation
of privacy from the other concerning our services in connection with this engagement, and we are at liberty to
share with either of you, without the prior consent of the other, any and all documents and other information
concerning preparation of your returns.
16. In the event that we become obligated to pay any judgment under a court proceeding, an award under any
mediation proceeding, or penalty assessed by any taxing authority in our capacity as a tax preparer, you agree
to pay any costs incurred as a result of any inaccurate or incomplete information that you provided to us during
the course of this engagement. You agree to indemnify us, defend us, and hold us harmless against such
obligations and/or costs. Any litigation arising out of this engagement, except actions by us to enforce payment
of our professional invoices, must be filed within one year from the completion of the engagement,
notwithstanding any statutory provision to the contrary. In the event of litigation brought against us, any
judgment you obtain shall be limited in amount, and shall not exceed the amount of the fee charged by us, and
paid by you, for the services set forth in this engagement letter.
17. You agree that any dispute that may arise regarding the meaning, performance or enforcement of this
engagement will, prior to resorting to litigation, be submitted to mediation, and that you will engage in the
mediation process in good faith once a written request to mediate has been given by either party to the
engagement. Any mediation initiated as a result of this engagement shall be administered by a law firm
specializing in the mediation process, not associated with either party, and selected by us, according to its
mediation rules. Any ensuing litigation shall be conducted within the County of Morgan, Indiana according to
Indiana law. The results of any such mediation shall be binding only upon agreement of each party to be bound.
The costs of any mediation proceeding shall be shared equally by the participating parties.
18. Unless you tell us otherwise, we will presume that you authorize us to discuss certain aspects of your tax returns
with the IRS and certain states/ local municipalities, if necessary.
2016INDIVIDUALQUESTIONNAIRE
1
Please review this questionnaire, which will provide us with information that normally does not come from third party
sources (such as W-2s, 1099s, and 1098s) or written representations from you (such as real estate taxes paid during the
year or charitable contributions). If any question is left blank or the questionnaire is not returned, the answer is assumed
to be “No” or “0.”
MARCH 23, 2017 – deadline to submit information, before an extension may be required
COMPLETION IS MANDATORY
Taxpayer Name: _______________________________ Taxpayer Date of Birth: ________________________
Spouse Name: _________________________________ Spouse Date of Birth: __________________________
Address: _____________________________________ School District: _______________________________
_____________________________________ County (as of 1/1/16): __________________________
Home Phone: ____________________________________ Cell Phone: ___________________________________
E-mail: ___________________________________________________________________________________________
Personal Information: Yes No
Were you married, divorced, or widowed at any time during the year?
If you are married, do you and your spouse want to file separate returns?
Dependents: Yes No
Can you or your spouse be claimed as a dependent by another taxpayer?
Were there any changes in dependents from the prior year? The determination of whether another
individual may be claimed as a dependent can be complex. If you have any question about the
exemption in respect of another person, please complete the Dependency Determination Schedule
attached to this Questionnaire.
If yes and adding a dependent, please provide the following information. If more than one addition, please include on a
separate attachment.
Name:
Social Security No.:
Date of Birth:
No. of Months Living at
Residence:
If yes and removing a dependent, please identify below. If more than one deletion, please include on a separate attachment.
Name:
Did you pay for childcare or other qualifying care for a dependent (such as a parent) while you worked
or looked for work?

2016INDIVIDUALQUESTIONNAIRE
2
Dependents Continued:
If yes, please provide the following information:
Provider’s Name:
Provider’s Address:
Social Security/EIN No.:
Amounts Paid in 2016:
$
Do you have any children under the age of 18 on 1/1/16 or under the age of 24 on 1/1/16 and were full-
time students with wages, interest, or dividend income over $1,050, or who have sold any stock in
2016?
If yes, do you want us to prepare their return(s)?
Did you adopt a child or begin adoption proceedings during 2016?
Home/Residence: Yes No
Did the residence for which you claimed the first-time homebuyer credit cease to be your principal
residence in 2016?
What was the amount of the credit claimed? $
If yes, on what day and year was the home purchased?
If yes, on what day and year was the home sold?
Health Insurance: Yes No
Did you have qualified health insurance coverage from your employer during the year?
If yes, did it cover ;you and the members of your household the entire year?
If no, which months was each member covered?
Did you receive Form 1095-B or 1095-C? If yes, please include
If no, did your employer offer you coverage?
If yes, was the cost of coverage no more than 9.66 percent of your W-2 wages?
Did you purchase health coverage on a Marketplace Exchange (www.healthcare.gov)?
If yes, did you receive Form 1095-A? If yes, please include.
If no, do you qualify for an exemption such as hardship or by reason of being in a protected
group?
Gambling: Yes No
Do you have any gambling losses (to the extent of gambling winnings)?
Gambling losses need to be substantiated with contemporaneous gambling logs or other
documentation. Can you substantiate your gambling losses with the required supporting
documentation?
Amount of Loss in 2016:
$

2016INDIVIDUALQUESTIONNAIRE
3
Checklist to assist you in gathering your information:
Complete the following checklist of common items that are used to prepare your individual tax return. Please
indicate the number of the items that pertain to your return. EXAMPLE: If you & your spouse have one job
each, then you will have 2 W-2’s. If you only have interest income from one source then number will be 1
1099-INT, etc.
Number of
Forms
Items of Income
Compensation – Wages/Salary (W-2s)
Interest Income (1099-INTs)
Dividend Income (1099-DIVs)
Capital Gains/Losses (1099-Bs and Realized Gains/Loss Statements)
Sale of Real Estate (1099-Ss, Settlement Sheets, Cost Basis)
Self Employment /Business Income (1099-MISCs, Credit Card
Statements, and Associated Expenses)
Rental Real Estate Income (1099-MISCs and Associated Expenses)
Partnership, S-Corporation, Trust/Estate Income (K-1s)
State/Local Tax Refunds (1099-Gs)
IRA and Pension Income (1099-Rs)
Social Security Benefits (1099-SSAs)
Alimony and Unemployment Compensation (1099-Gs)
Long-term Care (1099-LTCs)
Cancellation of Debt Income (1099-Cs)
Gambling Income (1099-MISCs or W-2Gs)
Other Income: List
Income Adjustments:
Self-Employed Health Insurance (1099-SAs/ K-1s/ list)
IRA/SEP Contributions
Tuition Expenses Paid (1098-Ts)
Tuition Plan Contributions/Withdrawals (1099-Qs)
Student Loan Interest Paid (1098-Es)
Other Adjustments: List
Items of Deductions & Credits:
Medical Expenses
Real Estate Taxes (1098s or Real Estate Tax Bills)
Mortgage Interest (1098s)
Investment Interest Expense
Charitable Contributions
Unreimbursed Business Expenses
Other Deductions: List
Child and Dependent Care Expenses
Other Credits: List
2016INDIVIDUALQUESTIONNAIRE
4
Schedule A - Itemized Deductions Information: Yes No
Are you claiming a deduction for mortgage interest expense and real estate taxes paid on your personal
residence or second home? (Defined as a dwelling that provides basic living accommodations such as sleeping
space, toilet, and cooking facilities.)
If yes, please provide all 1098 mortgage interest statements and all real estate tax bills for 2016.
If all real estate taxes paid are not reported on a 1098, please provide all real estate tax bills for 2016, or
indicate the amount in the space provided. Amount Paid in 2016: $
Are you claiming a deduction for mortgage interest paid to a financial institution, for which someone else
received the Form 1098?
If yes, please provide the following information:
Individual’s Name:
Social Security/EIN No.:
Amounts Paid in 2016: $
Are you claiming a deduction for mortgage interest paid to an individual or other non-financial institution and
did not receive the Form 1098?
If yes, please provide the following information:
Lender’s Name:
Social Security/EIN No.:
Amounts Paid in 2016: $
Did you make any large purchases, such as a motor vehicle, RV, or boat in 2016?
If yes, please provide the invoice amount and sales tax paid on the transaction.
Did you incur any casualty or theft losses during the year?
If yes, provide the following details:
Description of Loss:
Property on Which Loss Occurred:
Amount of Loss in 2016: $
Amount Reimbursed by Insurance in 2016: $
Schedule C - Self-Employment/Business Income and Expenses: Yes No
Did you make payments of fees and other non-employee compensation, interest, rents, royalties, real estate
transactions, annuities, or pensions?
If yes, did you file all required Forms 1099?
Did you start, continue or dispose of a business activity during the past year? If yes, please discuss the matter
with one of our tax managers.
If yes, please provide a list of your related business revenue and expenses (including health insurance), any newly acquired
business assets, and assets that were disposed of in 2016.
Were you or your spouse eligible to be covered under an employer’s health plan at another job?
If yes, how many months were you covered? Months:
Did you use any part of your personal residence as a home office?
Do you have un-reimbursed business automobile expenses?
Mileage From January 1, 2016 to December 31, 2016:
Total Miles Driven: Total Business Miles Driven:
2016INDIVIDUALQUESTIONNAIRE
5
Schedule D - Capital Transactions: Yes No
Did you sell any type of asset (rental real estate, vacation home(s), land, securities, bonds, privately held
corporations or partnerships, collectibles, etc.) and did not receive a Form 1099-B and/or Form 1099-S?
If yes, please attach a statement of cost basis, dates of purchase, date of sale, and sales price.
If you sold a security or bond at a loss, did you buy back the identical security or bond sold within 30 days
before or after the sale?
Did any securities sold this year pay a stock dividend or have a stock split?
Was the sale of any asset in conjunction with a plan to acquire a like-kind asset in a §1031 exchange?
Did you receive a note receivable from the buyer as part or all of your proceeds from the sale?
If you sold any asset at a loss, were you related to the buyer?
Did you receive grants of stock options from your employer, exercise any stock options granted to you, or
dispose of any stock acquired under a qualified employee stock purchase plan?
If yes, please provide support (statements/schedules from your employer).
Did you engage in any put or call transactions?
Did you have any debts canceled, forgiven, or refinanced during 2016?
Schedule D - Principal Residence Transactions: Yes No
Have you refinanced a mortgage or taken out a home equity loan on your principal residence this year?
Did you use any of the proceeds for any other purpose than improving your principal residence?
Did you sell your principal residence in 2016? If no, go to the next section. If yes:
Did you occupy the home as your principal residence for at least 2 years out of the 5-year period prior to
the sale?
Did you ever rent out this property?
Did you ever use any portion of the home for business purposes?
Have you or your spouse sold a principal residence within the last 2 years?
At the time of the sale, the principal residence was owned by: Taxpayer Spouse Both
IRA/Pension Contributions and Distributions: Yes No
Did you or your spouse withdraw any amounts from your Individual Retirement Account (IRA), Roth IRA, or
pension plan?
If yes, was it to acquire a principal residence or pay for qualified higher education expense?
If yes, were any distributions from your IRA and/or Roth IRA distributed directly to a charitable
organization?
Did you make a nondeductible contribution to a traditional IRA?
If yes, indicate amount contributed:
Did you or your spouse make a contribution to a retirement plan, 401k, SIMPLE, SEP, or IRA that is not
reported on your W-2 or K-1?
If yes, indicate amount contributed:
Taxpayer’s Retirement Plan
and Contribution Amount:
Spouse’s Retirement Plan and
Contribution Amount:
Did you or your spouse contribute to a Roth IRA?
If yes, indicate amount contributed:

2016INDIVIDUALQUESTIONNAIRE
6
IRA/Pension Contributions and Distributions Continued:
Taxpayer’s Contribution Amount:
Spouse’s Contribution Amount:
Did you or your spouse convert an existing IRA to a Roth IRA?
If yes, indicate the amount converted:
Taxpayer’s Conversion Amount:
Spouse’s Conversion Amount:
Did you retire or change jobs in 2016?
Did you receive retirement or severance compensation?
Did you or your spouse turn age 70 ½ (or were older than 70 ½) during 2016 and have money in an IRA or
other retirement account without taking your required minimum distribution?
Gifts: Yes No
Did you or your spouse make any gifts, including birthday, holiday, anniversary, graduation, etc., with a total
aggregate value in excess of $14,000 to any individual during the year?
Did you or your spouse assist in the purchase of any asset (auto, home, etc.) for any individual during the
year?
Did you or your spouse make any gifts to a trust for any amount during the year?
Do you or your spouse have a life insurance trust?
Did you or your spouse forgive any indebtedness to any individual, trust, or entity during the year?
If yes, please explain:
Education: Yes No
Did you or your dependents incur any post-secondary education expense, such as tuition?
If yes, indicate the dependent, the type of expenses and the amount paid:
Dependent’s name:
Year of Post-Secondary Education:
Type of Educational Expenses:
Amounts Paid in 2016: $
Has the dependent student taken less than ½ of the normal full time workload in their course of study?
Has the dependent student ever had a felony conviction for possessing or distributing a controlled
substance?
Did you or your spouse withdraw amounts from a Qualified Education Program (Section 529 plan) or
Coverdell Education Savings Account that was not used for qualified higher education expenses?
Did you or your spouse make any contributions to a Qualified Education Plan (Section 529 plan) or a
Coverdell Educational Savings Account during 2016?
If yes, please enter the following information:
Name of Designated
Beneficiary:
Social
Security
No.
State Sponsoring Plan Account No. Amount
Contributed in
2016
$
$
$
Did you pay any student loan interest?
2016INDIVIDUALQUESTIONNAIRE
7
2016 Federal, State and Local Estimated Tax Payments:
Date Paid Federal Amount State Amount
2016 1st Qtr. ES – due 4-18-16
2016 2nd Qtr. ES – due 6-15-16
2016 3rd Qtr. ES – due 9-15-16
2016 4th Qtr. ES – due 1-17-17
2017 Tax Planning: Yes No
Refund Application: If you have an overpayment of 2016 taxes, do you want the excess:
Refunded via a check in the mail?
Refunded via Direct Deposit?
Applied to the 2017 estimated tax liability?
Do you expect any of the following to occur in 2017:
A change in your marital status;
A change in the number of dependents;
A substantial change in your income;
A substantial change in your withholdings; and/or
A substantial change in your deductions?
Authorization: Yes No
With your authorization, the IRS and certain states allow us to verify credits, payments, etc., for your tax
account online. If you do NOT want us to have authorization to view this information, please indicate so by
marking yes. Checking no helps us to prepare your return more efficiently.

2016INDIVIDUALQUESTIONNAIRE
8
Appendix A – Medical & Dental Expenses
Medical and dental expenses, such as: doctors, dentists, nurses, hospital and nursing homes, lab fees and x-rays, medical and
surgical supplies, hearing aids, guide dogs, eye glasses and contact lenses, and insurance reimbursements received:
Description:
Amount:
Medical insurance premiums you paid:
Long-term care premiums you paid: Indiana Partnership
Plan
Taxpayer: Yes No
Spouse: Yes No
Prescription medicines & drugs:
Medical Miles Driven:________________________
Did you make modifications to your home for medical purposes? If so, please provide details:
2016INDIVIDUALQUESTIONNAIRE
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Appendix B – Charitable Contributions
Contributions made by cash or check:
Description:
Amount:
Were any distributions taken from your IRA and/or Roth IRA distributed directly to a
charitable organization? YES NO
Volunteer Miles Driven:_______________________________________
Noncash items, such as: Goodwill, Salvation Army:
Appendix C – Interest & Tax Expenses
Description:
Amount:
Home Mortgage Interest Paid:
Real Estate Taxes Paid:
Auto Excise Tax Paid:
Yes No
Did you make any large purchases, such as a motor vehicle, RV or boat in 2016?
If yes, please provide the invoice amount & sales tax paid on the transaction:
Invoice Amount:______________________________ Sales Tax Paid:_______________________________
2016INDIVIDUALQUESTIONNAIRE
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Appendix D – Miscellaneous Deductions
Unreimbursed expenses, such as: uniforms, professional dues, business publications, job seeking expenses, educational expenses:
Description:
Amount:
Union Dues:
Tax Preparation Fees:_________________________________
Other expenses, subject to 2% AGI limitation such as: legal/accounting fees, IRA custodian fees:
Safe deposit box rental:_______________________________:
Investment expenses, other than on K1’s:
Other expenses, not subject to the 2% AGI limitation:
Gambling losses (enter only if you have gambling income):
2016INDIVIDUALQUESTIONNAIRE
11
THIS QUESTIONNAIRE APPLIES ONLY IF YOU HAVE RECEIVED K-1s OR HAVE A
RENTAL REAL ESTATE ACTIVITY. PLEASE ANSWER ALL QUESTIONS. FAILURE TO
ANSWER WILL BE TREATED AS A “NO” RESPONSE AND BLANK AMOUNTS WILL BE
TREATED AS ZERO AMOUNTS.
S corporation and partnership/LLC: Yes No
Did you participate in the operation and management of any business for which you received a K-1?
If so, which ones? Name of K-1 issuer Hours of participation
Can you substantiate the hours claimed for each above-named activity?
S corporation and partnership/LLC:
Self-charged interest
Yes No
Did you receive interest on a loan you made to any business for which you received a K-1?
If so, which ones and
how much?
Name of K-1 issuer Interest received
Rental real estate:
Self-charged rents
Yes No
Did you rent real estate for consideration to a partnership, LLC, C corporation, or S corporation in which
you participated?
If so, how many hours, did you participate in the trade or business of such
partnership, LLC, C corporation, or S corporation?
Can you substantiate such hours claimed?
Rental real estate:
Real estate professional
Yes No
Did you perform
services in any one or
more of the
following:
Activity
Development and/or redevelopment
Construction and/or reconstruction
Acquisition
Conversion
Rental or leasing
Operation
Management
Brokerage
Did the number of hours performing services in all such activities exceed 750?
Can you substantiate such hours claimed?
Did the number of hours performing services in a rental activity exceed 500?
Can you substantiate such hours claimed?
1
RE: 2016 Individual Tax Return Disclosure Policies
Dear Client:
This letter serves to inform you of this firm’s policy of disclosure with respect to tax return information in
connection with the above engagement.
We shall not knowingly or recklessly disclose the information you furnish us except as provided by law.
We may disclose tax return information to an officer or employee of the Internal Revenue Service.
If the firm provides software to you that is used in connection with the preparation or filing of your tax
return, the tax return preparer may use your tax return information to update your software for the purpose
of addressing changes in IRS forms, e-file specifications and administrative, regulatory and legislative
guidance, or to test and ensure the software's technical capabilities without the taxpayer's consent. In
addition, an officer, employee, or member of the firm may use the tax return information, or disclose the
tax return information to another officer, employee, or member of the same firm, for the purpose of
performing services that assist in the preparation of, or assist in providing auxiliary services in connection
with the preparation of, the taxpayer's tax return, except with respect to such individuals who are located
outside the United States or any territory or possession of the United States unless you give consent to such
use or disclosure.
In general, an officer, employee, or member of the firm may disclose tax return information to another tax
return preparer (who is not an officer, employee, or member of the firm located in the United States
(including any territory or possession of the United States) for the purpose of preparing or assisting in
preparing a tax return, or obtaining or providing auxiliary services in connection with the preparation of
any tax return, so long as the services provided are not substantive determinations or advice affecting the
tax liability reported by taxpayers. A substantive determination involves an analysis, interpretation, or
application of the law. The authorized disclosures permitted include one tax return preparer disclosing tax
return information to another tax return preparer for the purpose of having the second tax return preparer
transfer that information to, and compute the tax liability on, your tax return by means of electronic,
mechanical, or other form of tax return processing service. The authorized disclosures permitted also
include disclosures by a tax return preparer to an Authorized IRS e-file Provider for the purpose of
electronically filing the return with the IRS. Authorized disclosures also include disclosures to a second tax
return preparer for the purpose of making information concerning the return available to the taxpayer. This
would include, for example, whether the return has been accepted or rejected by the IRS, or the status of
your refund. The firm may not disclose tax return information to another tax return preparer for the purpose
of the second tax return preparer providing substantive determinations without first receiving the taxpayer's
consent. The firm may disclose tax return information to a person under contract with the tax return preparer
in connection with the programming, maintenance, repair, testing, or procurement of equipment or software
used for purposes of tax return preparation only to the extent necessary for the person to provide the
contracted services, and only if the tax return preparer ensures that all individuals who are to receive
disclosures of tax return information receive a written notice that informs them of the applicability of
§§6713 and 7216 to them and describes the requirements and penalties of such sections.
2
In preparing a tax return of a second taxpayer, the firm may use, and may disclose to the second taxpayer
in the form in which it appears on the return, any tax return information that the tax return preparer obtained
from you if the second taxpayer is related to you, and your tax interest in the information is not adverse to
the second taxpayer's tax interest in the information. However, you may expressly prohibit such disclosure
or use. For these purposes, a taxpayer is related to another taxpayer if they have any one of the following
relationships: Husband and wife, child and parent, grandchild and grandparent, partner and partnership,
trust or estate and beneficiary.
The disclosure limitations do not apply to the order of any court of record, federal, state, or local; a
subpoena issued by a grand jury, federal or state; a subpoena issued by the United States Congress; an
administrative order, demand, summons or subpoena that is issued in the performance of its duties by any
federal agency, or a state agency, body, or commission charged under the laws of the state or a political
subdivision of the state with the licensing, registration, or regulation of tax return preparers; a written
request from a professional association ethics committee or board investigating the ethical conduct of the
tax return preparer; or a written request from the Public Company Accounting Oversight Board in
connection with an inspection under §104 of the Sarbanes-Oxley Act of 2002, or an investigation under
§105 of such Act, for use in accordance with such Act. The firm may disclose tax return information to an
attorney for purposes of securing legal advice; to an employee of the Treasury Department for use in
connection with any investigation of the tax return preparer (including investigations relating to the tax
return preparer in its capacity as a practitioner) conducted by the IRS or the Treasury Department; or to any
officer of a court for use in connection with proceedings involving the tax return preparer (including
proceedings involving the tax return preparer in its capacity as a practitioner), or the return preparer's client,
before the court or before any grand jury that may be convened by the court.
The firm may use your tax return information, or disclose the information to another officer, employee or
member of the firm, consistent with applicable legal and ethical responsibilities, who may use the tax return
information for the purpose of providing other legal or accounting services to you. As an example, an
accountant who prepares a tax return for you may use the tax return information, or disclose it to another
officer, employee or member of the firm, for use in connection with the preparation of books and records,
working papers, or accounting statements or reports for you. In the normal course of rendering the
accounting services to you, the accountant may make the tax return information available to third parties,
including stockholders, management, suppliers, or lenders, consistent with the applicable legal and ethical
responsibilities, unless you direct otherwise.
A tax return preparer's accounting firm does not include any related or affiliated firms. For example, if
accounting firm A is affiliated with accounting firm B, officers, employees, and members of accounting
firm A must receive a taxpayer's consent before disclosing the taxpayer's tax return information to an
officer, employee, or member of accounting firm B.
The firm may, consistent with the applicable legal and ethical responsibilities, take your tax return
information into account, and may act upon it, in the course of performing accounting services for another
client, or disclose the information to another officer, employee or member of the firm to enable that other
officer, employee or member to take the information into account, and act upon it, in the course of
performing accounting services for another client. This is permissible when the information is, or may be,
relevant to the subject matter of the accounting services for the other client, and consideration of the
information by those performing the services is necessary for the proper performance of the services. In no
event, however, may the tax return information be disclosed to a person who is not an officer, employee or
member of the accounting firm, unless the disclosure is exempt from the disclosure provisions.
If, after furnishing tax return information to the firm, the [trust or estate] becomes incompetent, insolvent,
or bankrupt, or its assets are placed in conservatorship or receivership, the firm may disclose the information
to the duly appointed fiduciary of such estate, or to the duly authorized agent of such fiduciary.
3
The uses and disclosures with respect to software preparation, other tax return preparers within the firm,
and tax return preparers located outside the United States, as well as the disclosures to other tax return
preparers within the United States and the disclosures to programming and maintenance contractors
permitted above apply to the disclosure of any tax return information in the preparation of, or in connection
with the preparation of, any tax return under the law of any state or political subdivision thereof, of the
District of Columbia, of any territory or possession of the United States, or of a country other than the
United States. The nondisclosure and non-use provisions do not apply to the use by the firm of any tax
return information in the preparation of, or in connection with the preparation of, any tax return of yours
under the law of any state or political subdivision thereof, of the District of Columbia, of any territory or
possession of the United States, or of a country other than the United States. They also do not apply to the
disclosure or use by any tax return preparer of any tax return information in the audit of, or in connection
with the audit of, any tax return of yours under the law of any state or political subdivision thereof, the
District of Columbia, or any territory or possession of the United States.
The firm may use and disclose tax return information that you provide to us to pay for tax preparation
services to the extent necessary to process or collect the payment. For example, if you give us a credit card
to pay for tax preparation services, the firm may disclose your name, credit card number, credit card
expiration date, and amount due for tax preparation services to the credit card company, as necessary, to
process the payment. Any tax return information that you did not give us for the purpose of making payment
for tax preparation services may not be used or disclosed by the firm without your prior written consent,
unless otherwise permitted under another provision.
The firm may retain your tax return information, including copies of tax returns, in paper or electronic
format, prepared on the basis of the tax return information, and may use the information in connection with
the preparation of another of your tax returns or in connection with an examination by the Internal Revenue
Service of any tax return or subsequent tax litigation relating to the tax return. The firm may compile and
maintain a separate list containing solely the names, addresses, email addresses, and phone numbers of
taxpayers whose tax returns the firm has prepared or processed. This list may be used by the compiler solely
to contact the taxpayers on the list for the purpose of providing tax information (and general business or
economic information or analysis for educational purposes), or soliciting additional tax return preparation
services. The list may not be used to solicit any service or product other than tax return preparation services.
The compiler of the list may not transfer the taxpayer list, or any part thereof, to any other person unless
the transfer takes place in conjunction with the sale or other disposition of the compiler's tax return
preparation business.
Due diligence conducted prior to a proposed sale of a compiler's tax return preparation business is in
conjunction with the sale or other disposition of a compiler's tax return preparation business, and will not
constitute a transfer of the list if conducted pursuant to a written agreement that requires confidentiality of
the tax return information disclosed and expressly prohibits the further use or disclosure of the tax return
information for any purpose other than that related to the purchase of the tax return preparation business.
The tax return information submitted for the purpose of due diligence as authorized in this paragraph is a
disclosure of tax return information subject to the provisions of this section.
A person who acquires a taxpayer list, or a part thereof, in conjunction with a sale or other disposition of a
tax return preparation business is subject to the provisions of this paragraph with respect to the list. The
term ‘list’ includes any record or system whereby the names and addresses of taxpayers are retained.
The firm may use, for the limited purpose specified, tax return information to produce a statistical
compilation of data. The purpose and use of the statistical compilation must relate directly to the internal
management or support of the firm's tax return preparation business, or to bona fide research or public
policy discussions concerning state or federal taxation or requiring data acquired during the tax return
preparation process. The firm will not disclose the compilation, or any part thereof, to any other person
unless disclosure of the statistical compilation is anonymous as to taxpayer identity, does not disclose cells
containing data from fewer than ten tax returns, and is in direct support of the firm's tax return preparation
4
business or of bona fide research or public policy discussions concerning state or federal taxation or
requiring data acquired during the tax return preparation process. A statistical compilation is anonymous as
to taxpayer identity if it is in a form which cannot be associated with, or otherwise identify, directly or
indirectly, a particular taxpayer. For these purposes, marketing and advertising is in direct support of the
tax return preparer's tax return preparation business provided the marketing and advertising is not false,
misleading, or unduly influential. This does not authorize the use or disclosure in marketing or advertising
of any statistical compilations, or part thereof, that identify dollar amounts of refunds, credits, or deductions
associated with tax returns, or percentages relating thereto, whether or not the data are statistical, averaged,
aggregated, or anonymous. Disclosures made in support of fundraising activities conducted by Volunteer
Return Preparation programs and other 501(c) organizations in direct support of their tax return preparation
businesses are not marketing and advertising under this paragraph. The firm may disclose the compilation
in order to comply with financial accounting or regulatory reporting requirements whether or not the
statistical compilation is anonymous as to taxpayer identity or discloses cells containing data from fewer
than ten tax returns.
The tax return preparer may not sell or exchange for value a statistical compilation of data, in whole or in
part, except in conjunction with the transfer of assets made pursuant to the sale or other disposition of the
tax return preparer's tax return preparation business. The provisions regarding the transfer of a taxpayer list
also apply to the transfer of any statistical compilations of data. A person who acquires a statistical
compilation, or a part thereof, in conjunction with a sale or other disposition of the firm’s tax return
preparation business, is subject to these limitations with respect to the compilation.
The firm may disclose your tax return information for the purpose of a quality or peer review to the extent
necessary to accomplish the review. A quality or peer review is a review that is undertaken to evaluate,
monitor, and improve the quality and accuracy of a tax return preparer's tax preparation, accounting, or
auditing services. A quality or peer review may be conducted only by attorneys, certified public
accountants, enrolled agents, and enrolled actuaries who are eligible to practice before the Internal Revenue
Service. Tax return information may also be disclosed to persons who provide administrative or support
services to an individual who is conducting a quality or peer review, but only to the extent necessary for
the reviewer to conduct the review. Tax return information gathered in conducting a review may be used
only for purposes of a review. No tax return information identifying a taxpayer will be disclosed in any
evaluative reports or recommendations that may be accessible to any person other than the reviewer or the
tax return preparer being reviewed. The tax return preparer being reviewed will maintain a record of the
review, including the information reviewed and the identity of the persons conducting the review. After
completion of the review, no documents containing information that may identify any taxpayer by name or
identification number may be retained by a reviewer or by the reviewer's administrative or support
personnel.
These limitations do not apply to any disclosure necessary to accomplish a conflict review. A conflict
review is a review undertaken to comply with requirements established by any federal, state, or local law,
agency, board or commission, or by a professional association ethics committee or board, to either identify,
evaluate, and monitor actual or potential legal and ethical conflicts of interest that may arise when a tax
return preparer is employed or acquired by another tax return preparer, or to identify, evaluate, and monitor
actual or potential legal and ethical conflicts of interest that may arise when a tax return preparer is
considering engaging a new client. Tax return information gathered in conducting a conflict review may be
used only for purposes of a conflict review. No tax return information identifying a taxpayer may be
disclosed in any evaluative reports or recommendations that may be accessible to any person other than
those responsible for identifying, evaluating, and monitoring legal and ethical conflicts of interest. No tax
return information identifying a taxpayer may be disclosed outside of the United States or a territory or
possession of the United States unless the disclosing and receiving tax return preparers have procedures in
place that are consistent with good business practices and designed to maintain the confidentiality of the
disclosed return information.
5
The firm is not prohibited from the disclosure of any tax return information to the proper federal, state, or
local official in order, and to the extent necessary, to inform the official of activities that may constitute, or
may have constituted, a violation of any criminal law or to assist the official in investigating or prosecuting
a violation of criminal law. A disclosure made in the bona fide but mistaken belief that the activities
constituted a violation of criminal law is not subject to the nondisclosure and non-use rules.
In the event of incapacity or death of the tax return preparer, disclosure of tax return information may be
made for the purpose of assisting the tax return preparer or his legal representative (or the representative of
a deceased tax return preparer's estate) in operating the tax return preparer’s business.
If you believe your tax return information has been disclosed or used improperly in a manner unauthorized
by law or without your permission, you may contact the Treasury Inspector General for Tax Administration
(TIGTA) by telephone at 1-800-366-4484, or by email at complaints@tigta.treas.gov.
We trust this policy is informative, and you may contact us with any questions that you may have.
Sincerely,
Martin James, CPA, PFS
Martin James, CPA, PC
Dear Client:
RE: 2016 Consent To Use of Tax Information
Federal law requires this consent form be provided to you. Unless authorized by law, we cannot disclose your tax return
information to third parties for purposes other than the preparation and filing of your tax return without your consent. If
you consent to the disclosure of your tax return information, Federal law may not protect your tax return information from
further use or distribution.
You are not required to complete this form to engage our tax return preparation services. If we obtain your signature on
this form by conditioning our tax return preparation services on your consent, your consent will not be valid. Your
consent is valid for the amount of time that you specify. If you do not specify the duration of your consent, your consent
is valid for one year from the date of signature.
For your convenience and added value Martin James, CPA, PC offers Financial, Insurance and Tax Planning Services
through Martin James Investment & Tax Management, LLC an entity owned 100% by Martin James, CPA/PC. Martin
James, CPA/PFS and Kyle James, CPA/PFS are Registered Representatives and Investment Advisor Representatives of
World Equity Group, Inc a broker/dealer that is not affiliated with Martin James, CPA/PC or Martin James Investment &
Tax Management. To determine whether these services may be of interest to you, Martin James, CPA, PC. will need to
use your tax return information.
If you would like Martin James, CPA, PC to use your tax return information to determine whether these services are
relevant to you while we are preparing your return, please check the corresponding box, provide the information requested
below, and sign and date this consent to the use of your tax return information.
I/We ___________________________ authorize Martin James, CPA, PFS to use the information I/we provide to Martin
James, CPA, PC during the preparation of my tax return for 2015 to determine whether tax, financial and investment
planning is appropriate and advisable.
Signature:_________________________________________ (taxpayer)
Signature:_________________________________________ (spouse, if applicable)
Date:_______________________
If you believe your tax return information has been disclosed or used improperly in a manner unauthorized by law or
without your permission, you may contact the Treasury Inspector General for Tax Administration (TIGTA) by telephone
at 1-800-366-4484, or by email at complaints@tigta.treas.gov.
We trust this policy is informative, and you may contact us with any questions that you may have.
Sincerely,
Martin James, CPA, PFS
Martin James, CPA, PC
1
Audit Fee Protection Program
(AFPP)
The Internal Revenue Service, the Indiana Department of Revenue and the Department of Workforce Development have
been much more active in selecting individuals and companies for exam. Technology and updated statistical information
have made our government entities much more efficient in increasing the number of tax returns that are being examined.
Exam techniques included a 1099 and K1 matching program; Exams in which you receive a letter denying your
deductions requiring you to provide support for your deductions; and actual face-to-face examinations.
The fact that you get chosen for an exam does not mean you have done anything wrong or that there was an error in the
preparation of your tax return. Exams can be the result of random chance or that your tax return contains line items or
schedules in which the government entity has determined has a high potential for non-compliance. Additionally, the
Internal Revenue Service regularly performs special project exams for certain entities, industries or items on personal
returns to establish statistical data for selecting future tax returns for exam.
Per the engagement letter for the preparation of your tax returns, our fees for representing you in an exam are not included
in the tax preparation fees. Fees for representing you will be charged at our standard hourly rates plus expenses incurred
for the exam and must be paid prior to the beginning of the exam (minimum fee schedule will apply). Depending on the
nature of the exam, these fees could be significant and well above the fees incurred for the preparation of the tax return
being examined. To alleviate the risk of incurring these fees we are offering a program that protects our clients from
additional fees resulting from representation by our firm in an exam. We refer to this program as the Audit Fee Protection
Program (AFPP). If you participate in the program, we will represent you at no charge as follows:
We will represent you in exams concerning tax returns and/or tax forms prepared by our firm, to the
extent we are allowed by our professional designations. This includes correspondence from the
Internal Revenue Service, Indiana Department of Revenue and the Department of Workforce
Development.
The Audit Fee Protection Program includes only fees incurred for our representation. You will remain responsible for any
additional tax, penalties, and/or interest that may be assessed by taxing authorities. Additionally, you will be responsible
for any fees resulting from other professionals involved in your exam, which may include, but not limited to attorneys,
appraisers and expert witnesses. If at anytime any fraud or criminal investigation begins, we may withdraw from the
engagement and a recommendation to an attorney specializing in such matters will be made.
Participation in the AFPP is optional. If you elect to participate in the program you agree to cooperate with our staff by
providing all necessary documentation and source documents requested within 30-days of such request. You agree to sign
all forms necessary to allow us to properly represent you.
Martin James, CPA/PFS
Martin James CPA, PC/Martin James, Investment and Tax Management, LLC
2
Audit Fee Protection Program
Fee Schedule
To participate in the program, indicate by checking the appropriate box and signing below.
Fees are as follows:
Annual Audit Fee Protection Program:
Individual $55
Individuals with (Schedules C, E and F) $105
Individuals with multiple securities sales on Schedule D $75
Corporations & Partnerships $165
Trusts and Estate 1041 $85
Estate 706 $300
Gift 709 $75
Minimum Fee Schedule Without Audit Fee Protection Program
Individual Audits
$425
Corporation & Partnership Audits
$875
Estates 706
$1,250
Correspondence
$200
Please check:
_______ YES, I wish to participate in the Audit Fee Protection Program and acknowledge that I will be billed annually
for the protection unless I inform you that I do not wish to participate.
________ NO, I do not wish to participate in the Audit Fee Protection Program and acknowledge that I will be billed at
least the minimum fee per occurrence without Audit Protection.
_______________________________ _____________
Printed Date
_______________________________
Signed
_______________________________ ______________
Printed Date
________________________________
Signed
Bank Account Verification
For Direct Deposit
If you would like to receive a refund via direct deposit into your bank account, per IRS Security
Summit requirements, complete the name of the financial institution, routing transit number,
account number, and type of account below. Sign and date at the bottom to indicate that the
account listed is correct and return to our office.
Name of Financial Institution:
Routing Transit Number:
Account Number:
Type of Account: Checking: Savings:
Joint Account? Yes: No:
ATTACH VOIDED CHECK HERE:
VOIDED CHECK
__________________________________ _________________
Taxpayer Signature Date
__________________________________
Taxpayer Printed
__________________________________ __________________
Spouse Signature Date
__________________________________
Spouse Printed
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- 2016 Individual Cover Letter - Copy

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Completed 14 May 2021

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