Title: Integrated Benefits’ Tax Interview
Author: Philip Catterton
Last saved by: peter alessi
Company: Financial Planning Services

Tax Interview 				--

Personalized Services Tax Interview
Tax Year  2013
 Fill out the form below and return it to Personalized Services at:
E-mail: alessi.peter7@gmail.com
Fax: 001-347-438-3060  U.S. Telephone number
Or Mail to:

Peter T. Alessi
Personalized Services
PSC 808 Box 30
(Income tax Office)
FPO AE 09618
USA
  
Total time required by you to complete this form is only 15 minutes!
The Tax Interview: For Personalized Services to prepare your taxes we first need to obtain information from you concerning your tax situation. Our Tax Interview is designed to make it as simple as possible for you to communicate this information to us. In fact, it is so simple that all you need to do in most questions is answer “yes” or “no.” We doubt if it will take more than 10 minutes of your time. But before you start it would make your job a lot easier if you would gather all of your tax information together and have it with you while you answer the questions.
Instructions: Please make sure to accurately fill out the Personal Family Section  so that we may be able to reach you. Most questions require only a simple “Yes” or “No” from you. Go through the questions and mark the applicable “Yes” or “No” box. If you do not know the answer or have never heard of the form chances are this question does not concern you. Just mark the “No” box and move on to the next question.
If you have received this form electronically you may wish to send the completed form back to us electronically, our e-mail address is: alessi.peter7@gmail.com. However, we ask that you change the name of the file by giving the file your name or initials so that we may more easily keep track of it. If you have received this in printed or faxed form you may resend the completed form back by either mail or fax.  You would have to fax this form to 001-347-438-3060.  This is a U.S. Fax Number but I receive 

faxes in Naples.
						Personal Family Section
Contact Address: | | Tel: | | Fax: |
E-mail: | | | | |
Please state whether you prefer to be contacted via mail, fax, tel, or e-mail: | |
Taxpayer Name: | | Soc Sec #: | | Date of Birth: |
Spouse: | | Soc Sec #: | | Date of Birth: |
Dependant's Name: | | Soc Sec #: | | Date of Birth: |
Dependant's Name: | | Soc Sec #: | | Date of Birth: |
Dependant's Name: | | Soc Sec #: | | Date of Birth: |

Income Section
| Yes | No
1. Wages, Salaries, or any other employer compensation: | |
2. Tips: | |
3. Interest on Savings, U.S. Bonds, Dividends on Stocks Mutual Funds: | |
4. Income from Social Security: | |
5. Lump Sum distribution from an IRA or Pension Plan: | |
6. Retirement or IRA distribution & recipient under 59.5: | |
7. Other pension or retirement income: | |
8. Unemployment compensation: | |
9. Alimony: | |
10. Self-Employment and/or operation of a business: | |
11. Operation of a farm: | |
12. Rental of land & property for agricultural purposes: | |
13. Other rental property: | |
14.  Gambling winnings: (lottery, race track, casinos) | |
15. Royalties: | |
16. Any miscellaneous income: (prizes, awards, jury duty) | |

Income Verification Section
Important: for any “Yes” answered questions in this section please mail, fax or e-mail (if you have a scanner) us a copy of the applicable form | Yes | No
17. W-2 (indicates wages earned/taxes witheld etc.) | |
17a. If you did not receive a W-2 form, state your (foreign earned) income here: | |
17b. If you did not receive a W-2 form, state (foreign) taxes witheld, if any, here: | |
18. W-2 G: | |
19. 1099R: (distribution from an IRA retirement plan) | |
20. 1099 INT: (interest earned with banks) | |
21. 1099 DIV: (dividends earned on stocks/mutual funds) | |
22. 1099 MISC: (self-employed income etc.) | |
23. 1099 B: | |
24. 1099 S: | |
25. 1099 G: | |
26. any other 1099: | |
27. K-1: (information for Trusts/Limited Partnerships) | |

General Tax Questions
| Yes | No
28. IRS notice of change of prior year’s return: | |
29. Closing statements from real estate sales: | |
30. Stock, Mutual Funds, or other non-business security: | |
31. Own or live in personal residence not rented out: | |
32. Rental Property: | |
33. Property relating to a business or farm: | |
34. Any other personal property used for business: | |
35. Did sale of any property above involve bartering: | |
36. Are you receiving installments on any property sold: | |
37. Have a home mortgage: | |
38. Use a portion of your home exclusively for business: | |
39. Have medical expenses or pay for health insurance: | |
40. Make contributions to charity, church etc. | |
If YES, did you make over $500 in non cash contributions: | |
41. Suffer a casualty loss from fire, theft, acts of God: | |
42. Itemized last year & received a state tax refund: | |
43. Incur employee expenses/travel/ use of personal vehicle: | |
44. Moved for job related reasons: | |
45. Have Federal/State estimated tax payments for 1998: | |
46. Partnership and S-Corporation K-1’s: | |
47. Estate and Trust K-1’s: | |
48. Purchase fuel for off –road use (agricultural or air): | |
49. Contribute to an IRA: | |
50. Get claimed as a dependent by someone else: | |
51. Did your children receive wages, interest, dividends: | |
52. Did you or your spouse pay child/ dependent care expenses: | |
53. Were there any births, adoptions, divorces, marriages or deaths in your household: | |
54. Did anyone in your family attend a school of  higher education: | |
If yes, please fill out question #55 | |
55. Education Tax Credits:
Name of Institution: | |
Tuition paid: | |
Who attended: | |
When classes began: | |
56. Interest paid on school loans: $ | |
57. The address you want on your return: | |