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Client Tax OrganizerPlease provide an additional page for any specific questions/comments that we should be alerted to1. Personal InformationNameSoc. Sec. No.Date of BirthOccupationWork PhoneTaxpayerSpouseStreet AddressCityTaxpayerSpouseStateZIPHome PhoneMarital lePres. Campaign FundYesNoYesNoWidow(er), Date of Spouse's DeathWill file jointlyYesNo2. Dependents (Children & Others)Name(First, Last)Date ofBirthRelationshipSocial SecurityNumberMonthsLivedDisabledWith YouFullTimeStudentDependent'sGrossIncomePlease provide:- Last year's tax return (new clients only)- All statements (W-2s, 1099s, etc)Please answer the following questions to determine maximum deductions1.2.3.Are you self-employed or do youreceive hobby income?Yes*No10. Did you give a gift of more than 14,000to one or more people?YesNoDid you receive income fromraising animals or crops?Yes*No11. Did you have any debts cancelled, forgiven,or refinanced?YesNoDid you receive rent from realestate or other property?Yes*No12. Did you go through bankruptcyproceedings?YesNoYesNo14. Did you pay interest on a student loan foryourself, your spouse, or your dependentduring the year?YesNo15. Did you pay expenses for yourself, yourspouse, or your dependent to attendclasses beyond high school?YesNo16. Did you have any children under age 24 withunearned income of more than 2,000?YesNoNo17. Did you purchase a new "hybrid", alternativetechnology vehicle or electric vehicle?YesNoNo18. Did you install any energy efficiencyimprovements, or energy property to yourresidence such as exterior doors or windows,insulation, heat pumps, furnace, central airconditioning or water heaters?YesNo4.Did you receive income fromgravel, timber, minerals, oil, gas,copyrights, patents?Yes*No5.Did you withdraw or writechecks from a mutual fund?YesNoDo you have a foreign bankaccount, trust, or business?YesNoDo you provide a home for orhelp support anyone not listedin Section 2 above?YesNo6.7.8.9.Did you receive any correspondencefrom the IRS or State Departmentof Taxation?Were there any births, deaths,marriages, divorces or adoptionsin your immediate family?*Complete Section 28 Below13. (a) If you paid rent, how much did you pay?YesYes(b) Was heat included?
3. Wage, Salary Income8. Property SoldAttach W-2s:Attach 1099-S and closing statementsTaxpayerEmployerSpousePropertyDate AcquiredCost & Imp.Personal Residence*Vacation HomeLandOther* Provide information on improvements, prior sales of home,and cost of a new residence. Also see Section 17(Job-Related Moving).4. Interest Income9. I.R.A. (Individual Retirement Acct.)Attach 1099-INT & broker statementsPayerAmountContributions for tax year incomeAmountU forRothDateTaxpayerSpouseTax ExemptAmounts withdrawn. Attach 1099-R & 5498PlanTrusteeReason forWithdrawalReinvested?5. Dividend IncomeFrom Mutual Funds & Stocks - Attach sNoYesNoYesNo10. Pension, Annuity IncomeAttach 1099-RPayer*6. Partnership, Trust, Estate IncomeReason forWithdrawalReinvested?YesNoYesNoYesNoYesNo* Provide statements from employer or insurancecompany with information on cost of orcontributions to plan.List payers of partnership, limited partnership, S-corporation, trust,or estate income - Attach K-1Did you receive:Social Security BenefitsRailroad RetirementTaxpayerYesYesSpouseNoNoYesYesAttach SSA 1099, RRB 10997. Investments SoldStocks, Bonds, Mutual Funds, Gold, Silver, Partnership interest - Attach 1099-BInvestmentDate Acquired/Sold////CostSale PriceNoNo
15. Casualty/Theft Loss11. Other IncomeList All Other Income (including non-taxable)For property damaged by storm, water, fire, accident, or stolen.Alimony ReceivedLocation of PropertyChild SupportScholarship (Grants)Description of PropertyUnemployment Compensation (repaid)Prizes, Bonuses, AwardsGambling, Lottery (expenses)Amount of DamageUnreported TipsInsurance ReimbursementDirector / Executor's FeeRepair CostsCommissionsFederal Grants ReceivedJury DutyWorker's Compensation16. Charitable ContributionsDisability IncomeVeteran's PensionPayments from Prior Installment SaleState Income Tax RefundOtherChurchUnited WayScoutsTelethonsOtherUniversity, Public TV/Radio12. Medical/Dental Expenses: See Section 26 below tooOnly provide if in excess of 10% of your incomeMedical Insurance Premiums(paid by you)Prescription DrugsInsulinHeart, Lung, Cancer, etc.Wildlife FundSalvation Army, GoodwillOtherNon-CashVolunteer (no. of miles)Glasses, ContactsHearing Aids, Batteries17. Job-Related Moving ExpensesMedical Equipment, SuppliesNursing CareMedical TherapyDate of moveMove Household GoodsHospitalDoctor/Dental/OrthodontistMileage (no. of miles)Travel to New Home (no. of miles)Lodging During MoveLong-Term Care Premiums13. Taxes Paid18. Employment Related Expenses That You Paid(Not self-employed)Dues - Union, ProfessionalReal Property Tax (attach bills)Books, Subscriptions, SuppliesPersonal Property TaxLicensesOtherTools, Equipment, Safety EquipmentUniforms (include cleaning)14. Interest ExpenseSales Expense, GiftsTuition, Books (work related)Mortgage interest paid (attach 1098)EntertainmentInterest paid to individual for yourhome (include amortization schedule)Paid to:NameOffice in home:In Square a) Total homeFeetc) StorageAddressSocial Security No.RentInvestment InterestInsurancePremiums paid or accrued for qualifiedUtilitiesmortgage insuranceb) OfficeMaintenance
19. Child & Other Dependent Care ExpensesName of Care ProviderAddressSoc. Sec. No. orEmployer IDAmountPaidStateCityAlso complete this section if you receive dependent care benefits from your employer.20. Business Mileage23. Estimated Tax PaidDo you have written records?YesNoDid you sell or trade in a car usedfor business?YesNoDate PaidFederalIf yes, attach a copy of purchase agreementMake/Year Vehicle24. Other DeductionsDate purchasedTotal miles (personal & business)Business miles (not to and from work)Alimony Paid to From first to second jobSocial Security No.Education (one way, work to school)Student Interest PaidJob SeekingHealth Savings Account ContributionsArcher Medical Savings Acct. ContributionsOther Business Round Trip commuting distance25. Education ExpensesGas, Oil, LubricationBatteries, Tires, etc.RepairsStudent's NameType of ExpenseAmountWashInsuranceInterestLease paymentsGarage Rent21. Business TravelIf you are not reimbursed for exact amount, give total expenses.26. MMedical & Health InsuranceAirfare, Train, etc.LodgingMeals (no. of days)Taxi, Car RentalOtherReimbursement ReceivedWere you and your family covered by health insurance for all 12months last year? Yes / NoDo you have Marketplace insurance from healthcare.gov throughthe Affordable Healthcare Act? If yes, provide from 1095-A22. Investment-Related ExpensesTax Preparation FeeSafe Deposit Box RentalResidence:Mutual Fund FeeTownCountyInvestment CounselorVillageSchool DistrictOtherCity
27. Direct Deposit of RefundWould you like to have your refund(s) directly deposited into your account?(The IRS will allow you to deposit your federal tax refund into up to threedifferent accounts. If so, please provide the following information.)YesNoACCOUNT 1Owner of accountType of accountTaxpayerJointSpouseCheckingTraditional SavingsTraditional IRARoth IRAArcher MSA SavingsCoverdell Education SavingsHSA SavingsSEP IRAName of financial institutionFinancial Institution Routing Transit Number (if known)Your account numberACCOUNT 2Owner of accountType of accountTaxpayerJointSpouseCheckingTraditional SavingsTraditional IRARoth IRAArcher MSA SavingsCoverdell Education SavingsHSA SavingsSEP IRAName of financial institutionFinancial Institution Routing Transit Number (if known)Your account numberACCOUNT 3Owner of accountType of accountTaxpayerJointSpouseCheckingTraditional SavingsTraditional IRARoth IRAArcher MSA SavingsCoverdell Education SavingsHSA SavingsSEP IRAName of financial institutionFinancial Institution Routing Transit Number (if known)Your account numberTo the best of my knowledge the information enclosed in this client tax organizer is correct and includes allincome, deductions, and other information necessary for the preparation of this year's income tax returns forwhich I have adequate records.TaxpayerDateSpouseDate
28: Schedule C or E: BusinesV Income / Rental Income / Royalty IncomeType of Business & IndustryGross receipts and salesThis year's InformationAdvertisingCar and truck expensesCommissions and feesContract laborDepletionDepreciationEmployee benefit programs (Include Small Employer Health Ins Premiums credit):Insurance (Other than health):Interest:Mortgage (Paid to banks, etc.)Other:Legal and professional servicesOffice expensePension and profit sharing:Rent or lease:Vehicles, machinery, and equipmentOther business propertyRepairs and maintenanceSuppliesTaxes and licenses:Travel, meals, and entertainment:TravelMeals and entertainmentMeals (Enter 100% subject to DOT 80% limit)UtilitiesWages (Less employment credit):Other expenses:
Roth Reinvested? Yes Yes Yes Yes No No No No 5. Dividend Income From Mutual Funds & Stocks - Attach 1099-DIV Payer Ordinary Capital Gains Non-Taxable 10. Pension, Annuity Income Attach 1099-R P
