2
A. INCOME SOURCES
Yes No Please Answer All Questions Amount
Did you receive any unemployment during 2018?
If yes, please provide Form 1099 G.
$
Did you receive a K-1 from any entities–Corporation,
Estate, Trust, Partnership, etc.? If yes, enclose.
$
Did you receive any Social Security during 2018?
(Enclose SSA - 1099)
$
Yes No Please Answer All Questions Amount
Gambling losses may only be used to offset winnings. Losses greater than winnings are
not deductible. You need to have documentation of your gambling losses.
Note: Provide Forms W-2G reporting state where winnings were paid.
Did you have any gambling winnings in 2018?
$
Did you have any gambling losses in 2018?
$
Did you receive any type of additional income during 2018? (jury duty pay, training stipends, duty free commissions,
taxable prizes, trustee fees, etc.) Specify type of income and provide amount. Provide 1099-MISC if applicable.
Taxpayer
$
Spouse
$
1099 Misc.—income should be reported in Small Business/Self Employment Section.
STATE RESIDENCY INFORMATION FOR 2018
All clients complete this section, even if you only lived in one state or lived in a state with no income tax.
If you paid taxes to more than one state, you may receive a separate W-2 for each state. We must have ALL of these W-2’s.
State Own Rent Other Date Moved In Date Moved Out Still a Resident? County School District
Yes No
Yes No
Yes No
If you are required to file a state return and DO NOT want Flightax to prepare your state return for you, initial here.
(Remember, you should not file your state return before you file your federal return.)
DO NOT
File my State
Initial
Here
B. ESTIMATED TAX PAYMENTS
The quarterly payments made to the IRS and/or your state. These payments are usually for tax on self-employment/investment income.
Federal Amount Date of Payment State Amount Date of Payment Local Amount Date of Payment
$ $ $
$ $ $
$ $ $
$ $ $
IMPORTANT QUESTIONS
FOREIGN ACCOUNTS
Yes No Please Answer All Questions Amount
Did you make any out of state purchases without paying
sales tax that you need to claim on your state return?
$
Do you have any children under age 24 with investment income
over $2,100? If yes, please provide 1099 statements.
Did you adopt a child during 2018? If yes, contact us for additional information.
Do you owe any back taxes to the IRS or your state?
Do you have any delinquent student loans or owe back child support?
Did the IRS garnish your refund last year?
Did you have any debts cancelled or forgiven? If yes, provide explanation
in Comments on pg. 10. Provide Form 1099-A and/or 1099-C.
Do you agree to allow Flightax to discuss this return with
the IRS should questions arise?
What is your maiden name or previous married name?
NEW CLIENTS ONLY
Yes No New Clients Please Answer All Questions Amount
Did Flightax prepare your 2017 tax return?
Did you receive a federal refund last year?
If yes, amount?
$
Did you receive a state and/or local tax
refund last year? If yes, amount?
$
Did you pay additional tax when you filed your state
or local tax return last year? If yes, amount?
$
Did you itemize your deductions for 2017?
Did you take a distribution from a retirement plan
(401K, IRA, SEP, Roth) during 2016 or 2017?
Have you been (or are you being) audited for 2016 or 2017?
Did you claim a Net Operating Loss (NOL) or carry over loss in 2017?
Who referred you to Flightax?
Yes No Please Answer All Questions
At any time during 2018, did you have a financial interest in, or a
signature authority over a financial account located in a foreign country?
(Foreign Bank, Securities or other financial account)
If you live in the U.S. and the balance of your foreign account(s) exceeds $50,000
for Single/MFS or $100,000 for Joint filers on the last day of the year OR the
balance exceeds $100,000/$150,000 at any point during the year, you are
required to file form 8938 with your tax return. Taxpayers living outside of the
U.S. have higher thresholds and are only required to file the form if the foreign
account(s) balance exceeds $200,000 for Single/MFS or $400,000 for Joint filers on
the last day of the year OR exceeds $300,000/$600,000 at any point during the
year. If you are required to file form 8938, please visit our website and download
the Foreign Accounts Worksheet.
Did the combined value of these accounts exceed $10,000 at any time
during 2018? If yes, provide the Country(ies) as these must be
reported on your tax return.
Additionally, you are required to submit an FBAR–FinCEN Report
114 electronically via the BSA E-Filing System; a link is available on
our website. Must be filed by April 15, 2019.