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    Name *

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    1) # of W-2s:

    2) Any self-employment Income

    If Yes, # of 1099-MISC forms:

    3) # of K-1 forms:

    4) Please list any States lived and / or worked in besides N.Y. :

    5) Do you itemize deductions?
    YesNoNot Sure

    6) Do you own your own home?

    7) Did you receive $ 1,500 or more of interest income and / or dividends?

    8) Did you SELL any stocks and / or bonds?

    9) Did you receive any rental income from real estate?

    If Yes, how many properties and what states are they in?

    10) Did you have $10,000 or more in foreign bank accounts?

    11) If you are not a U.S. Citizen or Permanent Resident, what is your immigration status and / or type of Visa:

    12) Please list any other income and/or deductions not mentioned above:

    MEI CPA, P.C. helps clients maximize their operating efficiency and minimize their tax liabilities!!