Download 1 - TAX4FA

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: