Personal Information. Name Soc. Sec. No. Date of Birth Occupation Work Phone Taxpayer: Spouse: Street Address City State Zip

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1 Paid to Taxpayer Paid to Spouse Client Tax Organizer Please complete this Organizer before your appointment. Prior year clients should use a personalized Organizer. To request a personalized Organizer, call us at and we will deliver it to you by mail, , fax or secure portal online. Please provide for your tax appointment: - Last year's tax return (new clients only) - All statements (W-2s, 1098s, 1099s, etc.) - Birch Bay Tax & Accounting Tax Preparation Questionnaire Personal Information Name Soc. Sec. No. Date of Birth Occupation Work Phone Taxpayer: Spouse: Street Address City State Zip Address Home Phone Cell Phone Other Phone Taxpayer Spouse Marital Status Blind Yes No Yes No Married Will file jointly: Yes No Disabled Yes No Yes No Single Pres. Campaign Fund Yes No Yes No Widow(er), Date of Spouse's Death: Dependents (Children & Others) Name Relationship Date of Birth Soc. Sec. No. Months Lived With You Disabled? Full Time Student? Dependent's Gross Income Attach W-2s Wage, Salary Income Name of Payer/Employer Gross Wages Federal Income Tax State Income Tax

2 Paid to Taxpayer Paid to Spouse Attach SSA 1099s, 1099-Rs, RRB 1099s Social Security & Pension Income Name of Payer/Employer Gross Received Federal Income Tax Social Sec. Tax Medicare Tax State Income Tax For Early Withdrawals Payer* Reason For Withdrawal Reinvested? * Provide statements from employer or insurance company with information on cost of or contributions to plan Attach 1099-INT, Form 1097-BTC & broker statements Interest Income Payer Tax Exempt? From Mutual Funds & Stocks - Attach 1099-DIV Dividend Income Payer Ordinary Capital Gains Non-Taxable

3 Capital Gains and Losses Stocks, Bonds, Mutual Funds - Attach 1099-B & confirmation slips Investment Cost or Other Basis Date Sold Net Sale Proceeds Other Gains & Losses Include details of dispositions of any business/rental/farm assets Investment Cost or Other Basis Date Sold Sale Proceeds Partnership, Trust, Estate Income List payers of partnership, limited partnership, S-corporation, trust, or estate income - Attach K-1 Taxpayer Spouse Property Sold Attach 1099-S and closing statements Property Cost & Improvements Vacation Home: Land: Other: Sale of Personal Residence Date Old Residence Acquired Was any part of residence rented or used for business? Cost or Basis of Old Residence Expenses of Sale (Commissions, legal fees, points, deed stamps, etc.) Cost of Improvements (landscaping, driveway, roof, etc.) Fixing Up Expenses to Prepare for Sale (painting, repairs, etc.) Date Old Residence Sold Selling Price Was it your principal place of residence for 2 of the last 5 years, ending on date of sale? Date New Residence Acquired (or construction began) Date You Occupied New Residence Cost of New Residence If married do you and/or your spouse meet the ownership and residence requirements?

4 Contributions for tax year income I.R.A. (Individual Retirement Account) Date Roth? Taxpayer Spouse s Withdrawn Attach 1099-R & 5498 Plan Trustee Reason For Withdrawal Reinvested? List All Other Income (Including non-taxable) Other Income Alimony Received Child Support Received Scholarship (Grants) Unemployment Compensation (repaid) Prizes, Bonuses, Awards Gambling, Lottery (expenses ) Unreported Tip Director/Executor's Fee Commissions Jury Duty Worker's Compensation Disability Income Veteran's Pension Payments from Prior Installment Sale State Income Tax Refund Other Other Other Medical & Dental Expenses Medical Insurance Premiums (paid by you) Prescription Drugs Insulin Glasses, Contacts Hearing Aids, Batteries Braces Medical Equipment, Supplies Nursing Care Medical Therapy Hospital Doctor Dentist/Orthodontist Mileage (no. of miles) Other Taxes Paid Real Property Tax (attach bills) Other: Personal Property Tax

5 Estimated Tax Paid Due Date Date Paid Federal State Child & Other Dependent Care Expenses Also complete this section if you receive dependent care benefits from youremployer. Name of Care Provider Address Soc. Sec. or Employer ID # Paid If you received dependant care assistance benefits from your employer, what was the amount? $ Rental & Royalty Income & Expense Income Rental Income Royalties Received Expenses Advertising Licenses and Permits Association Dues Management Fees Auto Miles Driven Mortgage Interest (Form 1098) Travel Cleaning & Maintenance Commissions Insurance Legal & Professional Fees Allocated Tax Preparation Fees Other Interest Repairs Supplies Property Taxes Utilities Other: Depreciation Description Cost or Other Basis Depreciation Method Prior Depreciation

6 Business Income & Expense (Sole Proprietorship) Business Name Principal Business/Profession Employer ID # Street Address City State Zip Address Home Phone Cell Phone Other Phone Business is owned by: Taxpayer Spouse Accounting Method: Cash Accrual Inventory Method: Cost Lower cost or market Other N/A Did you materially participate in the business? Yes No Is this the first year of the business? Yes No Income Gross Receipts or Sales Other Income Returns and Allowances Cost of Goods Sold Beginning of Year Inventory Materials and Supplies Purchases Other Costs Cost of Items Used Personaly End of Year Inventory Cost of Labor Expenses Advertising Supplies Bad Debts (N/A cash benefits) Payroll Tax Commissions and Fees Other Taxes Employee Benefits Licenses Health Insurance Travel Other Insurance Meals & Entertainment (in full) Mortgage Interest Utilities Other Interest Wages Legal & Accounting Fees Management Fees Allocation of Tax Preparation Fees Consulting Expenses Office Expense Payroll Service Pension & Profit Sharing Plans Employee Vehicle Expense Rent, Vehicles Employee Mileage Reimbursement Rent, Equipment Client Gifts (limited to $25/each)

7 Rent, Building Repairs & Maintenance, Building Repairs & Maintenance, Equipment Repairs & Maintenance, Vehicle Education & Seminars Other: Other: Other: Asset Acquisition Property Cost or Other Basis Business Use of Home Do you use any part of your home regularly and exclusively for business? Yes No Total area of home Total area of home used regularly for business If Daycare Facility: Days used as a daycare facility: Prior Year Carryover of Unallowed Losses: Total Expense Home Insurance Repairs and Maintenance Utilities Rent Other Cost of home improvements & prior depreciation Depreciation of home, improvements, furniture & equipment Property Cost or Other Basis Depreciation Method Prior Depreciation

8 Household Employees (Nanny Tax) Did you pay a household employee at least $1,700 this year? Yes No (e.g., housekeepers, nannies, nurses, yard workers, health aides, babysitters) If yes, please provide the following information: Name Social Security Number Wages Paid Federal Income Tax Social Sec. Tax Medicare Tax State Income Tax Your Employer Identification Number: You can no longer use your social security number Have W-2s been filed? Yes No If no, do you want us to prepare them for you? Yes No Have the necessary state employment returns been filed? Yes No If no, do you want us to prepare them for you? Yes No Was the household employee under eighteen years of age and a student? Yes No Job-Related Moving Expenses Employment Related Expenses (If NOT self-employed) Date of Move: Move of Household Goods Travel to New Home (no. of miles) Lodging During Move Other Job-Related Expenses Dues - Union, Professional Uniforms (include cleaning) Books, Subscriptions, Supplies Sales Expense, Gifts Licenses Tuition, Books (work related) Tools, Equipment, Safety Equipment Entertainment Business Travel If you are not reimbursed for exact amount, give total expenses Airfare, Train, etc. Taxi, Car Rental Lodging Other Meals (no. of days: ) Reimbursement Received

9 Business Mileage Do you have written records? Yes No Did you sell or trade in a car used for business? Yes No * If yes, attach a copy of purchase agreement Make/Year Vehicle: Mileage Total Miles Business miles (not to and from work) From first to second job Education (one way, work to school) Job Seeking Other Business Round Trip Commuting Distance Other Gas, Oil, Lubrication Batteries, Tires, etc. Repairs Wash Insurance Interest Lease Payments Questions, Comments, and Other Information

10 Direct Deposit of Refund Would you like to have your refund(s) directly deposited into your account? Yes No The IRS will allow you to deposit your federal tax refund into up to 3 different accounts. If yes, please provide the following information. Account 1 Owner of Account Taxpayer Spouse Joint Type of Account Checking Traditional Savings Traditional IRA Roth IRA Archer MSA Savings Coverdell Educational Savings HSA Savings SEP IRA Name of Financial Institution: Financial Institution Routing # (9 digits): Your Account Number: Account 2 Owner of Account Taxpayer Spouse Joint Type of Account Checking Traditional Savings Traditional IRA Roth IRA Archer MSA Savings Coverdell Educational Savings HSA Savings SEP IRA Name of Financial Institution: Financial Institution Routing # (9 digits): Your Account Number: Account 3 Owner of Account Taxpayer Spouse Joint Type of Account Checking Traditional Savings Traditional IRA Roth IRA Archer MSA Savings Coverdell Educational Savings HSA Savings SEP IRA Name of Financial Institution: Financial Institution Routing # (9 digits): Your Account Number: To the best of my knowledge, the information enclosed in this client tax organizer is correct and includes all income, deductions, and other information necessary for the preparation of this year's income tax returns for which I have adequate records. Taxpayer Date Spouse Date

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