2018 Income Tax Questionnaire

Answer all questions "Yes" answers require additional details. Include all statements you received. Please provide a copy of your last 3 years' income tax returns if they were not prepared by this office.

Personal Information

Provide or update all Personal Information on the enclosed form.

Yes No

Did your marital status change during the year? D □

Please explain.

Did your address change from last year? D D

Can you be claimed as a dependent by another taxpayer? D □

We are required to file your tax returns electronically. Ifwe are to prepare any State tax returns, please submit a copy of your drivers' licenses, as many States now require this information on electronically filed returns. D □

Do you want your refund direct deposited to your bank account? This is the fastest way to receive your refund. D □

Do you want to pay any 2018 balance due by having the IRS electronically remove the money from your bank account on the due date? (You can also pay online, by check or money order, by debit or credit card or by EFTPS). D D

If you file quarterly 20 I 9 estimates, would you like the IRS to electronically remove the payments from your bank account on the due dates? D D

Do you reside in or operate a business in a federally-declared disaster area (which includes hurricanes, tropical storms, floods, as well as wild fires)? D □

Provide or update your bank account information to be used to direct deposit (or direct debit) funds from (or to) the IRS or other taxing authority? See the form attached for the information we need.

Dependent Information

Provide or update all dependent information on the enclosed form.

Does anyone other than you and your children live in your home? Please

provide details.

Did you support anyone who did not live in your home? Please provide details.

Did you and your child live apart from your spouse during the year? Please

provide details.

Do you have any children under age 19 (or full-time student under age 24) with

unearned income in excess of $2, I 00? Provide all income details.

Did you pay for child care while you worked or looked for work?

Provide all details. See the enclosed forn1 for required information.

Did you pay any expenses related to the adoption of a child during the year?

Provide identifying numbers, dates, and all expenses.

Healthcare

YOU MUST PROVIDE PROOF OF HEAL TH INSURANCE COVERAGE

DURING 2018

The IRS requires that you report certain information related to your health care coverage on your 2018 tax return. Please read the following questions carefully. More than one might apply to your "tax family".

Did you have health care coverage with a government Marketplace (Exchange) during 2018? Please provide Form I 095-A, issued by the Marketplace. In some

family situations you may have more than one 1095-A.

Yes No

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Healthcare (Continued)

Are you claiming someone on your return who was included on another taxpayer's policy with a Marketplace? If so, provide a copy of that taxpayer's

Fonn I 095-A.

Did your dependent file a return for 2018? Provide a copy of the return.

Did you have compliant health insurance through an employer plan, private policy or with a government plan? Provide Fonn 1095-B, I 095-C or other proof

of insurance document.

Were you issued a hardship exemption by the Marketplace (Exchange)? Provide all applicable exemption certificate numbers issued for each member of your

family.

Were any members of your "tax family" not insured at any time during 2018?

Provide names and dates during which they were not insured.

Did you make contributions to or receive distributions from a health savings account (HSA), Archer MSA, or Medicare Advantage (MSA) this year? Describe how any distributions were used and enclose Fonns 1099-SA and

Fonns 5498-SA.

Did you contribute (or rollover) amounts to an ABLE (Achieving a Better Life Experience) account. Enclose Form 5498-QA you received. Also enclose

Fonn 1099-QA for any withdrawals made during the year.

Did you pay premiums or receive benefits from a long-term health care policy

for yourself or your family? Include any F onn 1099-L TC received.

lfyou are a business owner, did you pay health insurance premiums for your employees during the year? If so, enclose Fonn I 099-H for any tax credit

advance payments received.

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Purchases, Sales and Debt Information

Provide all HUDl, Statement of Monies and/or Forms 1099 received for any of the following transactions.

Did you sell, exchange, or purchase any real estate during the year?

Did you have a foreclosure or abandon a principal residence or other real property

during the year?

Did you acquire or dispose of any stocks, bonds or other investments? Enclose

all statements.

Did any of your stocks or bonds become totally worthless during the year?

Did you borrow money during the year, or refinance existing loans? Please provide the loan documents, or describe the details of the debt, including date,

terms, amount, how it is secured and the use of the proceeds.

Did you pay mortgage or investment-related interest during the year? Please include Forms I 098 or other documentation so that we can properly match the

interest to the applicable loan and the use of the money that was borrowed.

Did you pay "points" on new loans during the year? Please provide all details.

Did you sell an existing business, rental, or other property this year?

Did you incur any non-business bad debts this year?

Did you have any debts canceled or forgiven this year?

Did you acquire or dispose of any fixed assets used in a trade or business, or rental activity? For existing assets, provide specific details on attached

depreciation schedules.

Yes No

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Income Information

How many W-2 fonns are included? Taxpayer ___ Spouse __ _ Provide year-end pay stub for each of them.

Yes No

Did you receive income from interest and/or dividends? Include Fonns I 099. □ □

Did you receive a state tax refund? □ □

Did you own or operate a business or farm during the year? Provide all data for sole proprietorships and single-member LLCs. Provide all K-1 fonns from

partnerships and S corporations. □ □

Did you receive rental or royalty income? □ □

Did you receive income from an estate or trust? Provide all K-1 forms. □ □

Did you have any foreign income or pay any foreign taxes during the year? □ □

Did you receive any income from property sold in an earlier year? □ □

Did you receive or pay alimony? Provide amount, name and social security number.

Provide copies of any agreements we don't already have. □ □

Did you receive any unemployment or disability income during the year? □ □

Did you receive tip income not reported to your employer? □ □

Did any of your life insurance policies mature, or did you surrender any policies? □ □

Did you cash any Series EE or I U.S. Savings bonds issued after 1989? □ □

Did you have gambling winnings? □ □

Did you have any transactions using virtual currency during the year, or

are you holding virtual currency as an investment? □ □

Did you receive income from any other sources during the year? Explain. □ □

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Retirement

Please include all related Forms 1099 and/or other documents.

Did you receive any payments from a pension, profit sharing or 40l(k)?

Did you have contributions to or withdrawals from an IRA, Keogh, SIMPLE,

SEP, or other retirement plan? Enclose all year-end statements.

Did you convert all or part of your retirement money to a Roth IRA?

Did you transfer or rollover any of your retirement money to a different plan?

Were you an active participant in your employer's retirement plan this year?

Did you receive income from social Security?

Did you retire (or change jobs) during the year?

Education

Did you, your spouse, or your dependents attend a post-secondary school during the year? Provide all details, including who, the school, year of study,

amounts and dates of all payments you made. Include I 098-T.

Did you make any withdrawals from an Education Savings Account or 529 Plan?

Include all year-end account statements and provide details showing how the

money was used.

Did you make any contributions to an Education Savings Account or 529 Plan?

Include all year-end account statements.

Did you pay any student loan interest this year? Include I 098-E.

Would you like a worksheet to aid in the completion of your Free Application

for Federal Student Aid (FAFSA) with the US Department of Education?

Yes No

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Itemized Deductions

Did you directly pay for unreimbursed medical and/or dental expenses?

Please list all details including insurance premiums paid directly by you.

Did you pay real estate and/or personal property taxes? Please list.

Did you purchase a new car or boat during the year? Please list the sales tax paid.

Did you make out-of-state purchases that the seller did not collect state sales

or use tax on? Provide all details.

Did you incur a casualty or theft loss, during the year, that occurred in a federally declared disaster area? List all details including any insurance

reimbursements.

Did you make cash or other donations to charity? Please list all donations and separate them between cash and non-cash (clothing, furniture, etc). Include date, description, donee (name and address), and value of donated items. You must be

able to substantiate all amounts if the IRS examines your return.

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Miscellaneous itemized deductions have been eliminated for tax years 2018 through 2025 due to tax reform. These include employee business expenses, tax preparation fees, union dues, publications, professional dues, safety deposit box rental, small tools used as an employee, business telephone, uniforms, IRA custodial fees, investment expenses and business entertainment.

Did you use part of your home exclusively for your sole-proprietorship business? Please provide us with the sq. footage of your office and of the whole house. Also provide house totals for utilities, rents, repairs, maintenance and insurance as well as the cost of supplies, equipment and furniture used in the

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Miscellaneous Information

List date and amount of each 2018 Federal estimated tax payment you made.

List date and amount of each 2018 State estimated tax payment you made.

Do you have precious years' tax returns that are either untiled or filed with

unpaid taxes due?

Did you have unreimbursed expenses as an Am1ed Forces reservist, qualified

performing artist, a governrnent official or a disabled employee? Please list.

Did anyone work in your home dming the year?

Did you make gifts of more than $15,000 to any individual dming the year?

Did you engage in any bartering transactions?

Did you incur moving costs as a member of the US Armed Forces on active

duty, because of a permanent change of station?

Did you make energy efficient improvements to yom main home this year?

Did you purchase a qualified plug-in drive vehicle or qualified fuel-cell vehicle

during the year?

Did you have financial accounts (bank or securities) located in a foreign country that aggregate more than $10,000 at any time during the year? Provide all

details of each such account.

Yes No

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Miscellaneous Information (Continued)

Did you own any other foreign financial assets that are not held in a financial

Yes No

account? Provide all details. □ □

Did you receive correspondence from any State or the Internal Revenue Service? □ □

Please provide a copy.

Did you (or any dependent) receive an Identity Protection PIN from the IRS or have

you been a victim of identity theft? Enclose IRS letters. □ □

Do you want to designate $3 to the Presidential Election Campaign Fund?

Checking yes will not change your tax or reduce your refund. □ □

As a CPA and Certified Financial Planner, Mr. Cardinale provides comprehensive financial services to our clients, using a holistic approach that considers very complete solutions in the areas of investing, planning for retirement, college and insurance needs, as well tax-saving ideas. Once your tax returns have been completed, would you be interested in meeting with a representative of Cardinale Financial Group to discuss financial planning and tax-saving ideas that came to

our attention while preparing your returns? □ □

Notes: