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.