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.