Extension Review Form

Taxpayer's Name *

What is the best email for you? *

What is the best phone number to call you? *

How would you like to receive your extension voucher if we believe you will owe money? *

Send my voucher(s) to my Portal.

I would like to pick up my voucher(s) at your office.

Please mail me my voucher(s). (Time permitting)

Do you have a change in your marital status? *

Yes

Please describe the change in marital status.

Any significant changes in income up or down? *

Yes

If yes, please provide details.

Be very specific. If you have a Schedule C (Self-employment income) please let us know what you anticipate your gross profit to be. If you have rental properties please let us know the gross rent. For farm income please give us an estimate of total farm income. With any of these options also provide whether you think expenses for the year are similar to last year or if they've increased or decreased and if so give us a percentage up or down. If you have brokerage accounts we HIGHLY suggest that you review your December/end of the year statement to see what your Capital Gains look like for the year.

Did you sell any stocks? *

Yes

If yes, please provide details about the cost and sale price (or at least an estimate).

You should review your sales reports to make sure cost basis has been recorded. If not we will need to know WHEN and HOW you came into possession of the stock.

Any significant change in expenses? For example, large increase or decrease in medical expenses, education expenses, business expenses, or other expenses in general. *

Yes

If yes, please provide details.

Any change in the number of your dependents from the prior year, up or down? *

Yes

If yes, please provide details.

Any other major changes or reasons that make you expect that you will OWE money to the IRS or to your state this year? *

Yes

If yes, please provide details.

Would you like to make any further contributions into any of the following for tax year 2022? You have until April 18, 2023 to make these contributions and apply them to the previous year. *

Traditional IRA

Roth IRA

SEP IRA (For self-employed taxpayers only. You must have a profit to be eligible!)

HSA - Health Savings Account (You must have a high deductible health insurance plan to be eligible!)

No, I don't want to make any further contributions for this year.

Did you make any federal estimated payments in 2022? *

Yes

Federal Estimates

If we do not currently have a Power of Attorney for you, remember, you must provide proof of your estimated payments with your tax documents.

Fed Estimate Q1

Quarter 1

Fed Estimate Q2

Quarter 2

Fed Estimate Q3

Quarter 3

Fed Estimate Q4

Quarter 4

Did you make any state estimated payments in 2022? *

Yes

State Estimates

If we do not currently have a Power of Attorney for you, remember, you must provide proof of your estimated payments with your tax documents.

Name of state

Which state did you make estimated payments to?

State Estimate Q1

Quarter 1

State Estimate Q2

Quarter 2

State Estimate Q3

Quarter 3

State Estimate Q4

Quarter 4

Did you make estimated payments to any other state in 2022?

Yes

Other State Estimates

Name of state

Which state did you make estimated payments to?

State Estimate Q1

Quarter 1

State Estimate Q2

Quarter 2

State Estimate Q3

Quarter 3

State Estimate Q4

Quarter 4

Did you make any estimated payments to a locality or school district in 2022? *

Yes

Local Estimates

Please remember to provide proof of your estimated payments with your tax documents.

Name of Locality

What is the name of the locality or school district?

Local Estimate Q1

Quarter 1

Local Estimate Q2

Quarter 2

Local Estimate Q3

Quarter 3

Local Estimate Q4

Quarter 4