NEW Interview Document 2013

8/12/2019 NEW Interview Document 2013

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PERSONAL DOCUMENTS

INCOME DOCUMENTS

Previous year's tax return

W-2s

1099-Misc

1099-SSA (Social Security statement)

1099-DIV and 1099-INT (Dividend and interest statements)

Alimony received

1099-R (Retirement distribution)

1099-B (Brokerage statement) (Download Stock details in an xls/csv format)

Income and expenses for your rental properties

K-1 statements reporting earnings from small business, partnerships and trusts.

DEDUCTION DOCUMENTS

Real estate/property taxes

1098 (Mortgage Interest Paid)Child/Depdendent Care expenses (SSN/Tax ID required)

Charitable donations greater than $ 250

IRA contributions/Distrubutions (Traditional/Roth)

1098-E (interest on your student loan)

Residents of MA - 1099HC

Purchase of new automobile

Purchase of new home

Residential Improvements

1098-T (Tuition fees)

ITIN PREPARATION

Passport, Visa page

Documents Requir


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Previous year Tax return (Fed, State & City)

Attached

IRS Notices (if any)

1099 received, and details of other income

Asset Sale - Dates, Value & purchase info

Rental Property statements

Share purchase & Sold details

Dividend Statements

Quickbooks file

Last Bank Statement & ReconciliationLoans owed Statement

Salary register

Quarterly & Annual Payroll filings

Fixed Asset Register

R. Ashok KumarSr. Tax Associate Cynergytax.comUS Number:+1 201.510.0123 EXT-9025Indian Numb

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BUSINESS DOCUMENTS

REQUIRED

REQUIRED, IF

APPLICABLE

OPTIONAL

d


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er: +91 406.464.8160/61Timings: 8.30 AM to 07.30 PM CST E-mail: [email protected]: ww


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.cynergytax.com


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Software Services

IT Consulting

Retail

Finance

Construction

Food Service

Health Care

Insurance

Real Estate

Rental & Leasing

Transportation

Hotel

Non Profit Organisation

Religious Organisation

Chamber of Commerce

Services


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Personal Information

First Name(As on SSN Card)

Middle Name

Last Name

Gender

Date of Birth

Occupation

TYPE OF U.S VISA

CLIENT ID

MARRITAL STATUS

Contact Information Home

Address (Number, Street and Apt, or Suite No.)

City

State

County

Zip / Postal Code

Country

E-mail Address

Phone Number (LandLine)

Phone Number (Mobile)

Fax number

Family Information(insert additional columns if required) Spouse

First Name(As on SSN Card)

Middle NameLast Name

Gender

Relationship

Date of Birth

TYPE OF U.S VISA

Occupation

Social Security Number(SSN) or ITIN

Number of months stayed with you in the United States

Child/Dependent Care expenses.

Blind/Age 65 or greater No

INFORMATION ONLY IF WE APPLYING FOR ITIN

ITIN HELP NO

Passport Number

Passport Expiration date

City and State of Birth

Date Entered into US

Visa Number

Visa Expiry date

PERSONAL & FAMILY INFO


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Foreign Tax ID (PAN for Indians), if any

Previously received a US Temporary TIN/EIN No

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MANDATORY:

FIRST DAY IN US

TYPE OF VISA AT THE TIME OF FIRST

ENTRY

Office

Child/DEPNDENT Child/DEPNDENT Child/DEPNDENT

No No No


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No No No

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son

Daughter

Father

Mother

Grandparent

Brother

Sister

Aunt

UncleNewphew

Neice

Other


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CYN10A

CYN10B

CYN10C

CYN10D

CYN11A

CYN11B

CYN11C

CYN11D

CYN12A

CYN12B us citizen

CYN12C B1

CYN12D B2

CYN13A F1

CYN13B F2

CYN13C J1

CYN13D J2

H1

H1-B

H4

L1

Child/DEPNDENT Child/DEPNDENT

No No 2

3

4

5

6

7

8

9

10


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YES 11

No No NO 12


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Male

Female


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Year Trip From Date To Date Days Total Days

1 0

2 0

3 0

1 02 0

3 0

1 0

2 0

3 0

N/R

7/3/2014

State Name City/county start date end date

If you reside in multiple states

State Name City/county Start date End date

Did you change your residence during this year?

If YES change is due to employment, transfer, or self-employment?

Number of miles from your former residence to your new business location:

Number of miles from your former residence to your former business location:

Did your employer reimburse or pay directly any of your moving expenses?

Reimbursement amount received

Transportation expenses in moving household goods and family

Cost of storing and insuring household goods

State Residence of Tax Payer

TAX PAYER

MOVING EXPENSES IF ANY

FYCT MEETS ON

First port of entry

2013

2012

2011

0

0

0

RESIDENCY STATUS

State you reside for tax year 2013


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CA TO NJ

NJ TO IN

YES

NO

Alabama

Alaska

American Samoa

Arizona

Arkansas

California

Colorado

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Connecticut

Delaware

Dist. of

Columbia

Florida

Georgia

Guam

Hawaii

Idaho

Illinois

Indiana

Iowa

Kansas

Kentucky

Louisiana

MaineMaryland

Marshall

Islands

Massachusetts

Michigan


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Micronesi

a

Minnesota

Mississippi

Missouri

Montana

Nebraska

Nevada

New Hampshire

New JerseyNew Mexico

New York

North Carolina

North Dakota

Northern

Marianas

Ohio

OklahomaOregon

Palau

Pennsylvania

Puerto Rico


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Rhode Island

South Carolina

South Dakota

Tennessee

Texas

Utah

VermontVirginia

Virgin

Islands

Washington

West Virginia

Wisconsin

Wyoming


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Year Trip From Date To Date Days

1 0

183 2 0

3 0

0 1 0183 2 0

3 0

1 0

2 0

0 3 0

State Name City/county start date end date

If you reside in multiple states

State Name City/county Start date End date

State Residence of SPOUSE IF WORKING

State you reside for tax year 2013

2012

2011

2013

Cost of storing and insuring household goods

Did your employer reimburse or pay directly any of your moving expenses?

SPOUSE

MOVING EXPENSES IF ANY

First port of entry RESIDENCY STATUS

FYCT MEETS ON

Reimbursement amount received

Transportation expenses in moving household goods and family

Did you change your residence during this year?

If YES change is due to employment, transfer, or self-employment?

Number of miles from your former residence to your new business location:

Number of miles from your former residence to your former business location:


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YES

NO

Alabama

Alaska

American Samoa

Arizona

Arkansas

California

Colorado


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Connecticut

Delaware

D

i

s

t

.

o

f

C

o

l

u

m

b

i

a

Florida

Georgia

Guam

Hawaii

Idaho

Illinois

Indiana

Iowa

Kansas

Kentucky

Louisiana

MaineMaryland

M

a

r

s

h

a

ll

I

s

l

a

n

d

s

Massachusetts

Michigan


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M

i

c

r

o

n

e

s

i

a

Minnesota

Mississippi

Missouri

Montana

Nebraska

Nevada

New Hampshire

New JerseyNew Mexico

New York

North Carolina

North Dakota

N

o

r

t

h

e

rn

M

a

r

i

a

n

a

s

Ohio

OklahomaOregon

P

a

l

a

u

Pennsylvania

Puerto Rico


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Rhode Island

South Carolina

South Dakota

Tennessee

Texas

Utah

VermontVirginia

V

i

r

g

i

n

I

s

l

an

d

s

Washington

West Virginia

Wisconsin

Wyoming


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Total Days

1/1/2014

7/1/2014

181.5

183

1.5

N/R

7/1/2014

1

0.333333333

0.166666667


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T

No TYPE OF VISA

2013 2012

NON RESIDENT

Passport Number

What Country issued passport

Citizen of which country during the year

State :

City :

Zipcode :

Of what country were you a Citizen or

In what country did you claim residence for

Have you ever changed your visa type ?

Have you ever applied for green card?

Permanent Residency Address

Country :

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Did you file US Income tax return for any

prior year:

Number of days you stay in US for each year

Name & Telephone number of university director

Type of tax return you field

Date you enter in to US

Name and address of the academic institution you

attend during the year

FOR F,J,M and Q VISA HOLDERS


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Yes

No

2011

1040 NR

1040 EZ F1

F2

J1

J2

H1

H1-B

H4

L1

L2

TN


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PROJECT/ASSIGNMENT INFO Project/Assignment 1

Work location EMPLOYER

Employer Name

Project Name / Client name*

Work Location of the Project - City/County, State *

Project Start Date

Project End Date

Number of Months

City and State you Reside *

EXPENSES "PAID" PER MONTH Project/Assignment 1

Apartment Rent *

Cell Phone

InternetLaundry expenses

Parking fees

Others, if any (describe)

Any Amounts reimbursed by Employer:

TYPE OF CAR

Daily Commuting MILES ( To and From, Round trip)

Car model

car purchase dateTotal Miles travel in Year by car

EXPENSES PAID FOR THE ENTIRE

ASSIGNMENTProject/Assignment 1

Books purchased

Education expenses that improves or maintains your

skills

Job Hunting / employment agency expenses/Resume

preparation

Job related TrainingLease breakage due to Project cancelation

Subscriptions to journals required for work /

Technical periodicals

Transportation cost to attend job interviews

Uniform/work clothes required for work expenses


MODE OF COMMU

T.P 21


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PERSONAL ASSETS USED FOR WORK Date Purchased

Laptop

Desktop computer

Printers

Scanners

Other asset

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YESNO

CLIENT

EMPLOYER


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Project/Assignment 2 Project/Assignment 3

NOTE:-


OWN CAR

RENTAL CAR

SHARING

BUS

TRAINWALK


-

ING

6(EBE)


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Cost of the Asset Business use in %

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PROJECT/ASSIGNMENT INFO Project/Assignment 1

Work location

Employer Name

Project Name / Client name *

Work Location of the Project - City/County, State *Project Start Date

Project End Date

Number of Months

City and State you Reside *

EXPENSES "PAID" PER MONTH Project/Assignment 1

Apartment Rent *

Cell Phone

Internet

Laundry expenses

Parking fees

Meals and Incidentals


Less: Amounts reimbursed by Employer:

TYPE OF CAR

Daily Commuting MILES ( To and From, Round trip)

Car model

car purchase date

Total Miles travel in Year by car

EXPENSES PAID FOR THE ENTIRE

ASSIGNMENTProject/Assignment 1

Books purchased

Education expenses that improves or maintains your skills

Job Hunting / employment agency expenses/Resume

preparation

Job related Training

Lease breakage due to Project cancelation

Subscriptions to journals required for work / Technical

periodicalsTransportation cost to attend job interviews

Uniform/work clothes required for work expenses


PERSONAL ASSETS USED FOR WORK Date Purchased

Laptop

Desktop computer

Printers

MODE OF COMMUTIN

S.P 210


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Scanners

Other asset

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YES

NO

CLIENT

EMPLOYER


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NOTE:-



Cost of the Asset Business use in %

-

(EBE)


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OWN CAR

RENTAL CAR

SHARING

BUS

TRAIN

WALK


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AL YES

AK NO

AZ

AR

CA

CO

CT

DEDC

FL

GA

HI

ID

IL

IN

IA

KS

KY

LA

MEMD

MH

MA

MI

MN

MS

MO

MT

NE

NV

NH

NJNM

NY

NC

ND

OH

OK

OR

PW

PA

PR

RI

SCSD

TN

TX

UT

VT

VA

VI

WA

WV


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WI

WY


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NOTES

YesNo

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LECT>

OUNT

LECT>

LECT>


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PER MONTHPER YEAR


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STATE FROM WHICH YOU GOT REFUND (OR) DUE

STATE FROM WHICH YOU GOT REFUND (OR) DUE

PRE

AL

AK

AZ

AR

CA

CO

Did you receive any other Income from any other source

INCOME

Did you receive brokerage statement for sale of stocks

Did you receive refund from any State authorities

Have you itemized your deductions last year

Do you recive any Interest/Dividend income in 2013

Do you own any rental property

Do you recive any self-employment Income (1099-mis)

Did you receive income from sale of stocks or securities?


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CT

DE

DC

FL

GA

HI

IDIL

IN

IA

KS

KY

LA

ME

MD

MH

MA

MI

MN

MS

MO

MT

NE

NV

NH

NJ

NM

NYNC

ND

OH

OK

OR

PW

PA

PR

RI

SC

SD

TN

TX

UT

VT

VA

VI

WA

WV


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WI

WY


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Yes

No

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AMOUNT


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Rental Business Information Rental Prop 1 Rental Prop 2

Date started (as Rental property)

Address of the property for each property

City, State, Zip

Material Participation (activity participated in rental business) No No

Time spent in business (hours per day)

Rental Business Income & Expenses

Total Rent Received during the Tax year

Expenses-

Advertising

Cleaning and maintenance.

Commissions

Insurance.

InterestLegal Fees

Local transportation expenses.

Points

Rental Payments

Repairs

Tax return preparation fees(only to perpare Sche E)

Taxes (real estate tax, property Tax)

Travel expenses

Utilities

Other Expenses

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COMPLETE THIS ONLY PAGE ONLY YO


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Rental Prop 3 Rental Prop 4

No No

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HAVE RENTAL INCOME


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Name of Business

Doing business as (DBA)

Tax ID

Nature of Business

SIC CodeNAICS Code

State File number

State Webfile number

Business Address (state "home" in case of Home office)

City, State

ZIPCODE

Basis of Accounting

Income from Business

Accounting fees

Advertising

Bank charges

Commissions and sales expenses

Consultation expenses

Continuing professional education

Contract labor

Credit and collection feesDelivery charges

Dues and subscriptions

Employee benefit programs

Equipment rentals

Factory expenses

Insurance

Interest paid

Internet subscriptions, domain names, and hosting

Laundry

Legal feesLicenses

Maintenance and repairs

Home office Expense

Office expenses and supplies

Pension and profit-sharing plans

Postage

Print and copy

Professional development and training

Business Income received during the ta

Business expenses paid during the tax ye

Business Informati


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Professional fees

Promotion

Rent

Salaries, wages, and other compensation

Gifts (Upto $ 25 per person per year)

Automobile and transportation expenses

Meals and entertainmentSecurity

Small tools and equipment

Software

Supplies

Taxes

Telephone

Trade discounts

Travel - Airfare - Within USA

Travel - Airfare - Foreign Travel

Travel - Lodging- Within USATravel - Lodging- Foreign Country

Utilities

Assets used for Business

Laptop

Cell phone - Instrument purchased

Desktop computer

Computer accessories

Routers, Servers, Backup disks purchased for business

Computer furniturePrinters

Scanners

Software

Other asset

Notes:

Any expense above $ 75 per transaction needs receipts. These will have to be produced in case of an IR


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Cash

year

ar

n


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Cost of Asset Business use %age Date Purchased

/State audit*

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Office Rent Computation Per monthNumber of

monthsTotal(Full Cost)

Mortage Interest (If Owned) 12 -

Rent Expenses (If Rented) 12 -

Real Estate Taxes 12 -

Home Owners / Renters insurance 12 -

Electricty (Average) 12 -

Water, Sewerage & Trash expenses(Avg) 12 -

Heating expenses 12 -

Cable TV 12 -

Internet Charges 12 -

Housekeeping expenses 12 -

Pest Control 12 -

Repairs & Maintenance 12 -

Direct Expenses 0 -

Total Square Feet of the House

*Space used for Office measurements: (in sqft) SQUARE FEET

Dedicated Space:

Garage used for business car

Office Space with/without attached Rest Room

Shared Space:

Foyer, Lobby and Stair Case leading to Office/2nd Floor

(do not include one used by personal and office Guests)

Total Sqft for Business 0

Common Expenses Incurred

Home - Used for Business*

Business Use %age

Allocated Expenses for Business -

Depreciation Expenses Date Purchased Cost of Asset Business use %

Furniture

Furniture

FurnitureHome Cost (exclude land value)

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Enter in Squar

Usable sq

HOME OFFICE EXPENSE COMPUTATION


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Depreciation

-

-

--

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e Feet - Net

are feet


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YES

NO

Taxes Paid

Source of Income:(compensation or other)

Have you paid any estimated taxes during the year

Can you provide us your Prior Year AGI

Have you paid any real estate taxes in US

Taxes Paid in Other Countries

Country to which the tax has been paid


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AMOUNT


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Foreign Bank Account Information (FBAR)

Details Financial Account 1

FBAR

Account Belongs to (Name)

Type of Account Select

Account Number

Maximum A/c Value during the tax year

Jointly owned by anybody else

Name of Financial InstitutionMailing Address of Financial Institution

City, State, Zipcode

Country

YES

NO

COMPLETE THIS ONLY PAGE ONLY YOU HAVE FO

The Department of the Treasury requires that every US citizen or resident

accounts that exceed $10,000 USD in aggregate value at any time during the c

June 30 of the


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Add more columns if reqd

Financial Account 2 Financial Account 3 Financial Account 4 Financial Account 5

Select Select Select Select

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REIGN BANK ACCOUNTS

ith an interest in or an authority over foreign bank accounts, other financial

alendar year must report the foreign bank accounts Information no later than

following year.


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BANK NAME

ACCOUNT NUMBER

ROTTING NUMBER

TYPE OF ACCOUNT


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DETAILS FOR DIRECT DEPOSITS (OR) CREDIT

BANK INFORMATION

PRE


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NOTE:


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