Income Tax Organizer

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1 Income Tax Organizer This organizer will help you organize your tax information (and make sure that you don't miss important deductions). We hope you find it useful and informative! (This form was prepared for use by to collect information for preparation of Tax Returns for tax year 2013.) Taxpayer Information First Name Initial Last Name Occupation/Job Title Employer Street Address City State ZIP Home Telephone Work Telephone Other Telephone Spouse Information First Name Initial Last Name Occupation/Job Title Employer Home Telephone Work Telephone Other Telephone

2 Personal Info Continued Filing Status Single Head of Household Married filing jointly Married filing separate Automatic Deposit? - if yes attach a VOID check Yes No Dependents Name Relationship Months lived at home Name Relationship Months lived at home Name Relationship Months lived at home Name Relationship Months lived at home Name Relationship Months lived at home

3 Income Salaries and Wages W-2 Description Gross Income Federal Withholding FICA Medicare State W/H Local #1 Local #2 Other Income Interest: Attach 1099 Forms Payer Amount Dividends: Attach 1099 Forms Payer Total Amount Capital Gains Ordinary Dividends Tax Refunds State - Amount Received $ Local - Amount Received $ Check if you did not itemize in prior year

4 Income Continued Capital Gains Description Date Acquired Date Sold Sales Price Cost or Basis Pensions/IRA Distributions - attach form 1099/W2s Payer Gross Distribution Taxable Amount Check box if Federal or State Tax was withheld Alimony Received Payor Amount $ Payor's Unemployment Received Taxpayer Amount Spouse Amount Social Security Received Taxpayer Amount Spouse Amount Miscellaneous Income Description Amount

5 Deductions Medical & Dental Expenses Insurance Premiums $ Doctors, Dentists, etc. $ Taxes Paid State & Local Income Tax $ Sales Taxes Paid $ Real Estate Taxes- Residence $ Real Estate Taxes- Other property $ Other taxes $ Interest Paid - Attach 1098 Forms Home mortgage Interest Paid (1st) $ Home mortgage Interest Paid (2nd) $ Contributions - Attach Details Contributions by Cash or Check $ Contributions by Other than Cash $ Miscellaneous Deductions Unreimbursed Employee Business Expenses $ Union/Professional Dues $ Investment Expenses $ Tax Return Preparation Fees $ Safe Deposit Box Rental $ Office In - Home Area used Exlusively for Business Total Area of Home (Day care providers please call our office for additional info needed) Casulty Losses $ Insurance on Home $ Repairs & Maintenance $ Utilities(Excluding Telephone) $ Telephone (separate bus. Line or Long Distance) $ Rent $ Other $ (If you have expenses directly related to the office please list those seperately)

6 Business Income General Information Cash Basis Accrual Basis First Year Taxpayer Spouse Principal Bus./ Profession Business Name Business Address City, State, Zip Other Accounting Method Income Gross Receipts or Sales $ Returns and Allowances $ Other Income $ Costs of Goods Sold - If Applicable * Inventory at Beginning of the Year $ Inventory at End of the Year $ Purchases $ Cost of Items for Personal Use $ Cost of Labor $ Materials and Supplies $ Other Costs $ Expenses * Advertising $ Car & Truck Expenses $ Commissions $ Employee Benefit Programs $ Insurance (other than health) $ Health Insurance Premiums for Self $ Mortgage Interest $ Other Interest $ Legal and Professional Fees $ Office Expenses $ Pension & Profit Sharing Plans $ Vehicles $ Rent- Machinery & Equipment $ Rent- Other Business Property $ Repairs $ Supplies $ Taxes- Real Estate $ Taxes- Other $ Travel $ Total Meals & Entertainment $ Utilities $ Wages $ * Note: if you pay more than $600 to an individual, partnership or LLC or you pay an attorney any amount, then you are required to issue a 1099 to the subcontractor or attorney and file both forms 1098 and 1099 with the IRS. If you have any questions regarding 1099s and 1098s please contact our office.

7 Rental Income & Expenses Check if property was purchased/converted to rental in Number of Days of: # Property Description Address Fair Rental Personal Use Property Income: Rents Received Expenses: * Advertising Association & Condo Dues Auto & Travel Travel Cleaning/Maintenance Commissions Gardening Insurance Management Fees Miscellaneous Mortgage Interest Other Interest Professional Fees * Repairs & Maintenance * Subcontractors * Supplies Taxes Telephone Utilities Improvements Other: * Note: if you pay more than $600 to an individual, partnership or LLC or you pay an attorney any amount, then you are required to issue a 1099 to the subcontractor or attorney and file both forms 1098 and 1099 with the IRS. If you have any questions regarding 1099s and 1098s please contact our office.

8 Adjustments Adjustments to Income and Other Alimony Paid Payee Amount $ Payee's IRA Deduction $ Keogh/SEP Deduction $ SIMPLE Contributions $ Penalty on Early Withdrawal of Savings $ Moving Expenses $ Student Loan Interest $ Roth Contributions $ Coverdell Education Savings Accounts (formally known as Education IRA) $ IRC S529 Plan Contributions $ NonDeductible IRAs $

9 Estimates Estimated Tax Payments Federal Date Paid Amount Paid Overpayment -Prior Year 1st Quarter 2nd Quarter 3rd Quarter 4th Quarter State Date Paid Amount Paid Overpayment -Prior Year 1st Quarter 2nd Quarter 3rd Quarter 4th Quarter City Date Paid Amount Paid Overpayment -Prior Year 1st Quarter 2nd Quarter 3rd Quarter 4th Quarter School Date Paid Amount Paid Overpayment -Prior Year 1st Quarter 2nd Quarter 3rd Quarter 4th Quarter

10 Tax Questionnaire 2013 Please check the appropriate box and include all necessary details. Personal Information Did your marital status change during the year? If yes, explain: Have you or your spouse had a name change last year (such as marriage or divorce)? If yes, bring a copy of your corrected social security card. Did your address change from last year? If yes, please bring in the closing (settlement) statements for any house refinanced, sold or bought. Can you be claimed as a dependent by another taxpayer? Did you change any bank accounts that have been used to direct deposit (or direct debit) funds from (or to) the IRS or other taxing authority during the tax year? Are you or your spouse in military or Guard? Will you or your spouse reach 70 1/2 years of age this year or next? Are you or your spouse legally blind or disabled? Are you or your spouse disabled and receiving government benefits? Dependent Information Were there any changes in dependents from the prior year? If yes, explain: Do you have any children under age 19 or a full-time student under age 24 with unearned income in excess of $2,000? Do you have dependents who must file a tax return? Did you provide over half the support for any other person(s) during the year? Did you pay for child care while you worked, looked for work or either you or your spouse was a full-time student? Did you pay for any expenses related to the adoption of a child during the year? If you are divorced or seperated with child(ren), do you have a divorce decree or other fom of seperation agreement which establishes custodial responsibilities? Purchases, Sales and Debt Information Did you start a new business or purchase rental property during the year? Did you acquire a new or additional interest in a partnership or S corporation? Did you sell, exchange, or purchase any real estate during the year? Did you purchase or sell a principal residence during the year? Did you foreclose or abandon a principal residence or real property during the year? Did you acquire or dispose of any stock during the year? Did you have stocks or securities that became worthless, or money due you become uncollectible? Did you have a home equity loan at any time this year? Did you refinance a principal residence or second home this year? Did you sell an existing business, rental, or other property this year? Were you part of a partnership, Sub-S Corp, Joint Venture, Estate and Trust? If Yes, please provide forms K-I Did you incur any non-business bad debts this year? Did you have any debts canceled or forgiven this year? Did you purchase a qualified plug-in electric drive vehicle or qualified fuel cell vehicle this year? Did you pay any student loan interest this year? Questions Continued Yes No

11 Tax Questionnaire 2013 Income Information Yes No Did you receive any income from property sold prior to this year? Did you receive any lump-sum payments from a pension, profit sharing or 401(k) plan? Did you make any withdrawals from to an IRA, Keogh, SIMPLE, SEP account or other qualified retirement plans? Did you make any contributions to an IRA, Keogh, SIMPLE, SEP account or any other qualified retirement plan? Did you make any withdrawals from an education savings or 529 Plan account? Did you receive any distributions from a health savings account (HSA), Archer MSA, or Medicare Advantage (MSA) this year? Did you receive any Social Security benefits during this year? Did you receive any unemployment benefits during the year? Did you receive any disability income during the year? Did you receive tip income not reported to your employer this year? Did any of your life insurance policies mature, or did you surrender any policies? Did you cash any Series EE or I U.S. Savings bonds issued after 1989? Did you have employee stock options exercised, whether sold or not? If yes, bring all statements. Did you receive alimony this year? (Do not include child support.) Did you have gambling winnings or gambling losses this year? (Please bring supporting documents for losses.) Foreign Income and Information Did you maintain a foreign bank account or trust? Did you have ownership or beneficial interest in foreign accounts? Did you have any foreign income or pay any foreign taxes during the year, other than through a Mutual Fund? Did you receive a distribution from, or were you a grantor or transferor for a foreign trust? Did you have a financial interest in or signature authority over a financial account such as a bank account, securities account, or brokerage account, located in a a foreign country? Do you have any foreign financial accounts, foreign financial assets, or hold interest in a foreign entity? Itemized Deduction Information Did you incur a large casualty or theft loss or any condemination awards? Did you pay out of pocket medical expenses (Co-pays, prescription drugs, etc.)? Did you pay health insurance premiums and your employer paid $-0- on your behalf? If you are self employed, did you pay for health insurance? Did you make any noncash charitable contributions (clothes, furniture, etc.)? If yes, please provide evidence such as a receipt from donee organization, a cancelled check, or record of payment, to substantiate all contributions made. Did you donate a vehicle or boat during the year? (If yes, bring form 1098-C or other written acknowledgement from donee organzation.) Did you have an expense account or allowance during the year? Did you use your car on the job, for other than commuting? Did you work out of town for part of the year? For teachers, did you incur educator expenses (supplies, etc.)? Did you have any expenses related to seeking a new job during the year? Did you make any major purchases during the year (cars, boats, etc.)? If yes, attach bill of sale for potential sales tax deduction. Questions Continued

12 Tax Questionnaire 2013 Miscellaneous Information Did you pay alimony this year? (Do not include child support.) Did you make gifts of more than $14,000 to any individual? Did you have any educational expenses during the year on behalf of yourself, your spouse, or dependent? Did you make any contributions to an education savings or 529 Plan account? Did you make any contributions to a Health Savings Account (HSA) or Archer (MSA)? Did you enroll for lower cost Marketplace Coverage through healthcare.gov under the Affordable Care Act? Did you pay long-term health care premiums for yourself or your family? Did you pay any COBRA health care coverage continuation premiums? Are you a business owner and have paid health insurance premiums for your employees this year? Did you utilize an area of your home for business purposes? Did you engage in any bartering transactions? Are you an active participant in a pension or retirement plan? Did you retire or change jobs this year? Did you incur moving costs because of a job change? Did you, your spouse, or your dependents attend a post-secondary school during the year, or plan to attend one in the coming year? Did you pay any individual as a household employee during the year? Did you make energy efficient improvements to your main home this year? other financial account in a foreign country? Did you receive correspondence from the State or the Internal Revenue Service? If yes, explain: Did you receive an Identity Protection PIN from the Internal Revenue Service or have you been a victim of identity theft? Do you want to designate $3 to the Presidential Election Campaign Fund? Husband Wife Checking yes will not change your tax or reduce your refund. Do you want to designate $1 to the Ohio Political Party Fund? Husband Wife Checking yes will not change your tax or reduce your refund. Did you and/ your spouse make an Ohio political contribution? Taxpayer's amount $ Spouse $ Did you make any out-of-state purchases (by telephone, internet, mail, in person) that the seller did not collect state sales or use tax? Did you pay state and local real estate property taxes this year? If yes, please attach supporting statment and/or checks Did you make Estimated Tax Payments? If yes, list below or on the Estimates page. Other Financial Concerns Would you like to pay less to the Government on This year's tax return? Would you like to pay less to the Government on Next year's tax return? Do you have any other financial concerns? If yes, summerize below: Yes No Other Information: Did you read, sign and date the Tax Engagement Letter that was sent with this packet? Visit us on the web at

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