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LA Tax Service Questionnaire 2015 .pdf



Original filename: LA Tax Service Questionnaire 2015.pdf
Title: LA Tax Service LLP has gone green
Author: Olivia

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LA Tax Service, LLP
Questionnaire 2015
Questions reflect either You and/or Spouse
Yes No
Marital status change this year?
Registered Domestic Partner?
Changes to your dependents? (If so bring social security # of new
dependents)
Have any children under age 19 or full-time students under age 24 at the
end of 2015, with interest and dividend income in excess of $1000, or
total investment income in excess of $2000?
Did you and your dependents have health care coverage for the full-year?
Did you receive any of the following IRS documents? Form 1095-A
(Health insurance Marketplace Statement), 1095-B (Health Coverage) or
form 1095-C (Employer Provided Health Insurance Offer and Coverage)
If so, please attach
If you or your dependents did not have health care coverage during the
year, do you fall into one of the following exemptions categories: Indian
tribe membership, health sharing ministry membership, religious sect
membership, incarceration, exemption non-citizen or economic hardship?
If you received an exemption certificate, please attach
Child care expenses? Need Name of provider address, Federal ID# and
amount paid by provider.
Tip income of $20 or more in any month?
Disability or unemployment income? Bring 1099
Receive any settlements: due to injury or property?
Sell stocks, bonds or other investment property? (If so, please bring any
gain/loss information.) Bring 1099
LA Tax Service LLP
8350 Melrose Ave, Suite #202
Los Angeles, CA 90069
323-658-5271
Page 1 of 3

Purchase, sell or refinance your principal home or second home, or did
you take a home equity loan? (If so, please bring settlement closing
documents.)
Purchase a new alternative motor vehicle (hybrid, electric, fuel cell,
plug-in)? Bring car purchase details. Long sheet provided at purchase.
Receive a distribution from or make a contribution to a retirement
plan(401(k), IRA, etc)?
Transfer or rollover any amounts from one retirement plan to another
retirement plan?
Convert part or all of your traditional, SEP or SIMPLE IRA to a Roth
IRA?
Health Savings Account (HSA)? Provide amount contributed.
Tuition expenses? (college, university or vocational school) 1098T
provided by college.
Receive a distribution from an Education savings Account or a Qualified
Tuition Program?
Loss because of damaged or stolen property?
Use your car on the job (other than to and from work)? (If so, please
bring mileage log
Purchase a new motor vehicle? (If so, Please bring in the long sheet
provided to you by the dealer)
May the IRS discuss your, and/or your spouses, tax return(s) with your tax
preparer?
Home rented out or used for business? (Home office)

Audited by either the Internal Revenue Service or the State taxing agency
(FTB)?

LA Tax Service LLP
8350 Melrose Ave, Suite #202
Los Angeles, CA 90069
323-658-5271
Page 2 of 3

A FOREIGN BANK ACCOUNT that had $10,000 or more USD? at
any time during the year? (If so, you must provide the bank name,
address, account number and balance.) filing deadline of report is JUNE
30th
Did you receive a distribution from, or were you the grantor of, or
transferor to, a foreign trust or did you have an interest in any foreign
assets or accounts?
Did you, or your spouse, receive any foreign sourced funds from foreign
pensions, companies, trusts or individuals? Or pay foreign taxes?

Lose a home in bankruptcy, short sale or foreclosure?
Any debt cancelled or forgiven?
Does anyone owe you money which has become uncollectible?
Work as self-employed business person? (If so, did you file for city
business tax? Have you sent in your 1099’s?)
Start a business or farm, purchase rental or royalty property, or acquire
an interest in a partnership, S corporation, trust, or REMIC?
Purchase or dispose of any business assets (furniture, equipment,
vehicles, real estate, etc.) or convert any personal assets to business use?
Did you work out of town for part of the year?
Given any gifts in excess of $14,000?
Did you, or your spouse, purchase any items from an out-of-state
retailer (or a foreign retailer) and not pay California use tax? (i.e.
amazon.com, books, clothes, furniture, etc)
Have a living trust?
Did you make any estimated payment/s to IRS and or State? List dates of
payments and amounts.

LA Tax Service LLP
8350 Melrose Ave, Suite #202
Los Angeles, CA 90069
323-658-5271
Page 3 of 3


LA Tax Service Questionnaire 2015.pdf - page 1/3
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LA Tax Service Questionnaire 2015.pdf - page 3/3

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