First Print it, then fill out as much as you can, and bring it with you to your appointment with all the supporting documentation and receipts.
* Imprime este organizador de Declaracion de Impuestos, llena lo mas que puedas y junta todos los documentos que apliquen a tu situacion
y traelo contigo a tu cita junto con todos los documentos y recibos necesarios.
TAX ORGANIZER
L.N. Precision Taxes
1606 Cascade Ridge Dr
Plainfield, IL 60586
(815)342-2075
Fax (815) 782-4091
lnunez@lnprecisiontaxes.com
( If you are a new client, please send a copy of last years tax return)
FOR TAX YEAR ___________
Your Name | S.S. # - - | Birthdate / / |
Spouses Name | S.S. # - - | Birthdate / / |
Mailing Address | Home Phone Number Work or Cell Phone Number ( ) - ( ) - |
| E-mail Address |
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DEPENDENTS
NAME | S.S. # | D.O.B. | RELATIONSHIP |
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Was there anyone else you contributed support, that resides in the U.S., Canada or Mexico?
NAME | S.S. # | D.O.B. | RELATIONSHIP | % SUPPORTED | INCOME OF PERSON |
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CHILD OR DEPENDENT CARE
Did you pay a baby-sitter last year?
NAME OF SITTER | S.S. # | ADDRESS | AMT. PD. |
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If your sitter is an adult & works in your home, you are required to file W-2 forms by January 31. If you want us to prepare
these forms contact us right away.
ESTIMATED TAXES
CREDIT FROM PRIOR YEAR’S VOUCHER PAYMENTS | FIRST QUARTER (APRIL 15) | SECOND QUARTER (JUNE 15) | THIRD QUARTER (SEPT. 15) | FOURTH QUARTER (JAN. 15) | TOTAL FOR YEAR |
Federal $ |
$ |
$ |
$ |
$ |
$ |
State $ |
$ |
$ |
$ |
$ |
$ |
INCOME
Wages, Salaries, Tips, Etc. (Attach W-2s)
Interest income from Seller-Financed Mortgages & Individuals:
Interests from Banks & Financial Institutions (Attach 1099 Int)
Include all that have your Social Security number on them.
NAME | AMOUNT | | NAME | AMOUNT |
_________________________ | $________________ | | _________________________ | $________________ |
_________________________ | $________________ | | _________________________ | $________________ |
Did you sell or turn in any U.S. Savings Bonds? | YES | | NO | |
If yes, Please list information:___________________________________________________________________________
Nontaxable Interest: (Attach Information) | | | | |
Did you have any foreign bank accounts? | YES | | NO | |
If yes, please explain__________________________________________________________________________________
Did you have any penalties on Early Withdrawal of Savings Certificates? | YES | | NO | |
If yes, list or attach information__________________________________________________________________________
Dividends: (Attach 1099Div’s) Capital Gain Distributions: (Attach 1099B’s) Education Distributions: (Attach 1099Q’s)
Nontaxable Distributions: (Attach 1099s) Pensions: (Attach 1099Rs)
Exclusions of Reinvested Dividends from Public Utility: Attach Information. Did you serve in a Combat Zone? _______
Did you Contribute to your pension plan?__________ If yes, have you already recovered your contribution?__________
Did you have any Rollovers?_____ If yes, Attach 1099 Distribution & Rollover papers Alimony: How much did you receive? $_____
OTHER INCOME
Estate & Trusts | $___________________ | (Attach K-1s) | | Jury Duty | $___________________ |
S-Corporations | $___________________ | (Attach K-1s) | | Other | $___________________ |
Partnerships | $___________________ | (Attach K-1s) | | Other | $___________________ |
Did you have any tips that you did not report to your employer? If not reported, how much did you receive? $________________
Prizes & Awards $_______________ State Tax Refund $_______________ Unemployment Compensation $_______________
Lump Sum Distributions $_______________ (Attach 1099R”s) Gambling Winnings (Attach W-2 G’s) $__________________
Gains & Losses from Sale of Property, Stock, Etc. (Attach 1099 B’s)
Description | Date Bought | Date Sold | Sale Price | Cost & Expense | Gain or Loss |
_______________________________ | ___/___/___ | ___/___/___ | $___________ | $___________ | $__________ |
_______________________________ | ___/___/___ | ___/___/___ | $___________ | $___________ | $__________ |
_______________________________ | ___/___/___ | ___/___/___ | $___________ | $___________ | $__________ |
SALE OF RESIDENCE - Please send or bring escrows of purchase & sale of new house. Also list improvements on old house.
DID YOU HAVE ANY OTHER INCOME FROM ANY OTHER SOURCE?
Source | _____________________________________ | Amount | $_______________ |
Source | _____________________________________ | Amount | $_______________ |
Source | _____________________________________ | Amount | $_______________ |
SOCIAL SECURITY
How much did you receive? $_______________ How much did your spouse receive? $_____________ (Attach SSA 1099s)
If you paid any individuals or Partnership $600.00 or more for rent or services for business purposes, you are required to file 1099s prior to
February 28th. If you would like us to prepare these, please contact us right away.
FARM INCOME - If you had any Farm Income, attach or bring in the information.
BUSINESS INCOME / BUSINESS EXPENSES (FOR SELF EMPLOYED)
What is the main business activity?________________________________________________________________________________________________ | |
Business Name_____________________________________________________________________________________ | |
Business Address____________________________________________________________________________________ | |
How much is your gross business income ? $____________________ (Attach 1099 Miscs)
HOW MANY MILES DID YOU DRIVE FOR BUSINESS PURPOSES? _______________________________ | |
Merchandise | $________________ | | Real Estate Taxes | $________________ |
Costs of Goods | $________________ | | Other Taxes & Licenses | $________________ |
Materials & Supplies | $________________ | | Travel (no meals) | $________________ |
Advertising | $________________ | | Meals & Entertainment | $________________ |
Bad Debts | $________________ | | Utilities & Telephone | $________________ |
Car & Truck Expense | $________________ | | Wages & Salaries | $________________ |
Commissions | $________________ | | Bank Service Charges | $________________ |
Insurance (other than health) | $________________ | | Tools | $________________ |
Mortgage Interest | $________________ | | Uniforms | $________________ |
Other Interest Paid | $________________ | | Safety Items | $________________ |
Legal & Professional Fees | $________________ | | Freight & Shipping | $________________ |
Office Expenses | $________________ | | Dues & Publications | $________________ |
Rent on Business Property | $________________ | | Laundry & Cleaning | $________________ |
Equipment Rentals | $________________ | | (other) | $________________ |
Repairs | $________________ | | (other) | $________________ |
Supplies | $________________ | | (other) | $________________ |
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INCOME FROM PROPERTY RENTAL
| RENTAL 1 | RENTAL 2 | RENTAL 3 |
Rents Received (Attach all 1099s) | $__________________ | $__________________ | $__________________ |
Advertising Costs | $__________________ | $__________________ | $__________________ |
Association Dues | $__________________ | $__________________ | $__________________ |
Auto & Travel | $__________________ | $__________________ | $__________________ |
Cleaning & Maintenance | $__________________ | $__________________ | $__________________ |
Commissions | $__________________ | $__________________ | $__________________ |
Gardening | $__________________ | $__________________ | $__________________ |
Insurance | $__________________ | $__________________ | $__________________ |
Legal & Professional Fees | $__________________ | $__________________ | $__________________ |
Licenses & Permits | $__________________ | $__________________ | $__________________ |
Management Fees | $__________________ | $__________________ | $__________________ |
Miscellaneous | $__________________ | $__________________ | $__________________ |
Mortgage Interest | $__________________ | $__________________ | $__________________ |
Other Interest Paid | $__________________ | $__________________ | $__________________ |
Painting & Decorating | $__________________ | $__________________ | $__________________ |
Painting Equipment ( brushes, ladders, etc. ) | $__________________ | $__________________ | $__________________ |
Pest Control | $__________________ | $__________________ | $__________________ |
Plumbing & Electrical | $__________________ | $__________________ | $__________________ |
Repairs | $__________________ | $__________________ | $__________________ |
Supplies | $__________________ | $__________________ | $__________________ |
Cleaning Supplies | $__________________ | $__________________ | $__________________ |
Tools | $__________________ | $__________________ | $__________________ |
Taxes | $__________________ | $__________________ | $__________________ |
Telephone | $__________________ | $__________________ | $__________________ |
Utilities | $__________________ | $__________________ | $__________________ |
Wages & Salaries | $__________________ | $__________________ | $__________________ |
Other (list) | $__________________ | $__________________ | $__________________ |
Other (list) | $__________________ | $__________________ | $__________________ |
Other (list) | $__________________ | $__________________ | $__________________ |
RENTAL INCOME (continued)
What type of property is the rental? (i.e. four bedroom house, warehouse, trailer park, etc.)
RENTAL 1________________________ | RENTAL 2________________________ | RENTAL 3________________________ |
When did you purchase your rental property? (Mm/Yy)
RENTAL 1................_______/_______ | RENTAL 2................_______/_______ | RENTAL 3 ...............________/_______ |
How much did the rental property cost you?
RENTAL 1 $______________________ | RENTAL 2 $______________________ | RENTAL 3 $_____________________ |
Did you have any Farm Rental Income? __________ If yes, attach information. Did you have any Royalties? __________If yes, attach information & 1099s. Did you receive an Education Distribution?______
DEDUCTIONS
MEDICAL
Medicines | $_____________________ | Drugs | $_____________________ |
NAME | Amount Paid After Insurance Reimbursement | NAME | Amount Paid After Insurance Reimbursements |
Doctors:______________________________ | $_____________ | Specialists:_________________________ | $_____________ |
____________________________________ | $_____________ | _________________________________ | $_____________ |
____________________________________ | $_____________ | _________________________________ | $_____________ |
Dentists: _____________________________ | $_____________ | Chiropractors:______________________ | $_____________ |
____________________________________ | $_____________ | _________________________________ | $_____________ |
____________________________________ | $_____________ | __________________________________ | $_____________ |
Orthodontists: _________________________ | $_____________ | Clinics:____________________________ | $_____________ |
____________________________________ | $_____________ | _________________________________ | $_____________ |
____________________________________ | $_____________ | _________________________________ | $_____________ |
Practitioners:__________________________ | $_____________ | Hospitals:__________________________ | $_____________ |
____________________________________ | $_____________ | _________________________________ | $_____________ |
| | | |
Transportation & Lodging_ | $_____________ | Insurance Premiums (include Medicare) | $_____________ |
Prenatal Care | $__________________ | Postnatal | $__________________ |
Eyeglasses | $__________________ | Hearing Aids | $__________________ |
X-Rays | $__________________ | Lab Fees | $__________________ |
Medical Lodging | $__________________ | Bandages | $__________________ |
Therapy Equipment | $__________________ | Crutches | $__________________ |
Medical Supplies & Appliances | $__________________ | Diabetic Expense | $__________________ |
Prosthesis Expense | $__________________ | Therapy Pool | $__________________ |
Required Air Conditioning Expense | $__________________ | Electrical Expense | $__________________ |
Repairs & Filters | $__________________ | Stop Smoking Expense | $__________________ |
TAXES
Did you pay State Taxes last year? _____ How much? $__________Did you pay State Taxes last year for prior years? _____ How much? $__________Did you pay Sales Taxes on Major Purchases last Year?______ How much? $________
Auto License Fees | $___________________ | Auto Sales Tax | $___________________ |
Real Estate Taxes | $___________________ | Property Taxes | $___________________ |
Irrigation Taxes | $___________________ | Personal Property Taxes | $___________________ |
Boat Taxes | $___________________ | Other Taxes | $___________________ |
Did you buy any cars, boats, motorcycles, R.V.s, trailers, mobile homes, airplanes, etc.?_______________ (Attach Information.)
DEDUCTIONS (CONTINUED)
INTEREST: (Attach all 1098s)
1ST HOME | NAME | AMOUNT | 2ND HOME | NAME | AMOUNT |
Mortgages.................. | _______________ | $_____________ | Mortgages.................. | _____________ | $______________ |
2nd Home Mortgage.. | _______________ | $_____________ | 2nd Home Mortgage... | _____________ | $______________ |
Late Charges.............. | _______________ | $_____________ | F.H.A. Charges | _____________ | $______________ |
Mortgage Insurance... College Loan Interest College Loan Interest | _______________ ______________________________ | $_____________$_____________$_____________ | Real Estate Loan Fees Points ………………. College Loan Interest | _______________________________________ | $______________$______________$______________ |
CONTRIBUTIONS
Churches | $__________________ | | Payroll Deductions | $__________________ |
Missions | $__________________ | | Youth Programs | $__________________ |
Evangelists | $__________________ | | Muscular Dystrophy | $__________________ |
Bazaar | $__________________ | | Salvation Army | $__________________ |
Public Schools | $__________________ | | County Fairs | $__________________ |
Jaycees | $__________________ | | Boy - Girl Scouts | $__________________ |
Heart Fund | $__________________ | | Xmas / Easter Seals | $__________________ |
Cancer Fund | $__________________ | | United Way | $__________________ |
Did you donate any non - cash items such as food or used clothing? Please list description and value: __________________________ ___________________________________________________________________________________________________________
Miscellaneous
Union Dues | $__________________ | | Spouse Dues | $__________________ |
Tax Preparer Fee | $__________________ | | Audit Fees | $__________________ |
Extension Fees | $__________________ | | Business Dues | $__________________ |
Books & Publications | $__________________ | | Safety Items | $__________________ |
Fire Retardant Clothing | $__________________ | | Safety Boots | $__________________ |
Protective Eye Wear | $__________________ | | Mosquito Spray | $__________________ |
Gloves | $__________________ | | Work Watch | $__________________ |
Tools | $__________________ | | Flashlights | $__________________ |
Batteries | $__________________ | | Water Jugs | $__________________ |
Uniforms | $__________________ | | Telephone for Business | $__________________ |
Cleaning | $__________________ | | Protective Headgear | $__________________ |
Investment Expense | $__________________ | | Sales & Promo Costume | $__________________ |
Adoption Expense | $__________________ | | Safety Deposit Box | $__________________ |
Record Keeping Costs | $__________________ | | Safety Glasses | $__________________ |
Other ( list ) | $__________________ | | Other ( list ) | $__________________ |
CONTINUED EDUCATION & 1ST TWO YEARS COLLEGE STUDENT CREDIT
Name of Student | ___________________ | | | |
Name of Institution | ___________________ | | Travel Expense | $__________________ |
Education Purpose | ___________________ | | Tuition Expense | $__________________ |
Dates Attended | ___________________ | | Supplies Expense | $__________________ |
Name of Student | ___________________ | | | |
Name of Institution | ___________________ | | Travel Expense | $__________________ |
Education Purpose | ___________________ | | Tuition Expense | $__________________ |
Dates Attended | ___________________ | | Supplies Expense | $__________________ |
EMPLOYEE BUSINESS EXPENSE
Did you use your personal vehicle to run errands, chase parts, carry job tools, etc. for your employer? Include Job Hunting.
Please explain : ______________________________________________________________________
How many miles did you drive for the year ? ________________ How many miles did you drive for business ? ________________
Description of vehicle: Make ______________ Model _________________ Year_________________
Did you purchase an automobile last year ? ________________ Please enclose purchase papers.
Auto License Fee | $__________________ | | Auto Sales Tax | $__________________ |
Auto Interest | $__________________ | | Parking & Tolls | $__________________ |
OPTIONAL
Oil & Lubrication | $__________________ | | Auto Club | $__________________ |
Washing & Polishing | $__________________ | | Tires, Batteries, Etc. | $__________________ |
Repairs | $__________________ | | Insurance | $__________________ |
Fuel | $__________________ | | Other ( list ) | $__________________ |
TRAVEL & EXPENSES OTHER THAN AUTO
Plane & Rail Fares | $__________________ | | Bus Fares | $__________________ |
Taxi & Public Transit | $__________________ | | Car Rentals | $__________________ |
Lodging | $__________________ | | Meals | $__________________ |
Telephone, Fax, Postage | $__________________ | | Tips & Baggage Charge | $__________________ |
Laundry & Cleaning | $__________________ | | Other ( list ) | $__________________ |
SALES EXPENSE
Lunches, Dinners, Etc. | $__________________ | | Show & Event Tickets | $__________________ |
Organization Dues | $__________________ | | Gifts | $__________________ |
Stationary & Postage | $__________________ | | Basic Phone | $__________________ |
Long Distance Phone | $__________________ | | Other ( list ) | $__________________ |
| | | | |
Did you make any modifications to your home for the handicapped ? Please Describe :_____________________________________
Cost of modifications $______________________________
Did you move last year? ___________ How many miles did you move? ___________ Date Moved ____/____/____
Transportation Cost $___________ Storage Cost $__________ Travel & Lodging $___________
How much were you reimbursed that was not included in your wages? $___________
Did you or your spouse contribute to a REGULAR IRA, ROTH IRA, SIMPLE or KEOGH ? $_____________________________
Do you or your spouse have a retirement plan at work ? ________________________________
Did you pay alimony ? _________ How much ? ____________________________________
Recipients Name & S. S. # ___________________________________________________
DECLARATION :
I have provided the information on this form to the best of my knowledge and hereby declare it is complete and ready for the preparation of my/our income tax returns. Where business deductions shown, I acknowledge having spent these amounts and have kept a log or diary of such activities, pursuant to section 274(a) and can fully substantiate such deductions.
__________________________________________ __________________________________________
SIGNATURE (must be signed) DATE