Bradshaw, Gordon & Clinkscales, LLC 630 E Washington St Ste B Greenville, SC

Transcription

1 Bradshaw, Gordon & Clinkscales, LLC 630 E Washington St Ste B Greenville, SC , Dear client(s): Enclosed is your 2014 tax organizer to help you organize your tax information. Even if you do not use it, please return this organizer with the information you provide to us. We typically need the following information to prepare your tax returns: o Year-end tax and brokerage statements (W2s, 1099s, and 1098s) o Schedules of realized gains and losses (usually provided with the brokerage statement) o Income and expenses for rental and businesses activities o Schedule K-1s from partnership, s-corporation, estates and trusts o Copies of HUD statements for the purchases or sales of real estate o Summary of itemized deductions, including: o real estate taxes o personal property taxes o mortgage interest (reported on form 1098) o cash and non-cash charitable contributions o unreimbursed business expenses o Education related tax statements, including: o 1098-T tuition statement o 1098-E student loan interest statement o 1099-Q qualified tuition program payments (Section 529 distributions) Let us know if your son or daughter attended university or college in SC, and: - graduated from a SC high school, - completed over 30 credit hours (or the equivalent), and - was not a LIFE or Palmetto scholarship recipient o Health insurance tax statements if you purchased (or were exempted from purchasing) health insurance coverage through a health insurance marketplace exchange, including: o 1095-A Health Insurance Marketplace Statement o Statements of exemption received from a health insurance marketplace exchange And, please confirm and/or provide the following information: o address on page 2 of organizer o Bank and account number used for direct deposits on page 3 of organizer o Estimated tax payments including the date paid on pages 5 and 6 of organizer o Did you own or have signatory authority over a foreign account? Yes or No o How would you like your returns delivered to you? Pickup Mail

2 We are required to file your returns electronically unless it cannot be submitted electronically or you inform us you wish to file with paper. Thank you for the opportunity to serve you. Sincerely, Bradshaw, Gordon & Clinkscales, LLC

3 Questions Please check the appropriate box and include all necessary details. Personal Information Yes No Did your marital status change? If so, explain: Did you marry a same-sex spouse in a state legally recognizing same-sex marriage? Did your address change from last year? Do you want any tax refunds directly deposited into your bank account? If so, please verify or provide bank account information on page 3 of the organizer Dependent Information Were there any changes in dependents from the prior year? If so, explain: Did any of your dependents have income of $1,000 or more ($400 if self-employed)? Did you provide over half the support of any other person(s) during the year? Was any dependent child a SC Life or Palmetto Fellows Scholarship recipient? Were you entitled to a dependency exemption under a divorce decree? Purchase, Sales and Debt information Did you buy or sell your primary residence or any other real estate? If so, please provide HUD settlement statement Did you dispose of any stocks or bonds? If so, please provide the purchase dates and costs Did you refinance a principal residence or second home? If so, please provide HUD settlement statement Did you buy or sell any business, rental or other investment? Income Information Were you granted or did you exercise any stock options? Did you receive a distribution from an IRA or other qualified plan? Were any IRA or plan distributions rolled over into another IRA or qualified plan? Did you make withdrawals from an education savings or 529 Plan account? Did you receive distributions from a health savings account? Did you have any debts cancelled or forgiven, such as a mortgage or student loans? Did you have any foreign income or pay any foreign tax? Did you receive any unemployment benefits? Did you receive any disability income? Did you surrender any life insurance policies or have any mature? Health Care Information Did you have qualifying health care coverage, such as employer-sponsored coverage or government-sponsored coverage (i.e. Medicare/Medicaid) for every month of 2014 for each member of your family? "Your family" for health care coverage refers to you, your spouse if filing jointly, and anyone you can claim as a dependent. Did you or any member of your family get health insurance coverage through the Health Insurance Marketplace exchange? If yes, please provide any Form(s) 1095-A you received.

4 Itemized Deduction Information Did you pay any significant medical costs (over 7.5% of your income)? Did you pay any health insurance costs other than through your employer? Did you make any non-cash charitable contributions? Did you incur a casualty or theft loss? Did you have any unreimbursed business expenses, including auto mileage? Other Deduction or Credit Information Did you make any contributions to an IRA or other qualified plan? Are you interested in making an IRA or other qualified plan contribution, if eligible? Did you pay for child care while you worked or looked for work? Did you have any educational costs? Did you pay any adoption related expenses? Did you incur moving costs because of a job change? Did you pay any domestic or caregiver costs? Did you make any health savings account contributions? Did you pay any student loan interest? Did you make any contributions to an education savings or 529 Plan account? Did you use any portion of you home exclusively for business purposes? Miscellaneous Information Did you make gifts of more than $14,000 to any individual? Did you engage in any bartering transactions? Did you make any out-of-state purchases on which no sales tax was paid? Did you own or have signatory authority over a foreign bank or security account? Did you receive correspondence from the State or the Internal Revenue Service? If yes, explain: Do you want to designate $3 to the Presidential Election Campaign Fund? Do you want us to be able to discuss your tax return with the IRS and state agencies? Are you aware of any changes to income, deductions or credits reported on any prior year returns? Please confirm any estimated tax payments made on page 5 and 6 of the organizer Please note any assets no longer in service on page(s) 83 of the organizer Other questions or comments:

5 Form ID: 1040 Personal Information 1 Filing (Marital) status code (1 = Single, 2 = Married filing joint, 3 = Married filing separate, 4 = Head of household, 5 = Qualifying widow(er)) Mark if you were married but living apart all year Mark if your nonresident alien spouse does not have an Individual Taxpayer Identification Number (ITIN) Taxpayer Social security number First name Last name Occupation Designate $3.00 to the presidential election campaign fund? (1 = Yes, 2 = No, 3 = Blank) Mark if dependent of another taxpayer Taxpayer with income less than 1/2 support age 18 or full-time student? (Y, N) Mark if legally blind Date of birth Date of death Work/daytime telephone number/ext number Home/evening telephone number Do you authorize us to discuss your return with the IRS? (Y, N) Present Mailing Address Spouse [4] [5] [6] [7] [8] [9] [10] [11] [12] [14] [15] [16] [17] [20] [1] [2] [3] [21] [22] [24] [26] [27] [28] [29] [30] [32] [34] [31] [33] Address Apartment number City, state postal code, zip code Foreign country name In care of addressee [40] [41] [38] [39] [42] [44] [47] Dependent Information (*Please refer to Dependent Codes located at the bottom) Care Months*** Dep expenses in Codes paid for First Name[48] Last Name Date of Birth Social Security No. Relationship home * ** dependent Name of child who lived with you but is not your dependent Social security number of qualifying person [49] [50] Dependent Codes *Basic 1 = Child who lived with you **Other 1 = Student (Age 19-23) 2 = Child who did not live with you 2 = Disabled dependent 3 = Other dependent 3 = Dependent who is both a student and disabled 5 = Qualifying child for Earned Income Credit only 6 = Children who lived with you, but do not qualify for Earned Income Credit 7 = Children who lived with you, but do not qualify for Child Tax Credit 8 = Children who lived with you, but do not qualify for Child Tax Credit or Earned Income Credit ***Months77 = Reported on odd year return 88 = Reported on even year return 99 = Not reported on return GENERAL Form ID: 1040

6 Form ID: Info Client Contact Information Preparer - Enter on Screen Contact 2 Tax matters person (Indicate which spouse handles tax return related questions) (Blank = Both, T = Taxpayer, S = Spouse) Taxpayer address Spouse address [8] [9] [10] Fax telephone number Mobile telephone number Mobile telephone #2 number Pager number Other: Telephone number Extension Preferred method of contact: , Work phone, Home phone, Fax, Mobile phone, Mobile phone #2 Taxpayer Spouse [11] [19] [12] [13] [20] [21] [14] [22] [15] [23] [16] [24] [17] [25] [18] [26] NOTES/QUESTIONS: GENERAL Form ID: Info

7 Form ID: Bank Direct Deposit/Electronic Funds Withdrawal Information 3 If you would like to have a refund direct deposited into or a balance due debited from your bank account(s), please enter information in the fields below. Note that electronic funds will be withdrawn only from the primary account listed below. Primary account: Financial institution routing transit number [1] Name of financial institution [2] Your account number [3] Type of account (1 = Savings, 2 = Checking, 3 = IRA*) [4] Mark if married filing jointly and this is a joint account (Both taxpayer and spouse names are on the account) [5] Mark if financial institution is foreign based (Not located in the territorial jurisdiction of the United States) [6] Enter the maximum dollar amount, or percentage of total refund Dollar [7] or Percent (xxx.xx) [8] Secondary account #1: Financial institution routing transit number [23] Name of financial institution [24] Your account number [25] Type of account (1 = Savings, 2 = Checking, 3 = IRA*) [26] Mark if married filing jointly and this is a joint account (Both taxpayer and spouse names are on the account) [27] Mark if financial institution is foreign based (Not located in the territorial jurisdiction of the United States) [28] Enter the maximum dollar amount, or percentage of total refund Dollar [9] or Percent (xxx.xx) [10] Secondary account #2: Financial institution routing transit number Name of financial institution Your account number Type of account (1 = Savings, 2 = Checking, 3 = IRA*) Mark if married filing jointly and this is a joint account (Both taxpayer and spouse names are on the account) Mark if financial institution is foreign based (Not located in the territorial jurisdiction of the United States) Enter the maximum dollar amount, or percentage of total refund Dollar [13] or Percent (xxx.xx) [29] [30] [31] [32] [33] [34] [14] *Refunds may only be direct deposited to established traditional, Roth or SEP-IRA accounts. Make sure direct deposits will be accepted by the bank or financial institution. Refund - U.S. Series I Savings Bond Purchases A tax refund may be used to buy up to $5,000 of U.S. Series I Savings bonds and registered for up to three different persons. If you would like to purchase U.S. Series I Savings bonds (in increments of $50) with your refund, if applicable, please complete the following information. Please note you may enter only one name per registration (with exception of married filing joint returns) and must enter the party's given name, do not use nicknames. Indicate either a maximum dollar amount (up to $5,000), or percentage of refund you would like used to purchase bonds The bonds will be registered to the name(s) on the return. For married filing joint returns this means the bonds will be registered in both names listed on the return. To register the bonds separately, leave these fields blank and use the fields provided below. Enter either a dollar amount or percent, but not both Dollar [11] or Percent (xxx.xx) [12] Bond information for someone other than taxpayer and spouse, if married filing jointly Maximum dollar amount (up to $5,000), or percentage of refund used to purchase bonds Owner's name (First Last) Co-owner or beneficiary (First Last) Mark if the name listed above is a beneficiary Dollar [36] [38] [15] or Percent (xxx.xx) [16] [37] [39] [40] Bond information for someone other than taxpayer and spouse, if married filing jointly Maximum dollar amount (up to $5,000), or percentage of refund used to purchase bonds Dollar [19] or Percent (xxx.xx) Owner's name (First Last) Co-owner or beneficiary (First Last) [43] Mark if the name listed above is a beneficiary [20] [41] [42] [44] [45] GENERAL Form ID: Bank

8 Form ID: Est Estimated Taxes 5 If you have an overpayment of 2014 taxes, do you want the excess: Refunded Applied to 2015 estimated tax liability Do you expect a considerable change in your 2015 income? (Y, N) If yes, please explain any differences: Do you expect a considerable change in your deductions for 2015? (Y, N) If yes, please explain any differences: Do you expect a considerable change in the amount of your 2015 withholding? (Y, N) If yes, please explain any differences: Do you expect a change in the number of dependents claimed for 2015? (Y, N) If yes, please explain any differences: Mark if you use the Electronic Federal Tax Payment System (EFTPS) to pay your estimated taxes [47] [48] [49] [50] [51] [52] [53] [54] [55] [56] [57] [58] [59] [60] [61] [62] [63] [64] [65] [66] [67] [68] [69] 2014 Federal Estimated Tax Payments 2013 overpayment applied to 2014 estimates Mark if you paid the calculated amounts on the dates due indicated below. Skip the remaining fields. [1] [4] If your estimated payments were not made on the date due or were for an amount other than the calculated amount below, please enter the actual date and amount paid. Date Due Date Paid if After Date Due Amount Paid Calculated Amount 1st quarter payment 4/15/14 [5] [6] 2nd quarter payment 6/16/14 [7] [8] 3rd quarter payment 9/15/14 [9] [10] 4th quarter payment 1/15/15 [11] [12] Additional payment [13] [14] NOTES/QUESTIONS: Control Totals PAYMENTS Form ID: Est

9 Form ID: St Pmt 2014 State Estimated Tax Payments 6 Taxpayer/Spouse/Joint (T, S, J) State postal code [1] [2] Amount paid with 2013 return 2013 overpayment applied to '14 estimates Treat calculated amounts as paid [3] [4] [8] Date Paid Amount Paid Calculated Amount 1st quarter payment [9] [10] 2nd quarter payment [11] [12] 3rd quarter payment [13] [14] 4th quarter payment [15] [16] Additional payment [17] [18] 2014 City Estimated Tax Payments City #1 City #2 City name [28] City name [50] Amount paid with 2013 return Amount paid with 2013 return [32] 2013 overpayment appliedto to '14 estimates Treat calculated amounts as paid [36] Treat calculated [58] amounts as paid [31] [53] [54] Date Paid Amount Paid Date Paid Amount Paid 1st quarter payment [37] [38] 1st quarter payment 2nd quarter payment [39] [40] 2nd quarter payment 3rd quarter payment [41] [42] 3rd quarter payment 4th quarter payment [43] [44] 4th quarter payment [59] [60] [61] [62] [63] [64] [65] [66] Calculated Amount 1st quarter payment 2nd quarter payment 3rd quarter payment 4th quarter payment Calculated Amount 1st quarter payment 2nd quarter payment 3rd quarter payment 4th quarter payment City name Amount paid with 2013 return 2013 overpayment applied to '14 estimates Treat calculated amounts as paid City #4 #3 City name Amount paid with 2013 return 2013 overpayment applied to '14 estimates [80] Treat calculated amounts as paid [72] [75] [76] [94] [97] [98] [102] Date Paid Amount Paid Date Paid Amount Paid 1st quarter payment [81] [82] 1st quarter payment 2nd quarter payment [83] [84] 2nd quarter payment 3rd quarter payment [85] 3rd quarter payment [86] 4th quarter payment [87] [88] 4th quarter payment [103] [104] [105] [106] [107] [108] [109] [110] Calculated Amount 1st quarter payment 2nd quarter payment 3rd quarter payment 4th quarter payment Calculated Amount 1st quarter payment 2nd quarter payment 3rd quarter payment 4th quarter payment Control Totals PAYMENTS Form ID: St Pmt

10 Form ID: W2 Wages and Salaries #1 Taxpayer/Spouse (T, S) Employer name Were these wages earned for service as: (1 = Minister, 2 = Military, 3 = Farming / Fishing, 4 = National Guard) Mark if this is your current employer Federal wages and salaries (Box 1) Federal tax withheld (Box 2) Social security wages (Box 3) (If different than federal wages) Social security tax withheld (Box 4) Medicare wages (Box 5) (If different than federal wages) Medicare tax withheld (Box 6) SS tips (Box 7) Allocated tips (Box 8) Dependent care benefits (Box 10) Box 13 - Statutory employee Retirement plan Third-party sick pay State postal code (Box 15) State wages (Box 16) (If different than federal wages) State tax withheld (Box 17) Local wages (Box 18) Local tax withheld (Box 19) Name of locality (Box 20) Please provide all copies of Form W Information Prior Year Information [1] [3] [5] [6] [10] [12] [14] [16] [18] [21] [23] [25] [27] [29] [30] [31] [32] [34] [36] [38] [40] [43] 9 Control Totals Wages and Salaries #2 Taxpayer/Spouse (T, S) Employer name Were these wages earned for service as: (1 = Minister, 2 = Military, 3 = Farming / Fishing, 4 = National Guard) Mark if this your current employer Federal wages and salaries (Box 1) Federal tax withheld (Box 2) Social security wages (Box 3) (If different than federal wages) Social security tax withheld (Box 4) Medicare wages (Box 5) (If different than federal wages) Medicare tax withheld (Box 6) SS tips (Box 7) Allocated tips (Box 8) Dependent care benefits (Box 10) Box 13 - Statutory employee Retirement plan Third-party sick pay State postal code (Box 15) State wages (Box 16) (If different than federal wages) State tax withheld (Box 17) Local wages (Box 18) Local tax withheld (Box 19) Name of locality (Box 20) Please provide all copies of Form W Information Prior Year Information [1] [3] [5] [6] [10] [12] [14] [16] [18] [21] [23] [25] [27] [29] [30] [31] [32] [34] [36] [38] [40] [43] Control Totals INCOME Form ID: W2

11 Form ID: B-1 Interest Income Please provide copies of all Form 1099-INT or other statements reporting interest income. *Whole numbers will be treated as $ amounts. Enter percentages in the XXX.XX format. For example, enter 100% as or 75.5% as Type Interest [1] Tax Exempt Penalty on U.S. Obligations* Tax Exempt* Foreign Taxes T/S/J Code (**See codes below) Income Income Early Withdrawal $ or % $ or % Paid Prior Year Information Amounts Amounts Amounts Amounts Amounts Amounts Amounts Amounts Amounts Amounts Blank = Regular Interest 3 = Nominee Distribution **Interest Codes 4 = Accrued Interest 5 = OID Adjustment 6 = ABP Adjustment 7 = Series EE & I Bond INCOME Control Totals Form ID: B-1

12 Form ID: B-2 Dividend Income Please provide copies of all Form 1099-DIV or other statements reporting dividend income. *Whole numbers will be treated as $ amounts. Enter percentages in the XXX.XX format. For example, enter 100% as or 75.5% as T Total U.S. Foreign S Ordinary [2] Qualified Cap Gain 28% Tax Exempt Obligations* Type Tax Exempt* Taxes Prior Year J Code (**See codes below) Dividends Dividends Distributions Section 1250 Sec Dividends $ or % $ or % Paid Capital Information Gain Amounts Amounts Amounts Amounts Amounts Amounts Amounts Amounts Amounts Amounts Blank = Other **Dividend Codes 3 = Nominee Control Totals Form ID: B-2 INCOME

13 Form ID: D Sales of Stocks, Securities, and Other Investment Property 14 Please provide copies of all Forms 1099-B and 1099-S Did you have any securities become worthless during 2014? (Y, N) Did you have any debts become uncollectible during 2014? (Y, N) Did you have any commodity sales, short sales, or straddles? (Y, N) Did you exchange any securities or investments for something other than cash? (Y, N) T/S/J Description of Property [1] Date Acquired Date Sold Gross Sales Price (Less expenses of sale) Cost or Other Basis [8] [9] [10] [12] Control Totals INCOME Form ID: D

14 Form ID: 1099R Pension, Annuity, and IRA Distributions #1 21 Please provide all Forms 1099-R Information Taxpayer/Spouse (T, S) Name of payer State postal code Gross distributions received (Box 1) Taxable amount received (Box 2a) Federal withholding (Box 4) Distribution code (Box 7) Mark if distribution is from an IRA, SEP, SIMPLE retirement plan State withholding (Box 12) Local withholding (Box 15) Amount of rollover Mark if distribution was due to a pre-retirement age disability Mark if distribution was from an inherited IRA Control Totals [1] [3] [5] [7] [9] [11] [14] [16] [17] [19] [21] [23] [24] Prior Year Information Pension, Annuity, and IRA Distributions #2 Please provide all Forms 1099-R Information Taxpayer/Spouse (T, S) Name of payer State postal code Gross distributions received (Box 1) Taxable amount received (Box 2a) Federal withholding (Box 4) Distribution code (Box 7) Mark if distribution is from an IRA, SEP, SIMPLE retirement plan State withholding (Box 12) Local withholding (Box 15) Amount of rollover Mark if distribution was due to a pre-retirement age disability Mark if distribution was from an inherited IRA Control Totals [1] [3] [5] [7] [9] [11] [14] [16] [17] [19] [21] [23] [24] Prior Year Information Pension, Annuity, and IRA Distributions #3 Please provide all Forms 1099-R Information Taxpayer/Spouse (T, S) Name of payer State postal code Gross distributions received (Box 1) Taxable amount received (Box 2a) Federal withholding (Box 4) Distribution code (Box 7) Mark if distribution is from an IRA, SEP, SIMPLE retirement plan State withholding (Box 12) Local withholding (Box 15) Amount of rollover Mark if distribution was due to a pre-retirement age disability Mark if distribution was from an inherited IRA Control Totals [1] [3] [5] [7] [9] [11] [14] [16] [17] [19] [21] [23] [24] Prior Year Information RETIREMENT Form ID: 1099R

15 Form ID: SSA-1099 Social Security, Tier 1 Railroad Benefits Please provide a copy of Form(s) SSA-1099 or RRB Taxpayer/Spouse (T, S) State postal code [1] [2] Social Security Benefits If you received a Form SSA , please complete the following information: Net Benefits for 2014 (Box 3 minus Box 4) (Box 5) Voluntary Federal Income Tax Withheld (Box 6) From the DESCRIPTION OF AMOUNT IN BOX 3 area of Form SSA-1099: Medicare premiums Prescription drug (Part D) premiums 2014 Information [8] [10] [12] [14] Prior Year Information Tier 1 Railroad Benefits If you received a Form RRB , please complete the following information: Net Social Security Equivalent Benefit: Portion of Tier 1 Paid in 2014 (Box 5) Federal Income Tax Withheld (Box 10) Medicare Premium Total (Box 11) 2014 Information [22] [25] [27] Prior Year Information Additional Information About Benefits Received Additional information about the benefits received not reported above. For example did you repay any benefits in 2014 or receive any prior year benefits in This information will be reported in the SSA-1099 DESCRIPTION OF AMOUNT IN BOX 3 area or in the RRB-1099 Boxes 7 through 9. [38] [39] [40] [41] [42] NOTES/QUESTIONS: Control Totals RETIREMENT Form ID: SSA-1099

16 Form ID: C-1 Schedule C - General Information 25 Preparer use only Taxpayer/Spouse/Joint (T, S, J) Employer identification number Business name Principal business/profession Business code Business address, if different from home address on Organizer Form ID: 1040 Address City/State/Zip Accounting method (1 = Cash, 2 = Accrual, 3 = Other) If other: Inventory method (1 = Cost, 2 = LCM, 3 = Other) If other enter explanation: 2014 Information Prior Year Information [2] [3] [5] [6] [11] [14] [15] [16] [17] [18] [20] [21] [23] Enter an explanation if there was a change in determining your inventory: [24] Did you "materially participate" in this business? (Y, N) If not, number of hours you did significantly participate Mark if you began or acquired this business in 2014 Did you make any payments in 2014 that require you to file Form(s) 1099? (Y, N) [25] [27] [29] [30] If "Yes", did you or will you file all required Forms 1099? (Y, N) [32] Mark if this business is considered related to qualified services as a minister or religious worker [34] Did you receive wages as a statutory employee or as a minister? (1 = Statutory employee, 2 = Minister) [36] Medical insurance premiums paid by this activity [40] Long-term care premiums paid by this activity [42] Amount of wages received as a statutory employee [45] Business Income 2014 Information Prior Year Information Gross receipts and sales [50] Returns and allowances [53] Other income: [55] Cost of Goods Sold Beginning inventory Purchases Labor: Materials Other costs: Ending inventory Control Totals 2014 Information BUSINESS [57] [59] [61] [63] [65] [67] Prior Year Information Form ID: C-1

17 Form ID: C-2 Preparer use only Principal business or profession Advertising Car and truck expenses Commissions and fees Contract labor Depletion Depreciation Employee benefit programs (Include Small Employer Health Ins Premiums credit): Insurance (Other than health): Interest: Mortgage (Paid to banks, etc.) Other: Legal and professional services Office expense Pension and profit sharing: Rent or lease: Vehicles, machinery, and equipment Other business property Repairs and maintenance Supplies Taxes and licenses: Travel, meals, and entertainment: Travel Meals and entertainment Meals (Enter 100% subject to DOT 80% limit) Utilities Wages (Less employment credit): Other expenses: Schedule C - Expenses Information Prior Year Information Control Totals Form ID: C-2 [6] [8] [10] [12] [14] [16] [18] [20] [22] [24] [26] [29] [31] [33] [35] [37] [39] [41] [43] [45] [47] [51] [53] [55]

18 Form ID: C-3 Schedule C - Carryovers 27 Preparer use only Principal business or profession Preparer use only Carryovers Operating Short-term capital Long-term capital 28% rate capital Section 1231 loss Ordinary business gain/loss Section 179 Regular [12] [14] [16] [18] [20] [22] [24] AMT [13] [15] [17] [19] [21] [23] [25] NOTES/QUESTIONS: Control Totals Form ID: C-3

19 Form ID: Rent Preparer use only Description Taxpayer/Spouse/Joint (T, S, J) [3] Physical address: Street City, state, zip code Foreign country Foreign province/county Foreign postal code Rent and Royalty Property - General Information Type (1 = Single-family, 2 = Multi-family, 3 = Vacation/short-term, 4 = Commercial, 5 = Land, 6 = Royalties, 7 = Self-rental, 8 = Other) Description of other type (Type code #8) [14] Did you make any payments in 2014 that require you to file Form(s) 1099? (Y,N) [16] If "Yes", did you or will you file all required Forms 1099? (Y, N) [18] Fair rental days (If not full year) (For types 1, 2, 4, 5, 7 and 8 only) (Use Rent-2 for type 3) [20] Percentage of ownership if not 100% Business use percentage, if not 100% (Not vacation home percentage) [22] [24] 2014 Information Prior Year Information State postal code [2] [4] [5] [6] [7] [8] [10] [11] [12] [13] 28 Rents and royalties : Rent and Royalty Income 2014 Information Prior Year Information [33] Advertising Auto Travel Cleaning and maintenance Commissions: Insurance: Legal and professional fees Management fees: Mortgage interest paid to banks, etc (Form 1098) Other mortgage interest Qualified mortgage insurance premiums Other interest: Repairs Supplies Taxes: Utilities Depreciation Depletion Other expenses: Control Totals Rent and Royalty Expenses 2014 Information Percent if not 100% Prior Year Information [35] [36] [38] [41] [66] [69] [87] [39] [42] [44] [45] [47] [50] [54] [57] [60] [63] [72] [75] [78] [81] [84] [90] [49] [52] [55] [59] [62] [65] [67] [71] [73] [76] [80] [82] [85] [88] RENT & ROYALTY Form ID: Rent

20 Form ID: Rent-2 Rent and Royalty Properties - Points, Vacation Home, Passive Information 29 Preparer use only Description Refinancing points paid - Recipient's/Lender's name Date of refinance Total # Payments Reported on 1098 in 2014 Total points paid Points deemed as paid in current year (Preparer use only) Refinancing points paid - Recipient's/Lender's name Date of refinance Total # Payments Reported on 1098 in 2014 Total points paid Points deemed as paid in current year (Preparer use only) Refinancing points paid - Recipient's/Lender's name Date of refinance Total # Payments Reported on 1098 in 2014 Total points paid Points deemed as paid in current year (Preparer use only) Refinancing Points Preparer - Enter on Screen Rent 2014 Information [92] Prior Year Information Vacation Home Information Number of days home was used personally Number of days home was rented Number of day home owned, if not 365 Carryover of disallowed operating expenses into 2014 Carryover of disallowed depreciation expenses into Information Prior Year Information [6] [8] [10] [20] [21] Passive and Other Information Preparer use only Carryovers Regular AMT Operating Short-term capital Long-term capital 28% rate capital Section 1231 loss Ordinary business gain/loss Comm revitalization [41] Section 179 [43] [29] [30] [31] [32] [33] [34] [35] [36] [37] [38] [39] [40] [42] [44] Control Totals Form ID: Rent-2

21 Form ID: A-1 Schedule A - Medical and Dental Expenses 52 T/S/J 2014 Information Prior Year Information Medical and dental expenses, such as: Doctors, Dentists, Hospital/nursing home fees, Lab/x-ray fees, Medical supplies, Hearing aids, Eyeglasses/contact lenses, and Insurance reimbursements received [1] [2] Medical insurance premiums you paid: (Do not include pre-tax amounts paid by an employer-sponsored plan or amounts entered [4] [5] Long-term care premiums you paid: (Do not include pre-tax amounts paid by an employer-sponsored plan or amounts entered [7] [8] Prescription medicines and drugs: [10] [11] [13] elsewhere, such as amounts paid for your self-employed business (Sch C, Sch F, Sch K-1, etc.) or Medicare premiums entered on Form SSA-1099.) elsewhere, such as amounts paid for your self-employed business (Sch C, Sch F, Sch K-1, etc.)) Miles driven for medical items Schedule A - Tax Expenses [14] T/S/J State/local income taxes paid: [18] 2013 state and local income taxes paid in 2014: [21] [22] Real estate taxes paid: [24] [25] Personal property taxes: [27] [28] Other taxes, such as: foreign taxes and State disability taxes [30] [31] Sales tax paid on major purchases: [36] [37] Sales tax paid on actual expenses: [39] [40] 2014 Information [19] Prior Year Information ITEMIZED DEDUCTIONS Control Totals Form ID: A-1