
This 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.
GENERAL INFORMATION:
□ 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 ___
□ 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 Advertising Auto: Parking &Tolls
Business Phone Expense Cell Phone Expense Subcontractors
Commissions Paid Insurance Interest Paid
General Office Expense Rent/Lease Fees Paid Legal or Professional Fees
Repairs Cleaning/Maintenance Dues & Publications
Equipment/Supplies Tools License Fees/Taxes Paid
Utilities Education Expense Association Dues
Bank/Credit Card Fees Postage Meals/Entertainment
Business Miles & Total Miles (A Mileage log is required) Hotel/Travel Expense
Asset Purchases (Date, amount and item)
ADDITIONAL ITEMS FOR RENTAL PROPERTIES:
Keys Condo/PUD Fees Management Fees
Mortgage Statements Yard Work Termite Treatment Expense
Utilities Mileage/Travel Other
DEDUCTIONS/CREDITS TO INCOME:
Self-employed Health Insurance IRAs /Keogh/SEPs Retirement Saver’s Credit
Health Savings Account (HSA) Teacher Expenses Adoption Expenses
Penalty on Early Withdrawal of Savings Moving Expenses
* American Opportunity/Lifetime Learning/Student Loan Interest/Education Expenses – 1098-T Please bring a detailed billing/payment statement from the educational institution.
* 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 each Federal 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.
If you had other healthcare insurance provide Form 1095-B or 1095-C.
Did you make any contributions to or receive distributions from a Health Savings Account, Archer MSA or Medicare Advantage MSA?
ITEMIZED DEDUCTIONS:
INTEREST
Mortgage Interest, Form 1098
MEDICAL
Medical & Dental bills Prescriptions Glasses/Contact Lenses
Out-of-pocket expenses Medical miles Lab fees
Hearing Aids Medical/dental/long term care insurance
TAXES
Prior year state tax paid City/local tax Real estate tax
Personal property tax Other
CHARITABLE CONTRIBUTIONS
Church Boy/Girl Scouts United Way/CFC
March of Dimes American Heart Easter Seals
Red Cross MDA/MS YWCA/YMCA
Salvation Army FoodBank Payroll deductions
Out-of-pocket Volunteer Expenses Charitable miles Other
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.
Identity Theft:
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.