The 2010 tax questionnaire consists of details related to income tax filing of an individual in the year 2010. This type of questionnaire reveals not only the tax information of individuals but also their personal and occupational information. This type of information is used by income tax consultants for determining the amount of income accrued and the tax payable by an individual.

2010 Tax Questionnaire Sample

Name of Taxpayer: ________________________________

Social Security Number: _________________________________

Address: ______________________________________

City: ________________ State: ___________________  Zip: _________________

Telephone: ____________________  Fax: ____________________________

Age:________________________ Occupation:_____________________________

Filling Status:  ________________________ (Married/Single/Head of household/Qualifying widow)

Q1. What is the amount of local tax and income tax paid by you in 2010?


Q2. What is the amount of real estate and personal property taxes paid by you in 2010?


Q3. What is your estimated tax payment for 2011?


Q4. What is your interest income in 2010?


Q5. Please list below the wages drawn in 2010 along with employer name, taxable wage, federal withholding, and state withholding.

1. _____________________________

2. _____________________________

3. _____________________________

4. _____________________________

5. _____________________________

Q6.  What was your dividend income in 2010?


Q7.  What expenses did you incur on the following in 2010?

a)   House rent

b)   Utilities – electric bills

c)   Utilities – phone bills

d)   Utilities – Others

e)   Travel

f)    Insurance

g)   Medical expenses

h)   Automobile expenses

Q8. Did you have income from any other source other than your current employer? If yes, provide details

a)   Yes

b)   No

c)   Details:_________________________________________________________________

Q9. What was your income from rent if you have any property on rent?


Q10. Please provide details on the following

a)   Pension, annuities, and IRA – Gross Distribution:

b)   Social security benefits:

c)   Government payments (if any)

d)   Miscellaneous income:

Q11. What is the amount of investment interest paid by you in 2010?