Tax Preparation by Robin G Wixom, LLC

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1 Tax Preparation by Robin G Wixom, LLC 2015 TAX ORGANIZER Please fill out the following questionnaire and gather the applicable documents. If you choose to send the documents via , please encrypt the files prior to attaching them. You may also send them via US Mail or Fax. Robin Wixom Fax:

2 Contact Information: NAME PHONE Tax Preparation by Robin G. Wixom, LLC 2015 TAX YEAR ADDRESS Street City, State, Zip County Taxpayer Information OCCUPATION Spouse Information OCCUPATION

3 Bank Information (for direct deposit or debit) Bank Name Account Type Checking Savings Routing Number Account Number Dependents

4 Tax Questionnaire If you answer YES to any of these questions, please provide detailed information/documents Do you want your return filed electronically? For 2014: YES NO Do you wish to designate $3 of your tax dollars to the Presidential Election Fund? Do you want to allow me (your preparer) to discuss your return with the IRS? If receiving a refund, would you like it directly deposited to your bank account? If you have a balance due, would you like it directly debited from your bank account? Did your marital status change? Is anyone in your household blind or disabled? Are any of your dependents in College? Did you buy or sell a home? Did you take out a new mortgage or refinance an existing mortgage? Did you make any energy efficient improvements to your home? Did you contribute to an IRA Did you roll over any retirement plan? Did you contribute to a 529 plan? Do you have assets outside the US? Did you receive any rental income? Did you sell any stocks or bonds? Did you earn income from a side business? Did you have any uninsured losses or thefts of your property? Did you pay any college tuition? Are you repaying any school loans? Were you required to work from home and/or use your car for business? Did you incur any unreimbursed business expenses? Did you change jobs and/or search for a new job? Did you move?

5 Did you pay or receive any alimony? Did you have any gambling or prize winnings? Did you serve on a jury? Did you pay any child care or day camp expenses? Did you make any cash donations? Did you donate any items? (clothing, furniture) Did you pay any estimated tax payments? (quarterly payments) Do you pay long term care insurance premiums? Did you have health insurance for the entire year? Did you purchase health insurance from the marketplace? Did you have health insurance through your employer? Did you make any gifts greater than $14,000? Did you receive any notices from the IRS or State? Did you receive any distributions from an IRA or other retirement account? Did you contribute to a Health Savings Account (HSA)? Did you have any debt cancelled or forgiven? Did you inherit anything? YES NO Is there any other important information to consider when preparing your tax return? Document Checklist

6 INCOME W2 s Retirement account income: pension, annuity, IRA (1099R) Income from Interest or Dividends Unemployment income (1099G) sale of stock/bonds (1099B) cancellation of debt (1099C) Social Security benefits received Alimony received Sale of home or other property Income an estate, trust or corporation (K-1) Misc. income: Jury duty, gambling, MSA disbursements, Scholarships IF YOU ITEMIZE YOUR DEDUCTIONS Mortgage interest Real estate taxes paid Expenses related to investment Personal Property tax paid (Vehicles) Donations Large medical/dental expenses Casualty or theft loss State taxes paid State tax refund received Tax preparation fees paid ADJUSTMENTS & CREDITS Records of contributions to retirement plan (SEP, SIMPLE, IRS) Contributions to HSA (Health Savings Account) Records of tuition paid Contributions to 529 plan Childcare records Moving expenses Healthcare/insurance paid, including form 1095A if received Student Loan Interest paid Energy Efficient home improvements Estimated tax payments made Alimony paid JOB RELATED EXPENSES Job Search expenses Unreimbursed Job expenses Use of Vehicle (miles driven) Home office information Union dues, uniforms, supplies Job related education Travel

7 RENTAL PROPERTY INCOME Tax Preparation by Robin G. Wixom, LLC Income received Mortgage interest paid Taxes paid Insurance Repairs, cleaning Management fees HOA fees Travel Utilities paid Appliances purchased Other related expenses SMALL BUSINESS INCOME (Self-employment or contract employment) Income received on 1099 Cash or check income Inventory Interest on business accounts Advertising Travel Mileage log, parking, tolls Use of home office Entertainment, meals with clients Purchase of assets/equipment Supplies Legal/professional fees

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