The 2011 tax questionnaire consists of details related to income tax filing of an individual in the year 2011 or the financial year 2010 – 2011. This type of questionnaire reveals information regarding earnings or income in 2011, expenses and taxable amount.  This type of information is used by income tax consultants for determining the amount of income accrued and the tax payable by an individual.

2011 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. Please list below the wages drawn in 2011 along with employer name, taxable wage, federal withholding, and state withholding.

1. _____________________________

2. _____________________________

3. _____________________________

4. _____________________________

5. _____________________________

Q4.  What was your dividend income in 2011?


Q5.  What expenses did you incur on the following in 2011?

a)   Utilities – electric bills

b)   Utilities – phone bills

c)   Utilities – Others

d)   House rent

e)   Medical expenses

f)    Insurance

g)   Automobile expenses

h)   Travel

Q6. Did you have income from any other source other than your current employer? If yes, provide details

a)   Yes

b)   No

c)   Details:_________________________________________________________________

Q7. What was your income from rent if you have any property on rent?


Q8. Please provide details on the following

a)   Social security benefits: __________________________

b)   Pension, annuities, and IRA – Gross Distribution: __________________________

c)   Government payments (if any): __________________________

d)   Miscellaneous income: __________________________

Q9. What is the amount of investment interest paid by you in 2011?


Q10. What is your estimated tax payment for 2011?


Q11. What is your interest income in 2011?