TAX RETURN QUESTIONNAIRE FOR TAX YEAR 2018

1 CHECK BOX IF YOU ARE A NEW CLIENTFor more information access our website as Last YearVoided Check EnclosedBlind BlindDisabled NAME DisabledSocial Security No. Date of Birth Social Security of BirthIf Law Enforcement,If Law Enforcement,Indicate Agency Occupation Indicate Agency Home # Work # Home #Work # Cell # Cell # E-Mail E-MailSchool DistrictCountyMARRIED If MARRIED & prefer to file married filing separately check boxSINGLE If SINGLE & provided a home for another person check box Date of DeathTaxpayerSpouseDEPENDENTSC heck If New NameRelationshipDaughter, Son,Mother, 2018No.

2 Of monthslived in tax-payer's homeDependenthad incomeover $4150?Yes/NoTaxpayer providedmore than 1/2of dep. support?Yes/NoAttends College?Yes/NoCheck if you are a noncustodial parent claiming a child because the custodial parent released the exemption to you. Provide us a signed Form 8332. Name on Card Account Number Expiration Date Security Code Type of Card Signature of Cardholder** Paid invoice will be enclosed with your tax returns for your records. **Type of account (Checking or Savings):_____SPOUSEA ccount #:_____Routing #:_____DIRECT DEPOSIT Check if you want a faster and more secure refund sent to your account.

3 Provide us with a voided check or write info below. If the account info is not provided you will receive a paper check. DIGITAL DOCUMENT STORAGE (DDS) (See website for more info)Check to have your 2018 tax records digitally converted and stored for $40. FREE DDS if you choose to prepay your invoice. SEE BELOW. All DDS documents will be mailed STATUS on 12/31/18 OATAXPARTNERS OATAXPARTNERS OATAXPARTNERS OATAXPARTNERS OATAXPARTNERS OATAXPARTNERS OATAXPARTNERS OATAXPARTNERS OATAXPARTNERS OATAXPARTNERS OATAXPARTNERS OATAXPARTNERS OATAXPARTNERS OATAXPARTNERS OATAXPARTNERS OATAXPARTNERS OATAXPARTNERS OATAXPARTNERS OATAXPARTNERS OATAXPARTNERS OATAXPAROATAXPARTNERS OATAXPARTNERS OATAXPARTNERS OATAXPARTNERS OATAXPARTNERS OATAXPARTNERS OATAXPARTNERS OATAXPARTNERS OATAXPARTNERS OATAXPARTNERS OATAXPARTNERS OATAXPARTNERS OATAXPARTNERS OATAXPARTNERS

4 OATAXPARTNERS OATAXPARTNERS OATAXPARTNERS OATAXPARTNERS OATAXPARTNERS OATAXPARTNERS OATAXPARS ocial Security #PREPAY INVOICE by CREDIT CARD & get FREE DDS. Include credit card info RETURN QUESTIONNAIRE FOR TAX YEAR 2018 Phone #: 631-858-2200 Date of BirthIf divorced or legally separated enter date PROVIDE COPY OF DECREEOATAXPARTNERS OATAXPARTNERS OATAXPARTNERS OATAXPARTNERS OATAXPARTNERS OATAXPARTNERS OATAXPARTNERS OATAXPARTNERS OATAXPARTNERS OATAXPARTNERS OATAXPARTNERS OATAXPARTNERS OATAXPARTNERS OATAXPARTNERS OATAXPARTNERS OATAXPARTNERS OATAXPARTNERS OATAXPARTNERS OATAXPARTNERS OATAXPARTNERS OATAXPAROATAXPARTNERS OATAXPARTNERS OATAXPARTNERS OATAXPARTNERS OATAXPARTNERS OATAXPARTNERS OATAXPARTNERS OATAXPARTNERS OATAXPARTNERS OATAXPARTNERS OATAXPARTNERS OATAXPARTNERS

5 OATAXPARTNERS OATAXPARTNERS OATAXPARTNERS OATAXPARTNERS OATAXPARTNERS OATAXPARTNERS OATAXPARTNERS OATAXPARTNERS OATAXPAROATAXPARTNERS OATAXPARTNERS OATAXPARTNERS OATAXPARTNERS OATAXPARTNERS OATAXPARTNERS OATAXPARTNERS OATAXPARTNERS OATAXPARTNERS OATAXPARTNERS OATAXPARTNERS OATAXPARTNERS OATAXPARTNERS OATAXPARTNERS OATAXPARTNERS OATAXPARTNERS OATAXPARTNERS OATAXPARTNERS OATAXPARTNERS OATAXPARTNERS OATAXPARHEAD OF HOUSEHOLD TAXPAYERNAMEO ccupationTAX RETURN address. This address will appear on the tax as Last YearMAILING address to send back tax documents (if different from tax RETURN )Name of Client:FOREIGN ACCOUNT REPORTING & HEALTHCARE & DRIVER'S LICENSE REQUIREMENTYou must complete this page in order for us to complete your tax received, please send all health insurance 1095 ACCOUNT REPORTING (must complete)yes1.

6 Did you have a foreign financial account including an overseas bank account or even havenosignature authority with a foreign account?yes2. If Q1 is yes, did the maximum value of all the foreign financial accounts in aggregate exceedno$10,000 at any time in 2018?3. If Q2 is Yes, then include additional information on the foreign account(s). Include the highest value of the accountin 2018, country location, account number, name & address of the financial (must complete)yes1. Were you covered by an Employer or Retirement health care plan or Medicarenothe entire tax year 2018?

7 Indicate the months of coverage if not a full Where did you receive your coverage?Employer or 1095-C, if or receive Form 1095-A, please of Minimum 1095-B, if No health care coverage (Complete only if you have NO health insurance)Waiver exemption reason for no insurance coverage (Provide certificate exemption)You re uninsured for less than 3 months of the yearThe lowest-priced coverage available to you would cost more than 8% of your household incomeYou don t have to file a tax RETURN because your income is too lowYou re a member of a federally recognized tribe or eligible for services through an Indian HealthServices providerYou re a member of a recognized health care sharing ministryYou re a member of a recognized religious sect with religious objections to insurance.

8 IncludingSocial Security and MedicareYou re incarcerated (either detained or jailed), and not being held pending disposition of chargesYou re not lawfully present in the qualify for certain hardship exemptionsDRIVER'S LICENSES (must provide)Both the TAXPAYER and SPOUSE must include aPHOTOCOPY of the FRONT & BACK of theirdriver's license or state issued OATAXPARTNERS OATAXPARTNERS OATAXPARTNERS OATAXPARTNERS OATAXPARTNERS OATAXPARTNERS OATAXPARTNERS OATAXPARTNERS OATAXPARTNERS OATAXPARTNERS OATAXPARTNERS OATAXPARTNERS OATAXPARTNERS OATAXPARTNERS OATAXPARTNERS OATAXPARTNERS OATAXPARTNERS OATAXPARTNERS OATAXPARTNERS OATAXPAROATAXPARTNERS OATAXPARTNERS OATAXPARTNERS OATAXPARTNERS OATAXPARTNERS OATAXPARTNERS OATAXPARTNERS OATAXPARTNERS OATAXPARTNERS OATAXPARTNERS OATAXPARTNERS

9 OATAXPARTNERS OATAXPARTNERS OATAXPARTNERS OATAXPARTNERS OATAXPARTNERS OATAXPARTNERS OATAXPARTNERS OATAXPARTNERS OATAXPARTNERS OATAXPAROATAXPARTNERS OATAXPARTNERS OATAXPARTNERS OATAXPARTNERS OATAXPARTNERS OATAXPARTNERS OATAXPARTNERS OATAXPARTNERS OATAXPARTNERS OATAXPARTNERS OATAXPARTNERS OATAXPARTNERS OATAXPARTNERS OATAXPARTNERS OATAXPARTNERS OATAXPARTNERS OATAXPARTNERS OATAXPARTNERS OATAXPARTNERS OATAXPARTNERS OATAXPAROATAXPARTNERS OATAXPARTNERS OATAXPARTNERS OATAXPARTNERS OATAXPARTNERS OATAXPARTNERS OATAXPARTNERS OATAXPARTNERS OATAXPARTNERS OATAXPARTNERS OATAXPARTNERS OATAXPARTNERS OATAXPARTNERS OATAXPARTNERS OATAXPARTNERS OATAXPARTNERS OATAXPARTNERS OATAXPARTNERS OATAXPARTNERS OATAXPARTNERS OATAXPAROATAXPARTNERS OATAXPARTNERS OATAXPARTNERS OATAXPARTNERS OATAXPARTNERS OATAXPARTNERS OATAXPARTNERS OATAXPARTNERS OATAXPARTNERS OATAXPARTNERS OATAXPARTNERS OATAXPARTNERS OATAXPARTNERS OATAXPARTNERS OATAXPARTNERS OATAXPARTNERS OATAXPARTNERS OATAXPARTNERS OATAXPARTNERS OATAXPARTNERS OATAXPAROATAXPARTNERS OATAXPARTNERS OATAXPARTNERS OATAXPARTNERS OATAXPARTNERS OATAXPARTNERS OATAXPARTNERS

10 OATAXPARTNERS OATAXPARTNERS OATAXPARTNERS OATAXPARTNERS OATAXPARTNERS OATAXPARTNERS OATAXPARTNERS OATAXPARTNERS OATAXPARTNERS OATAXPARTNERS OATAXPARTNERS OATAXPARTNERS OATAXPARTNERS OATAXPAROATAXPARTNERS OATAXPARTNERS OATAXPARTNERS OATAXPARTNERS OATAXPARTNERS OATAXPARTNERS OATAXPARTNERS OATAXPARTNERS OATAXPARTNERS OATAXPARTNERS OATAXPARTNERS OATAXPARTNERS OATAXPARTNERS OATAXPARTNERS OATAXPARTNERS OATAXPARTNERS OATAXPARTNERS OATAXPARTNERS OATAXPARTNERS OATAXPARTNERS OATAXPAROATAXPARTNERS OATAXPARTNERS OATAXPARTNERS OATAXPARTNERS OATAXPARTNERS OATAXPARTNERS OATAXPARTNERS OATAXPARTNERS OATAXPARTNERS OATAXPARTNERS OATAXPARTNERS OATAXPARTNERS OATAXPARTNERS OATAXPARTNERS OATAXPARTNERS OATAXPARTNERS OATAXPARTNERS OATAXPARTNERS OATAXPARTNERS OATAXPARTNERS OATAXPARC heck box if appliesINCOME ITEMSSALARIES, WAGES, TIPS & OTHER COMPENSATIONW-2's# of W-2's enclosed _____PENSIONS, ANNUITIES, IRA DISTRIBUTIONS/CONVERSIONS1099 - R # of 1099-R's enclosed _____ First year of retirement, enclose a final pay stub before retirement.