Tax Checklist
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.
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 ___
□ 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
- 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 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 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.
__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.
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