Tax
Organizer
Name:______________________________SS#________________________________
Spouse's
Name:_______________________SS#______________________________
Address:_________________________________________________________________________
Date of Birth:____________________________
Spouse's:_______________________________
Occupations:_____________________________________________________________________
Children\Dependence (Name & SS#)_______________________________________________
________________________________________________________________________________
OTHER INCOME
Interests &
Dividends:_____________________________________________________________
State Refunds:_______________ Social Security:________________
Pension:______________
Unemployment:_______________ Disability:_______________
Farm:_____________________
Single Proprietorship:________________ S Corporation:______________
Rental:__________
Partnership:_____________________________ Sale of
Residence:________________________
EXPENSES
Alimony (Paid\Received):______________ IRA:_______________ Child
Care:_____________
Estimated Taxes Paid (Fed. & State With
Dates):______________________________________
Employee Expenses: Mileage:______________________
Other:_________________________
Medical:__________ Glasses\Other:__________ Insurance
Reimbursement:_______________
Education Expenses:_____________________ IRA Custodial
Fees:_______________________
Real Estate Taxes:_____________________ Personal Property
Taxes:____________________
Home Interest:_____________________________
Points:_______________________________
Contributions (Names &
Amounts):_________________________________________________
Non-Cash
Contributions:__________________________________________________________
Union Dues:_____________ Casualty or Theft Loss:______________ Tax Prep.
Fee:_______
Safety Equipment\Tools:_______ Safety Deposit Box:_______ Uniforms & Cleaning:
_____
To the best of my knowledge, all information that is provided to complete my
individual tax return is true and correct. I accept all responsibilities and
have verifies all details.
Signature:_______________________________________________________________________
Spouse's
Signature:_______________________________________________________________
Please bring supporting information.
