Printable Form – PJ's Tax Service

2023 Tax Year
New Client Data Sheet
Full Name: _____________________________________________________________ Social Security Number: __________________________________________________ Date of Birth: ____________________________ Spouse’s Full Name (if married): ___________________________________________ Spouse’s Social Security Number: __________________________________________ Spouse’s Date of Birth:___________________________ Your Current Address (including zip code): ______________________________________________________________________ Current Phone Number w/ area code:_____________________________________________ What County did you and your spouse live in as of January 1, 2023? ________________ (Indiana Residents only) What County did you and your spouse work in as of January 1,2023? Taxpayer_______________________ Spouse ________________________ Your Current Occupation: ______________________________________________________ Spouse’s Current Occupation: __________________________________________________ Can you be claimed as a dependent on someone else’s taxes? (Ex. Parents) ____YES ____NO Will you claim any dependents? ____YES ____NO Dependent #1 Full Name: ___________________________________________________ Relationship to Taxpayer/ex Son/Daughter: _________________________________________ Social Security Number: ___________________________ Date of Birth: _________________________ Dependent #2 Full Name: ___________________________________________________ Relationship to Taxpayer /ex Son/Daughter: _________________________________________ Social Security Number: ___________________________ Date of Birth: _________________________ Will you claim the CHILD DEPENDENT CARE DEDUCTION for 2023? ____YES ____NO Are you a homeowner? ____YES ____NO Did you pay Real Estate Taxes in 2023? ___YES___NO Did you receive Form 1095-A, Health Insurance Marketplace Statement ? _____YES______NO Did you make any Energy Improvements to your main home in 2023?___YES___NO Did you make any Solar Energy Improvements to your main home in 2023 AND/OR received a Credit on previous years taxes? _____YES____NO Any virtual currency transactions in 2023?________YES________NO Will you be filing more than 1 State Return? ____YES ____NO If yes, which State? _______________________________ Will you be claiming any educational expenses in 2023 ? ____YES ____NO Will you be claiming any interest paid on student loans in 2023 ? ____YES ____NO (Indiana Residents & Part-Year Residents only) Did you rent? ____YES ____NO If yes, how many months did you rent in 2023? ____________ (Indiana Residents only) If renter, how much was your monthly rent? $_____________ (Indiana Residents only) If rented, what is the full name and address, including zip code of your landlord? ___________________________________________________________________________ Any personal Property Taxes? (Ex. Vehicle Excise taxes) ____YES ____NO Any unearned income? (Ex.Dividends, Bank Interest) ____YES ____NO Did you have any significant Medical and/or Dental expenses in 2023? ____YES ____NO Any cash or non-cash contributions to charity in 2023? ____YES ____NO Did you contribute to an IRA in 2023 or will you before 4/15/2024? ____YES ____NO Did you have any 1099-Retirement Distributions in 2023? ____YES ____NO Did you have any self-employment income in 2023? ____YES ____NO Did you sell any stocks or bonds in 2023? ____YES ____NO Did you have any rental income property in 2023? ____YES ____NO Did you have any Social Security income in 2023? ____YES ____NO Print out & Bring to Appt or Fax to 812-334-2718 __________________________________________________________________ Signature of Taxpayer Date