Phone: (785) 827-1304

Fax: (785) 827-0383

318 W. Cloud St

Salina, KS 67401

www.randjsalinatax.com

We would like to thank you for choosing R&J Salina Tax Service, Inc. for your tax preparation needs. We

are giving you a New Client Packet. You will find this packet contains:

1. New Client Information Sheet (a 2-sided page) – Please, fill this out as completely as possible.

2. Documentation Questionnaire (Two 2-sided pages) – Please, fill this out as completely as

possible, also.

3. ACA (Affordable Care Act) Requirements – Please, include all members of the household that

will be on your tax return. Check off the months they were covered by a qualifying health

insurance plan, mark the appropriate box and both Taxpayer and Spouse (if applicable) sign and

date.

4. Engagement Letter (a 2-sided page) – This letter is the contract between you and R&J Salina Tax

Service, Inc. for tax preparation services. Please, read and both Taxpayer and Spouse (if

applicable) sign and date.

5. Audit Protection Plan Brochure – This will explain the different Audit Protection Plans we offer.

6. Client Disclosure Agreement Form - This form is for you to pick one of our Audit Protection Plans

or if you would like to opt out. Please, check the appropriate box and both Taxpayer and Spouse

(if applicable) sign and date.

7. Privacy Policy - This is for you to keep for your information. It explains how we use information

you provide us.

8. Tax Appointment Checklist

Please, bring this packet with you to your appointment, along with the last 3 years of tax returns,

Driver’s License or State Issued Identification Card for Tax Payer and Spouse, Social Security Cards for

every person on the tax return, Birth Certificates for all dependents, any tax documentation (W2’s,

1099’s, etc.), and a list of any questions you may have. We look forward to seeing you on

(Appointment Date) _________________________ @ (Appointment Time) _______________________.

Thank you,

R&J Salina Tax Service, Inc.

Phone: (785) 827-1304

Fax: (785) 827-0383

318 W. Cloud St

Salina, KS 67401

www.randjsalinatax.com

New Client Information

Taxpayer (T) _____________________________________________________Spouse(S)_________________________________________________________

Occupation (T) ___________________________________________________Occupation (S)_____________________________________________________

Address ________________________________________________________City______________________________State______Zip ___________________

Home tel (T+S) ___________________________________________________Referred by_______________________________________________________

Work tel (T) _____________________________________________________Work tel (S)________________________________________________________

Cell (T) _________________________________________________________Cell(S) ___________________________________________________________

Email (T)_______________________________________________________ Email (S)_________________________________________________________

FAX (T) if private _________________________________________________FAX (S) if private___________________________________________________

❑ Married ❑ Single ❑ Head of Household Number of Dependents____________

Notes ______________________________________________________________________________________________________

_________________________________________________________________________________________________________________________________

_________________________________________________________________________________________________________________________________

WE RECOMMEND THAT YOU PROVIDE US WITH YOUR LAST 3 YEARS OF TAX RETURNS

THE INFO BELOW IS NOT NECESSARY BUT MAY BE HELPFUL IN DISCUSSING YOUR TAX SITUATION

Approximate Income:

Wages(T)_______________________________________________________ (S)____________________________________________________________

Freelance(T)_____________________________________________________ (S)____________________________________________________________

Interest _________________________________________________________ Dividends______________________________________________________

Other Income/Losses_______________________________________________ Source________________________________________________________

PLEASE BRING THIS WITH YOU TO YOUR APPOINTMENT

Things to bring to your appointment

• Your last 3 years of tax returns

• Completed Document Questionnaire

• Write down any questions you may have and bring them with you

• Tax documents (W2’s, 1099’s etc.)

• Proof of residence for children under the age of 17

• If you have a 1098-T you will need to bring an account transaction summary from the school

• Driver’s License or Government Issued ID for Taxpayer and Spouse (if applicable)

• Social Security Cards for every person on the return

• Please, do not bring receipts. Total them up and bring us the totals. If you do bring receipts, there will be a $75/hour charge with a

minimum of 1-hour charge to total them for you.

Itemized Deductions

Medical _____________________________

Prop Tax ____________________________

Mortgage ____________________________

Contributions_________________________

Job Related __________________________

Business Expenses

Supplies ______________________________

Travel/Enter ___________________________

Furn/Equp ____________________________

Advertising ____________________________

Misc. Expenses__________________________

Adjustment to Income

IRA _______________________________

Moving ____________________________

Health Ins. _________________________

Keogh/Sep________________________

Other _____________________________

Personal Information

1. Did your marital status change during the year?

If yes, explain: _____________________________________

2. Did you home address change from last year?

3. Can you be claimed as a depend by another taxpayer?

4. Did you change any bank accounts that have been used to

direct deposit (direct debit) funds from (or to) the IRS or other

taxing authority during the tax year?

Dependent Information

5. Do you have any dependents on this year’s return?

If yes, please fill out the chart below:

6. Did you provide over half the support for any other person(s)

during the year?

If yes, please fill out the chart below:

7. Did you pay for child care while you worked or looked-for

work?

8. Did you pay any expenses related to the adoption of a child

during the year?

9. If you are divorced or separated with child(ren), do you have

a divorce decree or other form of separation agreement

which establishes custodial responsibilities? If not, Form

8332 is required for the noncustodial parent.

Purchase, Sales, and Debit Information

10. Did you sell, exchange, or purchase any real estate during

the year?

11. Did you purchase or sell a principle residence during the

year?

12. Did you foreclose or abandon a principal residence or real

property during the year?

13. Did you acquire (buy) or dispose (sale) of any stock during

the year?

Yes No

1.

2.

3.

4.

5.

6.

7.

8.

9.

10.

11.

12.

13.

Name of dependents Date of

birth

Months lived in home

Relationship to taxpayer

College student?

Filed a tax return?

Any Investments

Name of dependents living with you Social

Security # Date of Birth Relationship to taxpayer Income

Documentation Questions The documentation questionnaire is needed before we are

able to start your tax return. Please check the appropriate box

and include all necessary details and documentation.

14. Did you take out a home equity loan this year?

15. Did you refinance a principal residence or second home this

year?

16. Did you incur any non-business bad debts this year?

17. Did you have any debts canceled or forgiven this year? (i.e.

credit card)

18. Did you purchase a new plug-in or electric motor energy

efficient vehicle this year?

19. Did you pay any student loan interest this year? (Form 1098-

E is required)

Income Information

20. Did you receive any income from property sold prior to this

year? (i.e. contract or installment sale)

21. Did you make any withdrawals out of:

____IRA ____SEP

____Roth ____401K

____Keogh ____Other qualified retirement plan

____SIMPLE

22. Did you make any contributions to a:

____IRA ____SEP

____Roth ____401K

____Keogh ____Other qualified retirement plan

____SIMPLE

23. Did you make any withdrawals from an education savings or

529 Plan account? (Form 1099-Q is required)

24. Did you make any contributions to an education savings or

529 Plan account?

25. Did you receive any distributions from:

____Health Savings Account (HAS) (Form 1099-SA is

required)

____Archer MSA

____Medicare Advantage MSA

26. Did you make any contributions to a Health Savings Account

(HAS) or Archer MSA (not payroll contributions)

27. Did you receive any Social Security or Social Security

Disability benefits during the year (Form 1099-SSA is

required)

28. Did you receive any unemployment/workshare during the

year? (Form 1099-G is required)

29. Did you receive any disability income during the year? (i.e.

third party sick pay)

30. Did you receive tip income not reported to your employer this

year?

31. Did any of your life insurance policies mature, or did you

surrender any policies?

32. Did you cash any Series EE or I U.S. Savings Bonds issued

after 1989?

33. Are you actively contributing to a pension or retirement plan?

34. Did you retire or change jobs during the year?

35. Did you incur moving costs because of a job change?

14.

15.

16.

17.

18.

19.

20.

21.

22.

23.

24.

25.

26.

27.

28.

29.

30.

31.

32.

33.

34.

35.

36. Did you invest in Bitcoin, Ethereum, or Lite Coin?

Itemized Deduction Information (if you itemize)

37. Did you incur a casualty or theft loss during the year?

38. Did you pay out-of-pocket medical expenses (co-pays,

prescription drugs, etc.)

39. Do you have evidence to substantiate charitable

contributions?

40. Did you make any noncash charitable contributions (clothes,

furniture, etc.)?

41. Did you donate a vehicle or boat during the year? If yes,

attach Form 1098-C.

42. Did you have an expense account or allowance during the

year?

43. Did you use your car on the job for other than commuting?

(requires mileage log)

44. Did you work out of town for part of the year?

45. Did you have any expenses related to seeking a new job

during the year?

46. Did you make any major purchases during the year (cars,

boats, etc.)?

47. Did you pay health care premiums/nursing home for your self

or your family (Nursing home insurance, etc.)?

48. Did you pay any COBRA health care coverage continuation

premiums?

49. Did you pay state and local real estate property taxes this

year? If yes, please attach a supporting statement.

Business/self-Employed/Rental

50. Are you a business owner and have paid health insurance

premiums for your employees this year?

51. Did you utilize an area of your home for business purposes?

52. Did you engage in any bartering transactions?

53. Did you start a new business during the year?

54. Did you purchase rental property during the year?

55. Did you acquire a new or additional interest in a partnership

or S Corporation?

56. Did you sell an existing business, rental, or other property

this year?

57. Do you have a vehicle used for your business? (mileage log

required)

Foreign Income

58. Were you a grantor or transferor for a foreign trust, have an

interest in or signature or other authority over a bank

account, securities account, or other financial account in a

foreign country?

59. Did you have any foreign income or pay any foreign taxes

during the year?

36.

37.

38.

39.

40.

41.

42.

43.

44.

45.

46.

47.

48.

49.

50.

51.

52.

53.

54.

55.

56.

57.

58.

59.

60. Do you have any interest in or signature/authority over a

foreign account in a foreign country?

If yes, please specify country: _____________________

Form TD F 90-22.1 must be filed if the taxpayer had an

account or accounts which had a value or accumulative

value at any time during the year exceeding $10,000.

Failure to disclose such an account and file Form TD F

90-22.1 can subject the taxpayer to fines as large as

$500,000.

Miscellaneous Information

61. Did you make gifts of more than $14,000 to any individual?

62. Did you pay any college or Votech educational expenses

during the year for your, your spouse, or dependents?

63. Did you participate in cow tipping this year?

64. Did you, your spouse, or your dependents attend a post-

secondary school during the year, or plan to attend on in the

coming year?

65. Did you pay any individual as a household employee during

the year?

66. Did you make any out-of-state purchases (by telephone,

internet, mail, in person) that the seller did not collect state

sales or use tax?

67. Did you receive correspondence from the State or Internal

Revenue Service?

If yes, explain: ___________________________________

68. Do you want to designate $3 to the Presidential Election

Campaign Fund:

____Taxpayer ____Spouse

69. Is there any other information we need to know that was not

included in this questionnaire?

If yes, explain: ____________________________________

IRC 6662(d) assesses an accuracy penalty of 20% when

the taxpayer substantially understates their income by

the great or 10% or $5,000. However, in the case of

unreported foreign account income the penalty is 40%.

Can we email/text you notifications?

Email address: ____________________________________

Cell Phone Provider: ________________________________

Taxpayer Signature: ________________________________

Date: __________________

Spouse Signature: ______________________________

Date: __________________

60.

61.

62.

63.

64.

65.

66.

67.

68.

69.

ACA Requirements

Please list the individuals in your household and the month’s they had health insurance coverage:

Please mark if you had qualified employer-provided health insurance for all of 2017 covering all household members.

Please mark if you had other qualified health insurance purchased directly from an agent or insurance company covering all household

members for all of 2017.

Please mark if you had Medicare for all of 2017

Please mark if you had No Coverage

Taxpayer Signature: ________________________________________________ Date: ___________________

Spouse Signature: ________________________________________________ Date: ___________________

Additional notes or explanation:

Name of Individuals Covered Jan. Feb. Mar. Apr. May Jun. Jul. Aug. Sept. Oct. Nov. Dec.

www.randjsalinatax.com 318 W. Cloud St.

Salina, KS 67401

Subject: Preparation of Your 2017 Tax Returns

Thank you for choosing R & J Salina Tax Service, Inc to assist you with your 2017 taxes. This letter confirms the terms of

our engagement with you and outlines the nature and extent of the services we will provide. We will prepare your 2017

federal and state income tax returns.

CLIENT WILL:

-Provide complete and accurate information for the preparation of the 2017 Income Tax Returns; including documentation

to satisfy requirements for the Affordable Care Act. Unless all required information is available fifteen (15) days prior to the

due date, filing an extension may be required.

-Certify that he/she has and will maintain all documentation as required to support the information used in preparing the

tax returns including, business expenses which may include usage of vehicles, computers, and cell phones.

- Carefully review the completed income tax return for accuracy before signing and mailing them to the taxing authorities.

In the case of Electronic Filing, a 24-hour delay will occur before transmitting your returns giving you adequate time to

review your copies for accuracy.

-Notify the preparer immediately of any corrections or additions to your tax return.

-Notify the preparer immediately of any tax correspondence received from taxing authorities related to these returns.

-Be responsible for any taxpayer penalties, additional taxes or interest assessed by the taxing authorities.

PREPARER WILL:

-Use professional judgement in providing guidance when the tax law is unclear, or where there may be conflicts between

taxing authorities’ interpretations of the law and what seem to be other supportable positions. Whenever possible, the

preparer will resolve such questions in the client’s favor as long as it is consistent with the Tax Codes, Regulations and

Interpretations.

-Prepare the returns(s) based on information and unaudited documentation provided by the client. A checklist will be

provided to aid the client in organizing this information. Such information will be reviewed if needed, client will be asked for

additional documentation or clarification. If needed, bookkeeping services will be rendered at $150 per hour and research

may be performed for an additional fee.

-Inform the client about information discovered that affects other tax years. However, the preparer cannot be held

responsible for identifying ALL items. Should the client become aware of such information, he/she will contact the

preparer to discuss resolution of the issue.

-Prepare and present the completed return(s) for filing and provide the client a copy of the return(s) along with their

original information and documentation used in its preparation.

-Treat any information received from the client as confidential and subject to disclosure ONLY AT WRITTEN REQUEST of

the client as compelled by law. Copies of the completed return(s) will be kept digitally on a secure cloud server. If the

client requests additional copies of the return(s) and/or documents, there may be a fee for the service.

Phone: (785) 827-1304

Fax: (785) 827-0383

-Although anything disclosed by taxpayer during the interview is confidential, the preparer cannot disregard the

implications of any information provided during the process of preparing the return. Additionally, there is not attorney-client

privilege in the tax returns and the Internal Revenue Service will not be misled in any way.

FEE POLICY:

The fee for these services will be based upon the amount of time required, billed at our standard rate. All fees are due and

payable upon presentation. The fee for preparing your income tax return(s) does NOT include responding to tax agency

inquiries, representations on your behalf, or subsequent consultations.

AUDIT AND/OR ASSISTANCE POLICY:

The return preparation fee does NOT include services requested after the return is completed in connection with

correspondence or audits. However, audit assistance is available on an hourly basis and is billed separately. All income

tax returns are subject to examination by the taxing authorities. If this should occur, we will assist you, if you so desire. It

is important for you to know that any items resolved against you by the examining agent, such as disallowance of doubtful

deductions or inadequate documentation, the resulting taxes, or penalties and interest are ultimately your responsibility

although you still have certain rights to appeal to the taxing authority.

RECORDS RETENTION:

Documents related to tax preparation that are left with the preparer will be returned to the taxpayer when the

corresponding return is completed and picked up. If the documents are left with the preparer the taxpayer will be notified

by telephone call or letter that the documents must be picked up or the preparer will securely keep a digital copy of the

documents on our secure cloud server and destroy the original copy.

We sincerely appreciate this opportunity to serve you and look forward to a long and mutually satisfying, professional

relationship.

R & J Salina Tax Service, Inc

Acceptance:

I have read and hereby accept the foregoing terms and conditions of this agreement.

(Both spouses must sign for preparation of joint returns.)

Accepted By:

_______________________________________________________

Print Taxpayer Name

_______________________________________________________ __________________

Sign Taxpayer Name Date

_______________________________________________________

Print Spouse Name

________________________________________________________ ___________________

Sign Spouse Name Date

Client Disclosure Agreement Form

The IRS sent out over 200 million automated notices last year to unsuspecting taxpayers leveraging technology

instead of relying on their own work force. A majority of these notices were downright incorrect that cost taxpayers

millions of dollars to defend and prove their “innocence”. Your chances of receiving one of these notices

questioning items on your return, or stating that you’re being audited or informing you that your tax identity was

stolen is increasing every year.

It can cost anywhere from $250 to $500 and up just to respond to an uncomplicated IRS/State computer generated

notice. Defending an actual audit or having your tax ID stolen can mean real financial stress to your life. Audit

representation fees alone can range from $3,500-$10,000 and up. In order to safeguard you from incurring any of

these unforeseen expenses, we’ve created our Audit Protection Plan. For just a small fee, you can rest assured-

we’ve got you covered under one of our Plans below:

Basic Plan - $49/yr. ($225 value)

✓ We’ll respond to written notices from the IRS, State, or local tax authorities.

✓ Certified Mail of All Correspondence & Payments

Silver Plan - $79/yr. ($3,725 value)

Includes everything in Basic Plan, PLUS:

✓ We’ll respond to written notices from the IRS, State, or local tax authorities.

✓ We’ll restore your tax account and any refunds due to Tax Identity Theft. ($750 value)

✓ One hour of additional consultation services at no additional charge. ($150 value)

Gold Plan - $129.95/yr. (Best Value!) ($4,550+ value)

Includes everything in Silver Plan, ($3,725 value), PLUS:

✓ We’ll provide copies of your tax returns upon your request at no charge.

✓ 4 planning meetings thru-out the year. ($600 value);

✓ Priority phone, email and office access;

✓ **Individual IRS & State “Worry-Free” Audit Representation. ($2,500 Value)

**We’ll waive our hourly Audit fee for up to 10 hours of audit representation.

Additional hours will be billed at our regular rate of $250/hour

(Value = Regular fee: $2,500 retainer + $250/hour).

This protection becomes effective upon the filing of your 2017 Form 1040 and generally lasts for 3 years from the

date your return was filed.

(Opt-OUT) By checking here, I indicate my choice not to participate in the Audit Protection Plan. I understand

that I will be subject to additional charges at $250 if my return is selected for audit, or if I receive notices from a

taxing authority questioning items on my return, or if my tax identity is stolen or if I need additional services not

included with the preparation of my tax return.

__________________________________________________ ________________________

Client Signature Date

Phone: (785) 827-1304

Fax: (785) 827-0383

318 W. Cloud St

Salina, KS 67401

www.randjsalinatax.com

Privacy Policy

Your privacy is important to us. Please read the following privacy policy.

We collect nonpublic personal information about you from various sources, including:

*Interviews regarding your tax situation

*Applications, organizers, or other documents that supply such information as

your name, address, telephone number, Social Security Number, number of

dependents, income, and other tax-related data

*Tax-related documents you provide that are required for processing tax returns,

such as Forms W-2, 1099-R, 1099-INT and 1099-DIV, and stock transactions

We do not disclose any nonpublic personal information about our clients or former

clients to anyone, except as requested by our clients or permitted by law.

We restrict access to personal information concerning you, except to our employees

who need such information in order to provide products or services to you. We maintain

physical, electronic, and procedural safeguards that comply with federal regulations to

guard your personal information.

If you have any questions about our privacy policy, please contact us.

Sincerely,

R & J Salina Tax Service, Inc

Phone: (785) 827-1304

Fax: (785) 827-0383

318 W. Cloud St

Salina, KS 67401

www.randjsalinatax.com

Personal Information:

• Last 3 years of income tax returns

• Social Security Number for taxpayer, spouse, and dependents

• Birth dates for taxpayer, spouse, and dependents

• Current address

• Current phone number

• Social Security Cards for taxpayer, spouse, and dependents

• State issued Identification for taxpayer and spouse

• Birth certificates for dependents

• Current bank account and routing numbers if wanting direct deposit

• Proof of health insurance Income Data Required:

• Wages and/or unemployment

• Interest and/or Dividend Income

• State/Local income tax refund

• Social Assistance Income

• Pension/Annuity/Stock or Bond Sales

• Contract/Partnership/Trust/Estate Income

• Gambling/Lottery Winnings and Losses/Prizes/Bonus

• Alimony Income

• Rental Income

• Self-Employment/Tips

• Foreign Income Expense Data Required:

• Dependent Care Costs

• Education/Tuition Costs/Materials Purchased

• Medical/Dental

• Mortgage/Home Equity Loan Interest/Mortgage Insurance

• Employment Related Expenses

• Gambling/Lottery Expenses

• Tax Return Preparation Expenses

• Investment Expenses

• Real Estate Taxes

• Estimated Tax Payment to Federal and State Government and dates paid

• Home Property Taxes

• Charitable Contributions Cash/No-cash

• Purchase qualifying for Residential Energy Credit

• IRA Contributions/Retirement Contributions

• Home Purchase/Moving Expenses

Tax Appointment Checklist