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2017 Tax Questionnaire – Individual 1040

Thank you for completing this questionnaire completely and accurately. This is a very important step in analyzing your tax position for the year. By doing so, you provide us with critical information to maximize your deductions. We recommend that you review last years tax return to ensure you are providing us with complete information and have not missed items that were included on prior year returns. You can access your prior years’ tax returns and last years questionnaire through the secure client portal.

Name/Names:

Address:

Is this a new address? � Yes � No

- Email: Self Telephone Number:

Spouse Telephone Number: - Email:

Person to Contact for Questions: NAME: Phone OR Email:

If completing this form by hand, must complete using black or blue ink only – NO RED INK OR PENCIL. Additional information is required in questions with an asterisk, space is provided on the last page of the questionnaire. Documentation or details must be provided in order for us to begin preparing your return.

General Information: YES NO Attachments

CPA Initial

1. Do you want Federal and/or State refunds direct deposited into a bank account? If yes, mustprovide a voided check or provide us with the routing and account numbers: Routing #: _____________________________ Account #: __________________________Institution: ___________________________ Type of Account: ______________________If you are filing your return Married Filing Jointly, is the above account a joint account?(Some financial institutions will not allow the deposit unless it is a joint account.)

2. Do you want federal and/or state amounts owed taken directly out of the account above?3. Are you legally married? 3a If yes, did you live with your spouse for the last 6 months of 2017? 4. Has your marital status changed since your last return? 5. Did anyone help support you or your household, or claim you as a dependent? 6. Are you or your spouse legally blind? 7. Are you and your spouse (if applicable) United States Citizens? If no, provide details.*8. Do you want to designate $3.00 to the presidential election campaign fund? (This will not

increase your tax liability or reduce your refund amount.) Self? Or, if married: Husband?

Wife? 9. Have you or your dependents had problems with identity theft that the IRS is aware of?

If yes, provide the ID Protection PIN assigned to you by the IRS and provide details.*10. Have you had potential identity theft problems that the IRS is not yet aware of? (The IRS can

be made aware that the account is possibly at risk, to safeguard a potential refund. We canprovide you with information on how to do this.)

11. May the Internal Revenue Service discuss questions about your return with us?12. Must list the occupation for self: ___________________________________ Or if married:

Husband: _________________________________________________________________Wife:______________________________________________________________________

13. For verification purposes required by Illinois, please provide your Illinois license numbers for: Self_________________Or, if married: Husband ________________ Wife_________________

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Dependent Information: YES NO Attachments

CPA Initial

14. Were there any changes in dependents from the prior year? If yes, provide details.*14a. Did you provide over half the support for any children under age 19 on December 31, 2017?

If yes, must list name(s): __________________________________________________________________________

15. Did you provide over half of the support for any children under age 24 on December 31, 2017who were full time students for a portion of at least five months of the year? If yes, must listname(s):__________________________________________________________________________(Must see questions in separate Education Section)

15a. If divorced or separated, did the student live with you when not away at school? 15b. Do you have dependents who must file a tax return? If yes, it may make sense to wait to file

the dependents’ return(s) until your return has been completed. Discuss with us. 16. Did you provide over half of the support for a permanently and totally disabled child over 18,

not included in line 15 above? List name(s): ____________________________________17. Are there any legal matters relating to claiming an exemption? For example, divorced

or unwed parents. If yes, must provide details.* (If no, skip to question 18)17a. If you are divorced or separated with child(ren), do you have a divorce decree or other form

of separation agreement which establishes who may claim the dependency exemption? If yes, must provide.*

17b. Were you the custodial parent (the child spent more nights with you than your ex-spouse)? 17c. If you were divorced in 2009 or later, and you are a non-custodial parent claiming a

dependent, do you have a Form 8332 signed by your ex-spouse? Must provide a copy of the form.*

18. Did you provide over half of the support for any person other than a child?List name(s): ________________________________________________________________

19. Did you pay to provide a home (separate from your own) for a related person? If yes, mustprovide details.*

20. Do you have any children 18 or younger at 12/31/17 with unearned income above $1,050such as dividends, interest, or stock sales?

21. Do you have any children older than 18 but younger than 24 at 12/31/17, who were full-timestudents during a portion of five months of the year with unearned income such as dividends,interest, or stock sales above $2,100? If yes, must provide details.*

Income: YES NO Attachments

CPA Initial

22. Number of employment W-2s for: Self: _____ Or if married, husband: _____ wife: _ ___Must provide all W-2s.*

23. Did you retire or change jobs in 2017?24. Did you receive dividends or interest? Must provide all 1099-INT, 1099-DIV and 1099-OID

forms.*25. Did you receive any pension, profit sharing, 401K, IRA, Roth, Keogh, Simple, SEP or other

retirement plan distributions or withdrawals?Number of 1099R Forms for: Self: _____ Or if married, husband: _____ wife: _____Must provide all 1099-R forms and details of any rollovers, including traditional to Rothrollovers.*

26. Did you inherit any IRA’s including Roth IRA’s? If yes, must provide details.*27. Did you receive Social Security or Railroad Retirement Benefits? If yes, must provide all SSA-

1099 or RRB-1099 forms.*28. Did you receive a state income tax refund? If we did not prepare your return, must provide

all 1099-G forms received or dollar amount of refunds.* (Note: States may not be sendingforms.)

29. Did you receive any tips or gratuities not reported on your W-2 form? If yes, must providedetails.*

30. Did you receive any unemployment benefits? Must provide 1099-G form.*

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Income Cont’d: YES NO Attachments

CPA Initial

31. Did you receive any taxable disability income not included on your W-2? If yes, must providedetails.*

32. Did you receive worker’s compensation? If yes, must provide details.*33. Did you have sales or redemptions of: Stock?

Mutual Funds? Other investments?

If yes, must provide Form 1099-B and/or other documents including basis.* (Note: many of these forms are not required to be issued until 2/15/18.)

34. Did you sell your primary residence? If yes, must provide the closing statement for the saleof the property and the closing statement from the property’s original purchase (orprovide cost of property information).* If no skip to question 35.

34a. Did you receive a Form 1099-S for the sale? If yes, must provide.* 34b. Was the home or a portion of it ever used for business or rental purposes? If yes, must

provide details.* 34c. If the property was sold at a gain: did you (and your spouse, if married) own and use the

home as a principal residence for at least two out of the five years prior to the sale? (The two years do not need to be consecutive.)

34d. There are exceptions for divorce and new marriages. Has there been a divorce or new marriage in the last five years? If yes, must provide details.*

34e. Have you sold another principal residence within two years of the sale of this residence? If yes, must provide details.*

35. Did you sell real estate, other than a principal residence? If yes, must provide closingstatement and explain use/type of real estate.*

36. Did you receive any income from property sold prior to this year? If yes, must providedetails.*

37. Did you cash any Series EE or I U.S. Savings Bonds? If no, skip to question 38.37a. If issued after 1989, were the proceeds used to pay education expenses? 37b. If issued after 1989, were the proceeds used to fund a 529 education savings account? 38. Were you granted or did you exercise any stock options or restricted stock? If yes, must

provide details.*38a. Did you sell the granted or exercised stock options or restricted stock in 2017? If yes, must

provide details.* 39. Did you sell any inherited assets in 2017? If yes, must provide details.*40. Did you receive alimony (not child support)? If yes, must provide details.*41. Did you receive any income from self-employment or hobbies, other than from an S-

Corporation, 2 or more Member LLC, or Partnership? Must complete the fillable Self-Employment Income Questionnaire available at www.cfcpas.com/client-forms .*

42. Did you receive a 1099-MISC form? If yes, must provide.*43. Did you have any rental income or own rental property? Must complete the fillable Rental

Income Worksheet available at www.cfcpas.com/client-forms .*44. Did you acquire a new interest in a business, Partnership, S Corporation, or rental property in

2017? If yes, must provide details.*45. Did you receive or do you anticipate receiving any K-1s?

List: ___ ________ ___ _____ _ ___ _____ _ If additional, must provide details.*

45a. If for a business, did you materially participate in the business? If you are not sure, ask us for criteria to determine if you materially participated.

46. Did any of your life insurance policies mature or did you surrender/sell any policies?47. Did you engage in any bartering transactions? If yes, must provide details.*48. Did you receive any bonuses, prizes, or awards not reported on your W-2 forms? If yes, must

provide details.*49. Did you receive any commissions or fees not given to us with self-employment income? If yes,

must provide details.*

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Income Cont’d: YES NO Attachments

CPA Initial

50. Did you have any gambling winnings? If yes, must provide details.*50a. Did you have gambling expenses? (May only be deducted up to the amount of winnings.)

If yes, must provide details.* 51. Did you have any lottery winnings? If yes, must provide details.*52. Did you have any jury duty pay? If yes, must provide details.*53. Did you have any election board fees? If yes, must provide details.*54. Have you provided us with information on all of your income? If no, must provide details.*

Foreign Income: YES NO Attachments

CPA Initial

55. Were you or your dependents a grantor of, transferor to, or receiver of a distribution from aforeign trust? If yes, must provide details about the trust, your interest in it and the accountsowned by the trust.*

56. At any time during 2017, did you or your dependents have a financial interest in, signature,control, or other authority over a bank account, securities account, retirement account orother financial account located in a foreign country? If yes, must provide details.*

57. Did you or any of your dependents have any foreign financial assets (bank accounts or assetsnot held at a financial institution including securities, contracts or an interest in a foreignentity) at any point during the year? If yes, must provide details.*

58. Did you or any of your dependents receive any gifts or bequests from foreign persons ortrusts? If yes, must provide details.*

59. At any time during the year, did you own more than 50% of an entity (U.S. or foreign) thatowned any type of account that was located outside the U.S.? If so, provide details about the entity and who owns it.*

60. At any time during the year, was your name on an account located outside the U.S. that heldmoney belonging to another family member or person? If yes, must provide details.*

61. During the year, did you or your dependents inherit any accounts or other assets that were, atthe time of inheritance, located outside the U.S.? If yes, provide details about the account(s) or asset(s).*

62. Did you have any foreign income or pay foreign taxes in 2017, other than in a US brokerageaccount reported on1099 or K-1 forms? If yes, must provide details.*

63. Do you have any assets or investments located in a foreign country? If yes, must provide details.*

64. Were you a resident of or did you have income from more than one state or country during2017?If yes, must provide dates of residency for each.*

65. Have you filed any form(s) such as FinCEN Form 114, TD F 90-22.1, Form 8938 or other form,in previous year(s) to disclose foreign assets? If yes, what form(s) did you file?*

Adjustment to Income: YES NO Attach ments

CPA Initial

66. Did you pay alimony per a divorce decree (not child support)? If yes, must provide name,amount, and social security number of payee.* If no skip to question 67.

66a. If yes, did your ex-spouse live with you during any portion of the year? 67. Did you make contributions to any of the following retirement plans in 2017 other than

pre-tax through your employer? If no skip to question 68.67a. A 401(k) through your employer? If yes, amounts are included on your W-2s, no further

info needed. 67b. A traditional IRA? If yes, indicate amounts: Self $ or Husband $__ ______

Wife $__ _______ 67c. A Roth IRA? If yes, indicate amounts: Self $ or Husband $__ _______

Wife $__ _ _____67d. Another retirement plan? If yes, name of plan? ___________________________________

Indicate amounts: Self $ or Husband $__ _ ____ Wife $__ _ ____

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Adjustment to Income Cont’d: YES NO Attach ments

CPA Initial

68. Other than through a flexible spending account, did you make any contributions to a: Health Savings Account (HSA)?

or Archer MSA? Amount of Contribution $ _ _____ ____ If no skip to question 69.

68a. Was the contribution made… pretax? OR … after-tax?

68b. Were you covered by an HSA-Qualified High Deductible Health Plan? 68c. Was the contribution for … self-only coverage?

OR … family coverage? 68d. Number of months you were in high deductible plan in 2017. Months: _ _ ___ 69. Other than through a flexible spending account, did you receive any distributions from a

Health savings account (HSA), Archer MSA, or Medicare Advantage MSA this year? If yes, must provide all 1099SA Forms.*

69a. Were all distributions from Health Savings Account (HSA), Archer MSA, or Medicare Advantage MSA used to pay unreimbursed qualified medical expenses?

70. Did you make contributions to an ABLE (Achieving Better Life Experience) account?If yes, must attach Form(s) 1099-QA.*

71. Did you receive withdrawals from ABLE (Achieve Better Life Experience) account?If yes, must attach Form(s) 1099-QA.*

72. Were you a K-12 educator working over 900 hours with unreimbursed teaching supplyexpenses? If yes must provide the unreimbursed amount $_____________

73. Did you move over 50 miles due to a job change?

Medical Expenses and Charitable Donations: YES NO Attachments

CPA Initial

74. Medical expenses are deductible if they exceed 7.5% of adjusted gross income. This includes after tax payments for health care and long-term care premiums. Do you believe you qualify for the deduction? If yes, must complete the fillable Medical Expense pdf form available at www.cfcpas.com/client-forms .* Included on the form are possible deductible items.

75. Did you make any monetary or nonmonetary charitable donations? If yes, must complete the Charitable Donations form available at www.cfcpas.com/client-forms .* Included on the form are requirements to be aware of for different levels of donations. If no skip to question 76.

75a. If you made a single donation(s) of $250 or more, do you have written acknowledgement(s) from the qualified organization(s) that indicates the donee’s name, date of the contribution, and amount contributed or description of any noncash property contributed, and a statement whether the donee provided you with any goods or services in exchange for the donation?

75b. Do any of the acknowledgements indicate that you received goods or services in exchange for your donation? If yes, must provide the acknowledgement letter.*

Tax Expenses: YES NO Attachments

CPA Initial

76. Did you make any federal estimated tax payments or an extension payment for 2017 (otherthan through withholding)? If yes, must provide dates and amounts of payments.*

77. Did you make any state estimated tax payments or an extension payment for 2017 (other thanthrough withholding)? If yes, must provide dates and amounts of payments.*

78. Did you make a state payment with your 2016 state tax return? If we did not prepare yourreturn last year, must provide this information.*

79. Did you pay sales tax on a motor vehicle, boat, airplane, or major home renovation? If yes,must provide ST-556 or other documentation from the dealer.*

80. Did you pay real estate taxes? If yes, must provide copies of the statements. If you have more than one home, provide us with a list of addresses and taxes related to each address.*

81. Do you live outside of Illinois and pay personal property taxes? If yes, must provide details.*82. Did you pay principal or interest on a special assessment? If yes, must provide details.*

83. Did you prepay any 2017 property taxes that are due in 2018? If yes must provide details*

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Interest Expense: YES NO Attachments

CPA Initial

84. Did you pay home mortgage interest? If yes, must provide 1098 form and loan balance.*85. Did you pay interest on a second mortgage or home equity line? If yes, must provide Form

1098, loan balance and information regarding the use of the funds.*86. Did you pay points on a new loan or have points amortized from a previous tax year?

If yes, must provide details.*87. Did you pay interest on a boat, mobile home, or house trailer with sleeping, cooking, and toilet

facilities? If yes, must provide details.*88. Did you pay mortgage insurance premiums (PMI), (not homeowner’s insurance)?

If yes, must provide details.*89. Did you pay investment interest on a margin account or to an investment broker?

If yes, must provide details.*

Miscellaneous Itemized Deductions: YES NO Attachments

CPA Initial

90. Did you have a loss from a flood, fire, theft, storm, or accident? Generally, this is deductible ifunreimbursed amounts exceed 10% of your adjusted gross income. If yes, must providedetails.*

91. Did you have unreimbursed employee expenses, such as union dues $__ _, tools $__ __,supplies $__ __, special uniforms $__ __, safety equipment $_ _ __, professional dues $__ _, subscriptions $__ _ _, job-related education $__ __, orunreimbursed business supplies $__ _? You must have documentation to support these amounts. The documentation should be saved by you; it does not need to be provided to us.

92. Did you have business miles or car expenses that were NOT reimbursed by your employer?You must have a log that includes mileage by date, destination and business purpose of trip.The documentation should be saved by you; it does not need to be provided to us.

93. In the calendar year 2017, did you pay for preparation of your 2016 tax return? If we did not prepare must provide the amount paid. $_______________

94. Did you have any expenses for a safe deposit box? Amount paid: $________________95. Did you have any expenses for investor advisement fees in a taxable account? If not on

statements already given, provide amount. $_________________96. Did you have job search costs? If yes, ask about deductibility of these costs.97. If you are a W-2 employee do you use a portion of your home for regular and exclusive

business use? (Note: There is a simplified option available for claiming the homeoffice deduction.) If no skip to question 98.

97a. If yes, does the employer provide office space? Discuss this with us.

Education: YES NO Attachments

CPA Initial

98. Did you or your dependent pay expenses for yourself, spouse, or dependent to attend classesbeyond high school? If yes, must attach 1098T form and itemized billing history from the school showing all payments.* If new client, must provide 1098T statements from prioryears, if any.* If answered no to this question, skip to question 106.

99. Is student enrolled in a degree program? 100. Were any amounts being showed as paid on the 1098T refunded in 2018? 101. Does the student have a felony drug conviction record?102. Did you pay any expenses for books or education related fees for student’s higher education? 103. Did the student or anyone in the family receive a scholarship of any type in 2017? 103a Was the scholarship received from other than the college attended? 103b Who received the scholarship? ____ _ 103c Was the scholarship used for anything other than tuition or books? 104. Did you pay student loan interest for yourself, spouse, or dependent? 104a Were you legally obligated to pay the interest? 105. Did you pay over $250 in tuition and book fees for your grade K-12 aged children in IL?

If yes, must provide student name, school, grade, and amount.*

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Education Cont’d: YES NO Attachments

CPA Initial

106. Did you make any contributions to an education savings, Coverdell, or 529 Plan? If yes, must provide 1099Q form or information.*

107. Did you make any withdrawals from an education savings, Coverdell, or 529 Plan? If yes, must provide 1099Q form or information.* If no, skip to question 108.

107a If yes, were all the funds used for education?

Credits: YES NO Attachments

CPA Initial

108. Did you pay for child care while you worked, looked for work, or were a full-time student? If yes, must provide name of provider, address, SSN or employer ID and amount paid.*

109. Did you pay any expenses related to the adoption of a child during 2017? 110. Did you purchase a qualified plug-in electric drive vehicle or qualified fuel cell vehicle in 2017?

If yes must provide purchase documentation.* 111. Did you make energy-efficient improvements to your home?

If yes, must provide details of improvement and provide manufacturer’s certificate.* 112. Did you sell stock options that were exercised in 2016? If yes, must provide details regarding

the sale of stock options.* 113. Have you obtained a mortgage interest certificate issued by the state or local government?

If yes must provide a copy of the mortgage interest certificate.*

Health Insurance Coverage **“YOUR FAMILY” for health care coverage, refers to you, your spouse if filing jointly, and

anyone you can claim as a dependent. YES NO Attachments

CPA Initial

114. Did you enroll for lower cost Marketplace Coverage through healthcare.gov under the Affordable Care Act? If yes, must provide Form 1095-A.*

114a If yes, was every member of “YOUR FAMILY” covered for every month of 2017? 114b If no to 114a, must provide list of family members and months without coverage.* 115. Did you enroll for lower cost Marketplace Coverage through healthcare.gov under the

Affordable Care Act and share a policy with anyone who is not included in “YOUR FAMILY”? 116. Did you have qualifying health care coverage, such as employer-sponsored coverage or

government-sponsored coverage (ex. Medicare/Medicaid) in 2017 for “YOUR FAMILY”? If yes, must provide Form 1095B or 1095C.*

116a If yes to 116, was every member of “YOUR FAMILY” covered for every month of 2017? 116b If no to 116a, must provide a list of family members and months without coverage.* 117. Did anyone in your family qualify for an exemption from the health care coverage mandate?

If yes, must provide a copy of the exemption certificate or type of exemption.*

Miscellaneous Information: YES NO Attachments

CPA Initial

118. In 2017, did you purchase a: new principal residence? second home? other real estate?

119. Did you have debts cancelled or forgiven, go through foreclosure or abandon a home or real estate, or go through personal bankruptcy proceedings? If yes, must provide details.*

120. If you are an Illinois resident, did you make purchases out of state, over the internet by telephone, mail or in person of items to be used or consumed in Illinois and pay less than 6.25% tax for general merchandise or 1% for food or prescription/nonprescription drugs?

121. If you are a resident of a state other than IL, did you make purchases that you did not pay tax on?

122. If you or your spouse is over the age of 70.5, are you taking required minimum distributions from all retirement accounts? (This includes: traditional IRA plans, past employer retirement plans, profit sharing plans, and current employer plans if greater than a 5% owner of the company.)

123. Did you pay an individual for domestic services? (Ex. cleaning person, yard/snow service, pet sit...) If yes, must provide details.*

124. Did you incur any non-business bad debts in 2017? If yes, must provide details.*

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Miscellaneous Information Cont’d: YES NO Attachments

CPA Initial

125. Have you received any correspondence from the IRS or state taxing authorities, other than a 1099 for a state refund? If yes, must provide copies.*

126. In 2017, did you make gifts to any one person or entity totaling more than $14,000? If yes, must provide details.*

127. Do you expect a large fluctuation in your income, deductions, or withholding next year? If yes, must provide details.*

127a Would you like tax projections for next year? 128. Do you have a will or trust? 128a If yes, has it been updated within the last 3 years? 128b If you have a trust, did you title all assets in the name of the trust? 129. Have you updated beneficiaries in all estate and legal documents, insurance policies,

retirement plans, etc.? 130. If eligible, are you interested in learning the potential tax savings for 2017 for making a

traditional Individual Retirement Account (IRA) contribution by April 18, 2018?

Printed Name: Signature: Date:

If you used the fillable version of this form just save it to your desktop before filling it out and again after completing it, then upload to your portal. This form and all others forms and documents may be scanned and uploaded to your secure portal. They will be saved there for your convenience. Do not email any information that contains social security numbers or other sensitive information. Must drop off the documents, mail with a tracking option or use your secure portal.

If you answered yes to any of the questions above that all documentation or details (in the order they are listed on this questionnaire) must be provided to us before the preparation of your return will begin. Question # Details or Additional Documentation Sent

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Notes:

TO UPLOAD YOUR DOCUMENTS TO YOUR SECURE PORTAL 1. Go to www.cfcpas.com and login through our Client Center using the login credential established for you. (Reminder: Your

username should be your email address. If you are unable to recall your password, please click on the “forgot password’ link).

2. Once logged in, click on FILE EXCHANGE on the left side of the screen. 3. Then click on DOCUMENT EXCHANGE.

4. Click on the Upload icon .

5. Click on Add Files. Browse to the file you would like to share, select open, and click Start Upload.

Please let us know if you have any questions.