Tax Worksheet for U.S. Resident Returns

We kindly request you complete the form below and submit all of the necessary documentation to prepare your U.S. Resident Income Tax Return. A reminder that your annual Agreement Letter has been sent to you and must be signed before Larson Gross can begin tax preparation.

To ensure your tax return is prepared and filed by the April 15th filing deadline, please submit your documentation no later than March 15th, 2023.

We look forward to serving you!

PERSONAL INFORMATION

First Name

Last Name

Did any of the following change during 2022 (please select all that apply):

Address

Phone Number

Email Address

Please provide new address:

Address Line 1

Address Line 2

City

State

Zip Code

Country

Please provide new phone number:

Please provide new email address:

What is your preferred method of contact?

Phone

Did your marital status change during 2022?

Yes

What is your new status?

Married

Divorced

Widowed

What is the date of marital status change?

Did you receive alimony during 2022?

Yes

Did you pay alimony during 2022?

Yes

Are you married?

Yes

Do you and your spouse want to file separate returns?

Yes

Are you in a domestic partnership, civil union, or other state-define relationship?

Yes

DEPENDENT INFORMATION

Do you have any dependents to claim in 2022?

Yes

How many dependents do you have?

Please provide full names and SSN of each dependent:

Are your dependents U.S. citizens?

Yes

Have your dependents lived with you for more than half of the year?

Yes

Did any of your dependents provide more than 50% of their own support during the year (including amounts spent for food, lodging, clothing, education, medical, dental, recreation, transportation, and other necessities)?

Yes

Did you make any payments for child or dependent care?

Yes

Please upload documentation containing the name, social security number, or employee identification number of the recipient and the amount paid (or include it with your other uploaded documents):

Choose File

Did any of your children file a joint return with their spouse?

Yes

Do you have any dependents other than children under the age of 24?

Yes

Has the IRS ever disallowed your Child Tax Credit or Other Dependent Credit?

Yes

Do you have dependent children under the age of 24 with investment income greater than $1,150?

Yes

Do you have any children who were full time students for more than 5 months during 2022?

Yes

Was income for the year less than $4,400?

Yes

Have you or your spouse ever signed form 8832 releasing the claim of an exemption for any of your children?

Yes

Can anyone claim you or your spouse as dependents?

Yes

Has the IRS ever disallowed a dependency exemption claim?

Yes

If you were audited, could you provide documentation to substantiate the responses provided above?

Yes

Did you adopt a child or begin adoption proceedings during 2022?

Yes

Please provide more detail:

HEALTHCARE INFORMATION

Did you pay health insurance premiums during 2022?

Yes

Please provide the amount:

Did you obtain healthcare coverage through the Marketplace?

Yes

Please upload all forms 1095-A (or include it with your other uploaded documents):

Choose File

Did you receive Form 1095-A for someone claimed as a dependent on another taxpayer's return or who is filing their own return and is not claimed on another taxpayer's return?

Yes

Did you or your spouse have any transactions pertaining to a health savings account (HSA)?

Yes

Please list the amount contributed and upload Form 1099-SA below if any funds were distributed from the HSA:

1099-SA upload (or include it with your other uploaded documents):

Choose File

Did you or your dependents incur large medical expenses during 2022?

Yes

Please provide more detail:

Did you or your spouse receive distributions from long-term care insurance contracts?

Yes

Please upload Form 1099-LTC (or include it with your other uploaded documents):

Choose File

EDUCATION INFORMATION

Did you, your spouse, or your dependents incur any post-secondary education expenses such as tuition?

Yes

Please upload Form 1098-T (or include it with your other uploaded documents):

Choose File

Did you or your spouse withdraw any amounts from your IRA to pay for higher education expenses?

Yes

Did you or your spouse withdraw any amounts from a Coverdell Education Savings Account or a Qualified Education Program (Section 529) plan?

Yes

Please upload all Forms 1099-Q (or include it with your other uploaded documents):

Choose File

Were the amounts withdrawn used for qualified tuition expenses?

Yes

Did you or your spouse pay any student loan interest?

Yes

Please upload student loan slip (1098-E) (or include it with your other uploaded documents):

Choose File

EMPLOYMENT AND BUSINESS INFORMATION

Did you receive wage or other employment income?

Yes

Please upload income reporting slips (W-2, 1099-MISC, 1099-NEC) issued to you (or include it with your other uploaded documents):

Choose File

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?

Yes

Did you retire or change jobs in 2022?

Yes

Did you or your spouse receive unemployment compensation in 2022?

Yes

Please upload slip (1099-G) (or include it with your other uploaded documents):

Choose File

Are you self-employed, work as an independent contractor, or as a farmer? If so, please attach a categorized list of income earned and expenses paid and include any 1099 forms you received that report income.

Yes

Did you work or perform any services for compensation outside your state of residence?

Yes

Were you or your spouse a partner in any partnership, member in any LLC, a stockholder in a U.S. S-Corporation, or receive a distribution from a U.S. trust/estate?

Yes

Please upload all federal, state 2022 K-1 forms you received (or include it with your other uploaded documents):

Choose File

Did you start a new business, purchase a new rental property, farm or acquire any new or additional interest in any partnership, LLC, or corporation during 2022?

Yes

Please upload purchase information (closing documents, purchase agreement, etc.) (or include it with your other uploaded documents):

Choose File

Did you sell an existing business, rental property, farm, or any existing interest (full or partial) in a partnership, LLC or corporation during 2022?

Yes

Please upload sale information (closing documents, purchase agreement, etc.) (or include it with your other uploaded documents):

Choose File

INVESTMENT INFORMATION

Do you have investment income?

Yes

Did you receive interest or dividend income?

Yes

Please upload income reporting slips (1099-DIV, 1099-INT, 1099-Consolidated) issued to you(or include it with your other uploaded documents):

Choose Files

Did you sell any stocks, mutual funds, or put/call options during 2022?

Yes

Please upload income reporting slips (1099-B or 1099-Consolidated) issued to you and/or information supplied by your investment brokerage, if any (or include it with your other uploaded documents):

Choose Files

Did you have a crypto currency account during 2022?

Yes

Did you sell or exchange any crypto currency during the calendar year?

Yes

Please upload documentation (or include it with your other uploaded documents):

Choose File

Did you sell, exchange, or purchase real estate in 2022?

Yes

Please upload closing statements (or include it with your other uploaded documents):

Choose File

Did you or your spouse engage in any rental properties?

Yes

If you were a Washington State resident in 2022, do you expect to have more than $250,000 in non-real estate long term gains in 2022?

Yes

Please upload a categorized list of rental income earned and expenses paid, by property address. Please also include copies of any 1099 forms or property manager reports, if applicable (or include it with your other uploaded documents):

Choose Files

RETIREMENT OR SEVERANCE INFORMATION

Did you have any activity from pension, retirement accounts, or annuities?

Yes

Did you take any retirement distributions?

Yes

Please upload slips (1099-R) issued to you (or include it with your other uploaded documents):

Choose Files

Did you or your spouse contribute to a traditional individual retirement account (IRA), Roth IRA, or business retirement account?

Yes

Please provide details:

Did you or your spouse convert an IRA or other pension plan into a Roth IRA?

Yes

Please upload slips (1099-R) issued to you (or include it with your other uploaded documents):

Choose Files

Did you or your spouse rollover amounts from a pension or IRA account to another IRA account?

Yes

Please upload slips (1099-R) issued to you for rollover (or include it with your other uploaded documents):

Choose Files

Did you or your spouse receive social security benefits?

Yes

Please upload income reporting slips (SSA-1099) issued to you (or include it with your other uploaded documents):

Choose Files

PERSONAL RESIDENCE INFORMATION

Do you own your home?

Yes

Did you pay property taxes during 2022?

Yes

Please provide the amount paid:

Did you pay mortgage interest during 2022?

Yes

Please upload Form 1098 (or include it with your other uploaded documents):

Choose File

Are your total mortgages on your first and/or second residence greater than $750,000?

Yes

Please provide the principal balance and interest rate at the beginning and end of the year.

Did you take out a home equity loan or refinance an existing mortgage in 2022?

Yes

Please provide description of what the loan proceeds were used for:

Did you sell your personal residence?

Yes

If you received 1099-S, please upload (or include it with your other uploaded documents):

Choose File

Did you or your spouse own and occupy the home as your principal residence for at least two years of the five-year period prior to the sale?

Yes

Did you or your spouse ever rent out the property?

Yes

Did you or your spouse ever use any portion of the home for business purposes?

Yes

Have you or your spouse sold a principal resident within the last two years?

Yes

DEDUCTIONS & CREDITS INFORMATION

Did you make any charitable contributions during 2022?

Yes

Please select all types of charitable contributions you made in 2022:

Contributed Cash

Contributed from your IRA as a Qualified Charitable Distribution (QCD)

Contributed Property (other than cash)

Please list all contributions made:

Please upload receipts received from the charity (if you contributed property be sure the receipts describe the items donated and their value) (or include it with your other uploaded documents):

Choose Files

Did you drive your car while performing volunteer duties for a charity during 2022?

Yes

Please provide the total miles you drove in this capacity.

Did you or your spouse incur any casualty or theft losses?

Yes

Please provide details:

Did you or your spouse make any large purchases, such as motor vehicles and boats?

Yes

Please provide details:

Did you or your spouse purchase a new alternative technology vehicle, including a qualified plug-in electric drive motor vehicle?

Yes

Please upload purchase statement (or include it with your other uploaded documents):

Choose File

Did you install any alternative energy equipment in your residence such as solar water heaters, solar electricity equipment or fuel cells?

Yes

Please provide additional details:

Did you install any alternative energy equipment in your residence such as exterior doors or windows, insulation, heat pumps, furnaces, central air conditioners or water heaters?

Yes

Please provide additional details:

Did you make any home improvements?

Yes

Please provide summary of sales tax paid:

GIFTING INFORMATION

Did you or your spouse make any gifts, including birthday, holiday, anniversary, graduation, education savings, etc., with a total (aggregate) value in excess of $16,000 to any individual?

Yes

Please provide more detail:

Did you or your spouse make any gifts of difficult-to-value assets (such as non-publicly traded stock) to any person regardless of value?

Yes

Please provide more detail:

Did you or your spouse make any contributions to a trust during the year?

Yes

Please provide more detail:

Did you or your spouse forgive any indebtedness to any individual, trust, or entity?

Yes

Please provide more detail:

REGULATORY CORRESPONDENCE INFORMATION

Were you notified by the IRS or other taxing authority of any changes to prior year returns or receive any other correspondence?

Yes

Please upload a copy (or include it with your other uploaded documents):

Choose File

FOREIGN INFORMATION

Did you work outside of the US or pay any foreign taxes?

Yes

At any time during 2022, did you or your spouse have an interest in or signature authority over a bank account, securities account, or other financial account in a foreign contry?

Yes

Please provide details of all accounts outside of the US:

Would you like us to send you a spreadsheet to input financial account details?

Yes

Were you or your spouse a trustee or beneficiary of a foreign trust, or executor of a foreign estate?

Yes

Did you or your spouse receive from or transfer money or property to a foreign trust, or a foreign corporation?

Yes

Did you or your spouse own shares in a foreign private corporation?

Yes

Did you or your spouse receive a gift from a non-U.S. person or a bequest from a foreign estate during 2022?

Yes

ESTIMATED TAX PAYMENTS MADE INFORMATION

If you made any Estimated Tax Payments during 2022, please fill out the applicable fields below:

Federal Date Paid

Federal Amount Paid

State & Date Paid

State Amount Paid

FINAL QUESTIONS

How would you like your tax return delivered to you?

Simple and Secure Electronic Delivery

Paper Delivery

Should any potential refund be electronically deposited into your US bank account?

Yes

Please provide a copy of a voided check for REFUND (or include it with your other uploaded documents):

Choose File

Would you like any PAYMENT DUE electronically withdrawn from your US bank account?

Yes

Please provide a copy of a voided check for PAYMENT (or include it with your other uploaded documents):

Choose File

Please upload any additional documents necessary for properly preparing your tax return:

Choose Files

Is there anything else you would like us to know?

Questions? Please reach out to your main point of contact via email or phone or call our main office line at 360.734.4280.

PERSONAL INFORMATION

DEPENDENT INFORMATION

HEALTHCARE INFORMATION

EDUCATION INFORMATION

EMPLOYMENT AND BUSINESS INFORMATION

INVESTMENT INFORMATION

RETIREMENT OR SEVERANCE INFORMATION

PERSONAL RESIDENCE INFORMATION

DEDUCTIONS & CREDITS INFORMATION

GIFTING INFORMATION

REGULATORY CORRESPONDENCE INFORMATION

FOREIGN INFORMATION

ESTIMATED TAX PAYMENTS MADE INFORMATION

FINAL QUESTIONS

Contact Information

Service Information