All required forms can be completed on-line. Simply fill in your answers and press “submit” at the bottom of each page/form. 
If you would like to print out the page/form, simply right click and select the print option. 
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Moshe Klein & Associates Ltd. 

Tax Organizer and Questionnaire – Individuals and Families

 

Welcome to Moshe Klein & Associates, Ltd. It is our pleasure to provide you with tax preparation services. Please read and complete this form carefully. You are responsible for the information on your tax return, so be sure to provide complete and accurate information. All information is strictly confidential. If you have any questions, please feel free to ask at any time.

 

In order for us to prepare your tax returns, we will need:

 

  • Last year’s tax return, if not filed by Moshe Klein & Associates, Ltd.
  • Social security cards or ITIN letters for you and all persons on your tax return, if not already on file.
  • Photo ID (such as a valid driver’s license or other government-issued ID) for you and your spouse, if applicable.
  • All tax information and forms you received from employers, banks, etc., such as Forms W-2, 1099, 1098. (See page 2)
  • Receipts or other records for all tax-related expenses. (See checklist on Page 2)
  • A voided check with bank routing number and account number for direct deposit of your refund.

Part I. Your Personal Information

Part II. Marital Status and Household Information

Date of final decree or separate maintenance agreement:
Year of spouse's death

List everyone who lived in your home in the year you indicated on this form (other than you and your spouse). Also list anyone who lived outside of your home who you supported during this same period.

For each box below, please provide the following information in a list format:

1. Name (first, last)

2. Social Security Number

3. Date of Birth(mm/dd/yy)

4. Relationship to you (e.g. daughter, son, mother, sister, none)

5. Number of months lived in your home in the year you indicated on this form

6. US Citizen or resident of US,Canada or Mexico in the year you indicated on this form (yes/no)

7. Marital status as of 12/31/19 (S/M)

8. Full-time student in the year you indicated on this form (yes/no)

9. Received less than $3800 income in the year you indicated on this form (yes/no)

Part III. Income – In the year you indicated on this form, did you or your spouse receive:

Part IV. Expenses – In the year you indicated on this form, did you or your spouse pay:

Part V. Life Events – In the year you indicated on this form, did you or your spouse:

Check here if you, or your spouse if filing jointly, want $3 to go to this fund.

Part VI. Health Care Information – In the year you indicated on this form, did you, your spouse, or dependent(s)

Part VII. Your Refund or Balance Due

Clarifying Questions

If "Yes," please upload these IRS letters EIP1, EIP2, and EIP3 for both spouses if applicable, to the MKA Secure Document Sharing File
If "Yes," please upload these IRS 6419 letters for both spouses if applicable, to the MKA Secure Document Sharing File

By my signature, I acknowledge that I have read, understand, and agree to the policies, terms, conditions, and procedures as outlined on this document. To the best of my / our knowledge and belief, the information that I/we have provided or will provide to Moshe Klein & Associates, Ltd. is true and accurate. To the fullest extent of the law, I/we shall indemnify, defend and hold harmless Moshe Klein & Associates, Ltd., its officers, employees, agents, representatives, consultants, and contractors from and against any and all loss, costs, penalties, fines, damages, claims, expenses (including attorney’s fees) or liabilities …arising out of, resulting from, or in connection with the services outlined in any Service Engagement Agreement or Contract signed with or provided by Moshe Klein & Associates, Ltd.

By signing this Acknowledgement, I agree that my electronic signature is the legally binding equivalent to my handwritten signature. Whenever I execute an electronic signature, it has the same validity and meaning as my handwritten signature. I will not, at any time in the future, repudiate the meaning of my electronic signature or claim that my electronic signature is not legally binding.

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