Your Name:
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Phone Number:
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E-mail Address:
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not required, but handy if you have one. |
Yes
No??
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1. Did your marital status change in
2009? |
Yes
No??
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2. Is there someone living in your home
that you are not claiming as a dependent? |
Yes
No??
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3. Do you employ a household worker? |
Yes
No??
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4. Do you have children that depend upon you for their
support? |
Yes
No??
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5. If you have dependent children, did any of them earn interest,
dividends, sell stock, or earn wages during 2009? |
Yes
No??
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6. Do you, your spouse, or
children own US Savings Bonds? |
Yes
No??
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7. Did you buy a home in 2009? If
so, I need a copy of the settlement statement. |
Yes
No??
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8. Did you sell a home in 2009? If
so, I need a copy of the settlement statement. |
Yes
No??
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9. Did you move in 2009 because of a job change? |
Yes
No??
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10. Did you move to Texas from another
state in 2009? |
Yes
No??
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11. Did you file a federal income tax return
for 2008? |
Yes
No??
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12. Did you file a state income tax return
for 2008? |
Yes
No??
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13. Did you refinance your home during
2009? |
Yes
No??
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14. Did you refinance your home or second home
in 2009? |
Yes
No??
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15. Did you inherit any property during
2009? |
Yes
No??
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16. Did you sell any stocks, bonds or
other securities during
2009? |
Yes
No??
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17. Were you granted any stock options during
2009? |
YesNo
??
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18. Did you exercise any stock options during
2009? |
Yes
No??
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19. Did you receive any distributions from a retirement
account, 401(k), IRA, etc. in 2009? |
Yes
No??
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20. Did you make any contributions to an
IRA or Roth IRA for 2009? |
Yes
No??
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21. Are you considering making an IRA or Roth IRA contribution for
2009? |
Yes
No??
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22. Are you self-employed? |
Yes
No??
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23. Do you have vacation property or a
second home? |
Yes
No??
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24. Do you own a boat, trailer, cabin,
etc.
that has eating and sleeping facilities? |
Yes
No??
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25. Have you loaned money to a friend or
relative that has not been re-paid? |
Yes
No??
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26. Did you purchase a vehicle, boat,
motorcycle, or ATV during 2009? |
Yes
No??
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27. Did you receive any oil and gas
royalties in 2009? |
Yes
No??
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28. Do you own any rental property? |
Yes
No??
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29. Do you own any vacant land? |
Yes
No??
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30. Do you work in a home office because
your employer does not provide an office for you? |
Yes
No??
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31. Did you purchase a hybrid vehicle
during 2009? |
Yes
No??
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32. Did you pay any student loan interest
during 2009? |
Yes
No??
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33. Did anyone in your household pay tuition to attend
school during 2009? |
Yes
No??
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34. Did you have a large amount of medical expenses during
2009 that were not reimbursed by insurance? |
Yes
No??
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35. Did you make any charitable donations by cash,
check, or charge during 2009? |
Yes
No??
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36. Did you make charitable donations
thru payroll deductions at work during 2009? |
Yes
No??
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37. Did you donate any items like clothing to
charity during 2009? |
Yes
No??
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38. Did you do volunteer work for church, school,
etc. during 2009? |
Yes
No??
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39. Did you pay any adoption expenses
during 2009? |
Yes
No??
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40. Do you pay for childcare that was not
reimbursed by an employer sponsored plan? |
Yes
No??
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41. Did you pay or receive alimony in
2009? |
Yes
No??
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42. Do you own any investments that are
worthless or near worthless? |
Yes
No??
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43. Did you receive any social security
payments during 2009? |
Yes
No??
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44. Did you receive unemployment benefits
during 2009? |
Yes
No??
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45. Do you have a foreign bank account or
similar foreign financial account? |
Yes
No??
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46. Did you have any gambling winnings
during 2009? |
Yes
No??
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47. Did you have any job hunting expenses
in 2009? |
Yes
No??
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48. Did you gift money or property to
someone in excess of $12,000 during 2009? |
Yes
No??
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49. Did you purchase building materials
to make improvements on your home during 2009? |
Yes
No??
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50. Are you or your spouse a K thru12th
grade teacher, instructor, counselor, principal or aide during 2009? |
Yes
No??
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51. Were you a National Guard reservist
or Armed Forces reservists during 2009? |
Yes
No??
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52. Did you make any quarterly estimated
tax payments during 2009? |
Yes
No??
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53. Do you have a Health Savings Account
(HSA) or Medical Savings Account (MSA)? |
Yes
No??
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54. Did you pay health insurance premiums
without the help of your employer during 2009? |
Yes
No??
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55. Did you have a significant loss of
property or property value due to fire, storm, theft or other casualty
during 2009? |
Additional information you want to make me aware of: |
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