• 1117 Perimeter Center West Suite W212, Atlanta, GA 30338 404-607-8400
  • 1030 Riverwalk Parkway, Suite 104, Rock Hill, SC 29730 803-831-0263
  • 404-607-8400 & 803-831-0263

Tax Return Questionnaire

Tax Return Questionnaire


Click on the button above to download and print the tax return questionnaire. When finished, you can FAX it to 404-607-7880 or EMAIL it to taxes@attawaylinville.com. Call us at 404-607-8400 if you have any questions.

I. Your Personal Information

Your Name (First, MI, Last) (required):

Your Spouse's Name (First, MI, Last) (required):

Mailing Address (required)

City/State/ZIP (required)


Email (required):

About You

Your Date of Birth

Your Job Title

Are you (check all that apply)
A U.S. citizenLegally BlindTotally and Permanently Disabled

About Your Spouse

Spouse Date of Birth

Spouse Job Title

Is your spouse (check all that apply)
A U.S. citizenLegally BlindTotally and Permanently Disabled

Can anyone claim you or your spouse on their tax return?

II. Marital Status and Household Information

As of December 31, were you:
SingleMarriedDivorced or Legally SeparatedWidowed

Everyone who lived in your home (other than you or your spouse).
Please include name, date of birth, relationship to you, how many months they lived with you in 2016 and whether they are a full-time student

III. Income

Did you or your spouse receive (check all that apply):
Wages or Salary? (Form W-2)Tip Income?Scholarships? (Forms W-2, 1098-T)Interest/Dividends from checking/savings accounts, bonds, CDs, brokerage? (Forms 1099-INT, 1099-DIV)Refund of state/local income taxes? (Form 1099-G)Alimony income?Self-Employment Income? (Form 1099-MISC)Cash/check payments for any work performed not reported on Forms W-2 or 1099?Income (or loss) from the sale of Stocks, Bonds or Real Estate (including your home)? (Forms 1099-S, 1099-B)Disability income such as payments from insurance or workers compensation? (Forms 1099-R, W-2)Distributions from Pensions, Annuities, and/or IRA? (Form 1099-R)Unemployment Compensation? (Form 1099-G)Social Security or Railroad Retirement Benefits? (Forms SSA-1099, RRB-1099)Income (or loss) from Rental Property?Other income (gambling, lottery, prizes, awards, jury duty, etc.)? (Forms W-2 G, 1099-MISC)

IV. Expenses

Did you or your spouse pay (check all that apply):
Alimony?Contributions to a retirement account?Education expenses for yourself, spouse or dependents, such as tuition, books, fees, etc.? (Form 1098-T)Unreimbursed employee business expenses (such as uniforms or mileage)?Medical expenses (including health insurance premiums)?Home mortgage interest? (Form 1098)Real estate taxes for your home or personal property taxes for your vehicle? (Form 1098)Charitable contributions?Child or dependent care expenses such as day-care?For supplies used as an eligible educator such as a teacher, teacher's aide, counselor, etc.?

V. Life Events

Did you or your spouse (check all that apply):
Have a Health Savings Account? (Forms 5498-SA, 1099-SA, W-2 with code W in Box 12)Have debt from a mortgage or credit card canceled/forgiven by a commercial lender? (Forms 1099-C, 1099A)Buy, sell or have a foreclosure on your home? (Form 1099-A)Have Earned Income Credit (EIC) disallowed in a prior year?Purchase and install energy-efficient home items such as windows, furnace, installation, etc.?Live in an area that was affected by a natural disaster?Receive the First Time Homebuyers Credit in 2008?Pay any student loan interest? (Form 1098-E)Make estimated tax payments or apply last year's refund to this year's tax?Attend school as a full-time student? (Form 1098-T)Adopt a child?File a 2011 federal tax return containing a "capital loss carryover" on Form 140 Schedule D?Become a victim of identity theft?