Download 2004 CLIENT TAX ORGANIZER

TAX YEAR 2016
CLIENT TAX ORGANIZER
INSTRUCTIONS
Dear Tax Client: Do not send your tax information until you have completed this organizer
and have all of your tax info. to send. We will not accept or store partial information.
Thank you for allowing us to prepare your tax returns for tax year 2016. Please read and follow
these instructions carefully. Failure to do this will delay the completion of your tax return and
result in an inaccurate result. If you are sending your child’s tax info., they must complete &
sign their own organizer. WARNING: No signed organizer, No tax preparation!!!
1. Fill in only the areas that apply to you.
2. Fill in all personal information even if you are a previous client.
3. Include all tax documents that you received for the tax year (W2s, 1099 Misc., 1099 Int., 1099
Div., etc.)
4.
For PA Clients Only - Include your local tax return forms that you
receive in the mail. We have all federal and state forms in our office.
5. If you moved during the year we need your moving date as well as your old and new
addresses.
6.
Do not send all your receipts for expenses.
Send us a list of your expenses
and group them in categories. We need to know that you have receipts for your expenses and
may ask to verify them; but we do not keep them on file in our offices.
7. If you have a ministerial housing allowance did you spend it all? If not, how much did you
have left over above your housing costs?
8. For auto expenses be sure to include a description of the auto, business miles, commuting
miles, personal miles, and purchase date of each vehicle for which you are claiming mileage.
Please separate your mileage for each vehicle. Do not send us just one mileage figure
for all vehicles!
9. If you have honoraria or other self employed income, list it separately. List your expenses
incurred due to this self employment income separately from other employee expenses.
10. List your federal, state, and local estimated tax payments that you made for the tax year along
with the dates that you made the payments.
11. Please sign the organizer (both husband & wife) at the signature lines to certify that the
information that you are providing us is accurate and that you have receipts or other
documentary evidence to support your income and expense information.
12. You must complete the Healthcare Worksheet page as completely as possible or your taxes
will be delayed. We will not prepare your taxes without the info. required on that page.
CERRAN ENTERPRISES
CLIENT TAX ORGANIZER
Tax Year 2016
Please complete this Questionnaire before your appointment and bring the following:
 All statements Last year’s tax return (new clients only)

All statements (W-2s, 1099s, etc.)
1. Personal Information
Name (First, Initial, Last)
Soc. Sec. No.
Date of Birth
Occupation
Work Phone
Zip
Home Phone
Taxpayer
Spouse
Street Address
City
County
State
Boro or Township
School District
Taxpayer E-mail Address
Spouse E-mail Address
Blind
Disabled
Taxpayer
___ Yes ___ No
___ Yes ___ No
Pres. Campaign Fund ___ Yes ___ No
Spouse
___ Yes ___ No
___ Yes ___ No
Marital Status
___ Married
___ Single
___ Yes ___ No
___ Widow(er)
Will file jointly
___ Yes ___ No
Date of divorce _________________
Date of Spouse’s Death __________
2. Dependents (Children & Others)
Name
( First, Initial, Last)
Relationship
Date of
Birth
Social Security
Number
Months Lived
with You
Disabled
Full Time
Student
Dependent’s
Gross Income
1. Did you receive rent from real estate or other property? __________________________________________________________
2. Did you refinance your main home or other property? ____________________________________________________________
3. Did you receive any correspondence from the IRS or State Department of Taxation? __________________________________
4. Did you pay interest on a student loan for yourself, your spouse, or your dependent during the year? _____________________
5. Did you pay expenses for yourself, your spouse, or your dependent to attend classes beyond high school? _________________
6. Beginning Jan. 1, 2011 we must efile all tax returns unless you opt out. Do you wish to opt out of efiling? ___ Yes ___ No
If yes, you must complete and ATTACH OPT OUT form.
7. Would you like your refund directly deposited into your bank? ____________________________________________________
Account Type:
Your Account Number:
Checking
____________
Bank Routing Number:
Savings
_____________
3. Wage, Salary Income
7. Partnership, Trust, Estate Income
ATTACH W-2s:
Employer
Taxpayer
Spouse
____________________________
______
______
List payers of partnership, limited partnership, S-corporation,
trust, or estate income – ATTACH K-1
__________________________________________________
____________________________
______
______
__________________________________________________
____________________________
______
______
__________________________________________________
____________________________
______
______
________________________________________________________
____________________________
______
______
____________________________
______
______
8. Property Sold
ATTACH 1099-S and closing statements
4. Interest Income
ATTACH 1099-INT & broker statements
Payer’s Name
Taxpayer Spouse
____________________________
______
______
____________________________
______
______
____________________________
______
______
____________________________
______
______
Tax Exempt
___________________________
______
______
___________________________
______
______
___________________________
______
______
Property
Personal Residence*
Vacation Home
Date Acquired
*Provide information on improvements, prior to sales of
home, and cost of a new residence
9. I.R.A. (Individual Retirement Acct.)
Contributions for tax year income – not listed on W2
Amount
X for Date X for Roth IRA
Taxpayer
Spouse
Amounts withdrawn – ATTACH 1099-R & 5498
Plan Trustee
Reason for Withdrawal
5. Dividend Income
From Mutual Funds & Stocks – ATTACH 1099-DIV
Payer’s Name
Taxpayer
Spouse
___________________________
_______
______
_______
______
___________________________
_______
______
___________________________
_______
______
Reinvested?
___ Yes ___
___ Yes ___
___ Yes ___
___ Yes ___
____ Yes ____ No
Did you receive:
Taxpayer
Spouse
Social Security benefits __ Yes __ No __ Yes __ No
Rail Road Retirement __ Yes __ No __ Yes __ No
ATTACH 1099-R, SSA 1099, RRB 1099
6. Investment Sold
Stocks, Bonds, Mutual Funds, Gold, Silver, Partnership interest – ATTACH 1099-B & confirmation slips
Investment
Date Acquired/Sold
Cost
.
No
No
No
No
10. Pension, Annuity Income
Did you receive pension funds?
___________________________
Cost & Imp.
Sale Price
11. Other Income
List All Other Income (including non-Taxable)
Alimony Received
Child Support
Scholarship (Grants)
Unemployment Compensation (repaid)
Prizes, Bonuses, Awards
Gambling, Lottery (expenses _______)
Unreported Tips and Gratuities
Director / Executor’s Fee
Commissions
Jury Duty Pay
Worker’s Compensation
Disability Income
Veteran’s Pension
Payments from Prior Installment Sale
State Income Tax Refund
Clergy Honoraria
Other
__________
__________
__________
__________
__________
__________
__________
__________
__________
__________
__________
__________
__________
__________
__________
__________
__________
16. Moving Information
Did you move during 2016?
Yes_____ No_____ Move Date ________________
If yes, previous address ______________________________
__________________________________________________
Previous County & School District _____________________
__________________________________________________
12. Medical/Dental Expenses
Long-term Care Premium
Medical Insurance Premiums (paid by you)
Prescription Medications
Insulin
Eyeglasses, Contact Lenses
Hearing Aids, Batteries
Braces
Medical Equipment, Supplies
Nursing Care Services
Medical Therapy
Hospital and Nursing Homes
Doctor, Dentist, and other
Healthcare Professionals
Lodging
Mileages (no. of miles)
__________
__________
__________
__________
__________
__________
__________
__________
__________
__________
__________
Current address _____________________________________
__________________________________________________
__________
__________
__________
18. Employment-Related Expenses That
You Paid (Not self-employed)
Current County & School District ______________________
__________________________________________________
17. Job-Related Moving Expenses
Date of move _________________
Move Household Goods
Travel to New Home (no. of miles)
Lodging During Move
__________
__________
__________
(List and identify Taxpayer & Spouse expenses separately)
13. Taxes Paid
Real Property Tax (attach bills)
Personal Property Tax
Other Taxes
__________
__________
__________
14. Charitable Contributions
Church ____________________________
15. Interest Expense
Mortgage interest paid (ATTACH 1098)
__________
Interest paid to individual for your
home (include amortization schedule)
__________
Paid to:
Name ___________________________________
Address _________________________________
Social Security No . ________________________
Investment Interest
__________
___________
Other Charities (List name and give amounts)
_______________________________
___________
_______________________________
___________
_______________________________
___________
Non –Cash ________________________
___________
Volunteer (no. of miles) ______________
___________
*Provide detail if over $5000.00 is paid to any one
organization.
Dues – Union, Professional
Books, Subscriptions, Supplies
Licenses
Tools, Equipment, Safety Equipment
Uniforms (including cleaning)
Sales Expense, Gifts
Tuition, Books (work related)
Entertainment
__________
__________
__________
__________
__________
__________
__________
__________
Office in home:
In
a) Total Home ________________
Square
b) Office
________________
Feet
c) Storage
________________
Rent
Insurance
Utilities
Maintenance
___________
___________
___________
___________
19. Child & Other Dependent Care
Name of Care Provider
Address
Soc Sec No. or
Employer ID
Amount
Paid
Also complete this section if you receive dependent care benefits from your employer.
20. Business Mileage / Actual Cost
Method
Do you have written records?
23. Auto Mileage Record / Standard
Deduction Method
___ Yes ___ No
Did you sell or trade in a car used
for Business?
___ Yes ___ No
Make/Model Year Vehicle __________________________
Date Purchased ___________________________________
Total Miles (personal & business)
__________
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
__________
Gas, Oil, Lubrication
__________
Batteries, Tires, etc.
__________
Repairs
__________
Wash
__________
Insurance
__________
Interest
__________
Lease Payments
__________
Garage Rent
__________
VEHICLE 1
Description:
VEHICLE 2
Description:
Date placed in
service:
Date placed in
service:
Total mileage
Business mileage
Commuting mileage
Personal mileage
21. Investment-Related Expenses
Tax Preparation Fee
Safe Deposit Box Rental
Mutual Fund Fee
Investment Counselor
Other
__________
__________
__________
__________
__________
24. Estimated Tax Payments /not W2
amounts
Date Paid
Federal
State
Local
22. Business Travel
If you are not reimbursed for exact amount, give total
expenses.
Airfare, Train, etc.
Lodging
Meals (no. of days ___________)
Taxi, Car Rental
Other
Reimbursement Received
__________
__________
__________
__________
__________
__________
25. Other Deductions
Alimony Paid to __________________________________
Social Security No. _________________
Student Loan Interest Paid
$___________
$_____________
26. Education Expenses
Student’s Name
Type of Expense
Amount
__________________ ______________ ______________
_______________ ____________ ____________
_______________ ____________ ____________
SPECIAL NOTE:
27. For Ministers Only
1. Designated Housing Allowance $___________________
Amount of Housing Allowance Actually
Spent $____________________________________
2. If you lived in a Parsonage - Fair Rental Value (FRV)
of the Church Parsonage $____________________
3. Unreimbursed Professional Expenses (DO NOT SEND
RECEIPTS / just give category totals)
Professional Dues
Travel
Books
Subscriptions
Gifts ($25/personal/year limit)
Supplies
Religious Materials
Entertainment
Education
Other
____________
____________
____________
____________
____________
____________
____________
____________
____________
____________
***************************
HEATHCARE INSURANCE COVERAGE
Enter the name, SSN/DOB and health insurance status for each person claimed on your
return in the table below regarding the new health insurance reporting requirements
beginning in 2014.
(If not all 12 months, indicate which months each
Name of covered
individual(s)
SSN/DOB Covered All Exchange Exemption
person was covered by MEC*)
12 months
Policy
Received Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec
Use this worksheet to list the names of individuals listed on the income tax return and their
health care insurance coverage status. It will help your tax preparer determine who has health
insurance coverage, who may have an exemption, and who may be subject to the individual
shared responsibility payment.
Beginning in 2014, most individuals are required to have:
 Minimum Essential Coverage (MEC*), or
 An Exemption from the responsibility to have minimum essential coverage, or
 Make a Shared Reponsibility Payment.
Minumum Essential Coverage includes employer-sponsored coverage, health insurance
purchased through the Health Insurance marketplace (Exchange), Medicare, medicaid, certain
VA coverage, Tricare, etc.
If you purchased a health insurance policy from an exchange (or marketplace, check the
Exchange Policy box above. You will receive Form 1095-A from the exchange that issued your
policy. Please provide us with this form.
Also if you received a 1095 B or C form, please include it with this organizer.
We cannot begin to process your taxes without this necessary
Healthcare information.
***************************
To the best of my knowledge the enclosed information 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.
Signature____________________________________________________________ Date _________________
Signature____________________________________________________________ Date _________________
Please Note: Your tax return will not be processed without the appropriate
signatures
On the lines above. Both persons whose names appear on a joint tax return
must sign
On the appropriate line above.
E-FILING IS NOW MANDATORY FOR FIRMS PREPARING 10
OR MORE TAX RETURNS!!! If you wish to opt out of efiling,
you must complete an opt out form and send it with your
completed organizer.
This form is available on our web site.
ADDITIONAL NOTES AND INFO
Please mail to:
Cerran Enterprises
65 Willow Mill Park Rd
Mechanicsburg, PA 17050
Please include your current email address
on page 1