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2013 Tax Organizer New Clients enclose a copy of last year’s tax return Name: ____________________ SS#: _______________ Date of Birth: __________ Taxpayer Occupation: ___________________________________ Spouse: ____________________ SS#: _______________ Date of Birth: __________ Spouse Maiden Name: _______________ Spouse Occupation: _______________________ Filing Status: [ ] Single [ ] Married Filing Joint [ ] Head of Household [ ] Marred Filing Separately [ ] Qualified Widow(er) Spouse’s (must supply name & ss# of spouse) Date of death _____________ Dependents**: Name (first, initial, last) Social Security # Date of Birth Relationship __________________________________ ______________ ____________ __________ __________________________________ ______________ ____________ __________ Tax Address: Mailing Address: __________________________________ ___________________________________________ __________________________________ ___________________________________________ Telephone Number (_____) ___________ Cell Number (_____) _________________________ E-MAIL Address (if any): ___________________________________________________________ Residents of: NJ,NY,OH,IN,MA,MI,MN,PA,VA IL Property Tax # _________________________ Rents Paid __________ County______________________ School District_____________________ Please include all ORIGINAL copies of Forms W-2, W-2G, K-1, brokerage & mutual fund year end statements, 1099-C, 1099-INT, 1099-DIV, 1099-G, 1099-MISC, 1099-OID, 1099-R, 1099-S and city/county local tax forms and instructions. Did you make any Estimated Tax Payments or pay any prior year(s) federal or state taxes? Fed Est Tax $ ______ Back Taxes $______ State Est Taxes $______ Back Taxes $ ______ Amount of 2012 State Income Tax Refund –DO NOT INCLUDE FEDERAL REFUNDS: $ _____. Wages W-2’s Interest Income Form 1099-INT's Dividend Income (Schedule B) Form 1099-DIV's and year-end statements. Capital Gains and Losses (Schedule D) Form 1099-B Send all selling transaction from your brokerage firm(s) and/or mutual fund(s), need sales price and cost as well as dates. Year End Tax Reporting Statement. Unemployment Insurance Compensation Form 1099-G Distribution of Pension/IRA Form 1099-R [ ] Rolled over [ ] Not Rolled over If rolled over, please tell me the amount rolled over into: Regular IRA $ _______ Roth IRA $ _______ or new employer 401(k) $ _______ IRA Contributions Traditional IRA ROTH IRA Taxpayer Contribution $ _________ Taxpayer Contribution $ _________ Spouse Contribution $ _________ Spouse Contribution $ _________ Educational Savings Accounts List contributions made on or before 12-31-2013. These 529 Plan contributions may be deducted on your state income tax return. Coverdell’s are not. Contributions to State College Savings 529 Plan: State Plan Name _________________ Beneficiary/Student ______________________ Amount $ ______________________ Tuition and Fees Deduction Form 1098T Expenses $ ___________ Alimony Alimony received (if any) in 2013 $__________ Alimony Paid in 2013 $ _____________ Recipient’s Name __________________________ Recipient's Social Security # _________________ Moving Expenses (FORM 3903) (Must be more than 50 miles for employment). Moved From: ________ Moved To: ________ Miles Moved: ____ Date of Move ___-___-___ Shipping Supplies $ _______ Shipping Expenses (van, truck) $ _______ Lodging $_______ Unreimbursed Medical Expenses** total for the year (include your cost of medical insurance premiums (but not gym, health club or spa expenses), long term insurance and services, physician, dentist, chiropractor, prescriptions, lab fees, contacts/eyeglasses, psychotherapy & counseling $ __________. Total miles traveled for medical purposes _____. Taxes Paid during the year: Real Estate Taxes $ _______, Personal Property Taxes $ _______, Auto registration fees $ ________ Taxes paid to state or local authorities to settle a previous year tax liability $__________. Interest Expense Form 1098 Mortgage interest paid. If you purchased or refinanced a home in 2013, please enclose a copy of Form 1098 and the settlement statement {Form HUD-1} “U.S. Department of Housing & Urban Development Settlement Statement an 8 ½” X 14” form. Student loan interest $ ________________ Charitable Contributions** Cash Contributions (If more than $250, you must keep a written acknowledgement from the donee organization) Name Amount $ Name Amount ($) __________________________________ ____________________________________ __________________________________ ________________________________________ Non-cash Contributions (If $500 or less in total, must have records indicating original cost, age or condition of items) (If over $500 in total) Include: Donated to name & address, Describe the item(s), Date acquired by you, How acquired (purchase, gift, etc.), Your cost or basis $, Current Fair Market Value (FMV) $, Date of contribution. __________________________________ ____________________________________ __________________________________ ____________________________________ Child Care Expenses (FORM 2441) Did you pay a company or individual to care for your child(ren) during the 2013? If yes, fill in below: Name: ______________________________ ID # (Social Security or Federal ID#) ______________________ Address: __________________________ Amount Paid During 2013 $ _____ # of Children cared for______ Job Hunting Expenses for 2013 Expense $ ___________ Other Expenses IRA Management Fees paid in 2013: $_________ Safe Deposit Box Rental $ _________ Tax return Preparation fees paid in 2013 $ _________ Penalty - early withdrawal of savings $ _________ Other Notes: