This form is to assist you in gathering your income tax information. Use it as a guide for information you need to provide. Please call or e-mail with any questions.
□ First, middle initial, and last names of taxpayers and dependents as written on the Social Security cards, and dates of birth for taxpayers and all dependents, especially new dependents.
□ Address (city, state, ZIP), telephone number and e-mail address.
□ Marital Status: Single ___ Married ___ Head of Household ___ Separated ___
□ Did you get married to a same-sex spouse in a state that legally recognizes same-sex marriage?
□ Number of Dependents: ___ Did any dependents have any income? Yes ___ No ___
□ Do all dependents live with you? Yes ___ No ___
TYPES OF INCOME AND TAX REPORTING FORMS:
□ Wages: All Forms W-2
□ Income from Rentals: All 1099-MISC
□ Pensions/Retirements: 1099-R
□ Business Income: All 1099-MISC & 1099-K
□ Social Security: SSA-1099
□ Farm Income
□ Bank Interest: 1099-INT
□ Alimony Received: Total amount
□ Dividends: 1099-DIV
□ Unemployment: 1099-G
□ Commissions: 1099-MISC
□ State Tax Refund: 1099-G
□ Tips and Gratuities
□ Miscellaneous: Jury Duty, Gambling, Other
□ Sales of Stock, Mutual Funds: 1099-B
Foreign Income Matters:
__Did you receive a distribution from, or were you a grantor or transferor for a foreign trust?
__Did you have a financial interest in or signature authority over a financial account located in a foreign country?
__Did you have any foreign financial accounts, foreign financial assets, or hold interest in a foreign entity?
BUSINESS INCOME & EXPENSE ITEMS: This list is not all encompassing. If you don’t see an expense listed below, ask.
- Total (Gross) Income
- Auto: Parking &Tolls
- Business Phone Expense
- Cell Phone Expense
- Commissions Paid
- Interest Paid
- General Office Expense
- Rent/Lease Fees Paid
- Legal or Professional Fees
- Dues & Publications
- License Fees/Taxes Paid
- Education Expense
- Association Dues
- Bank/Credit Card Fees
- Business Miles & Total Miles (A Mileage log is required)
- Hotel/Travel Expense
- Asset Purchases (Date, amount and item)
ADDITIONAL ITEMS FOR RENTAL PROPERTIES:
- Condo/PUD Fees
- Management Fees
- Mortgage Statements
- Yard Work
- Termite Treatment Expense
DEDUCTIONS/CREDITS TO INCOME:
- Self-employed Health Insurance
- IRAs /Keogh/SEPs
- Retirement Saver’s Credit
- Health Savings Account (HSA)
- Teacher Expenses A
- doption Expenses
- Penalty on Early Withdrawal of Savings
- Moving Expenses
- American Opportunity/Lifetime Learning/Student Loan Interest/Education Expenses
* Total Alimony Paid: Must have name and Social Security number of recipient, and amount paid.
* Child Care/Day Care Credit: Must have name, address, Social Security number or EIN of provider, and amount paid per child.
ESTIMATED TAXES PAID:
Date of payment and amount paid for eachFederal and State quarterly tax estimate.
HEALTH CARE INFORMATION:
__Did you have qualifying health care coverage (employer group plan coverage or government-sponsored coverage) for every month of 2014 for you, your spouse and all members of your family as claimed on your tax return?
__Did you or anyone in your family qualify for an exemption from the health care coverage mandate?
__Did you acquire health care coverage through the Marketplace under the Affordable Care Act? If yes, provide Form(s) 1095-A.
__Did you make any contributions to or receive distributions from a Health Savings Account, Archer MSA or Medicare Advantage MSA?
- Mortgage Interest, Form 1098
- Medical & Dental bills
- Glasses/Contact Lenses
- Out-of-pocket expenses
- Medical miles
- Lab fees
- Hearing Aids
- Medical/dental/long term care insurance
- Prior year state tax paid
- City/local tax
- Real estate tax
- Personal property tax
- Boy/Girl Scouts
- United Way/CFC
- March of Dimes
- American Heart
- Easter Seals
- Red Cross
- Salvation Army
- Payroll deductions
- Out-of-pocket Volunteer Expenses
- Charitable miles
For donations, please provide evidence such as a receipt from the done organization, a canceled check, or record of payment to substantiate all contributions made. An itemized listing of all non-cash donations must be maintained with the receipts. List must include the Fair Market Value for each donation of non-cash items.
__Did you receive an Identity Protection PIN from the Internal Revenue Service or have you been a victim of identity theft? If so, please provide the IRS letter.
For more information, contact Elite Bookkeeping & Tax Services at (800) 416-3820 or (775) 884-6188 Address: 123 West Nye Lane, Suite 103, Carson City, NV 89706. Visit our website at www.elitebookkeeping.biz