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Hilary Carpenter
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1 4-G Parkway Greensboro, North Carolina Phone: (336) Fax: ( 866) E- Mail: W Thompson1004@yahoo.com E-M ail : N ewsam@thechurchc.org T ax Office Address : 4 Parkway Suite G Greensboro, NC T he Church Coalition (TCC) M INISTER S T ax Year: Y our Name Y our Social Security Number: Y our Date of Birth: M o: Day: Yr: Y our Spouse s Name Spouse s Social Security Number: S pouse s Date of Birth: M o: Day: Yr: Y our Mailing Address: Y our Home Phone: ( ) - Y our Work Phone: ( ) - E mail Address: D EPENDENTS N ame R elationship S ocial Security Number D ate of Birth No.# Months In H ome I NFORMATION ON YOUR INCOME Do you currently have an approved form 4361 exemption? MINISTERIAL and/or P ROFESSIONAL INCOME C hurch Salary ( Attach all forms W- 2 or 1099 to document income) A uto Allowance S pecial Services L ove Offerings and Other Gifts H onorariums for outside speaking L ist source and amount of any other ministerial income S tate Income Tax Refund N ame of State Non-T axable Compensation H ousing Allowance E quity Allowance P arsonage Allowance ( Fair Market Value) F urniture Allowance A ll Rights Reserved 1 of

2 I NFORMATION ON ESTIMATED TAXES ESTIMATED T AXES C REDIT FROM PRIOR FIRST QUARTER S ECOND QUARTER T HIRD QUARTER F OURTH QUARTER T OTAL FOR YEAR Y EAR S VOUCHER P AYMENTS ( APRIL 15) ( JUNE 15) ( SEPT. 15) ( JAN. 15) F ederal S tate NON-M INISTERIAL INCOME Wages, S alaries, Tips, Etc. ( Attach W- 2 s) I nterest Income from Seller- F inanced Mortgages & Individuals: I nterest Income f rom Banks & Financial Institutions (Attach 1099 INTs) : B ank Name: B ank Name: B ank Name: B ank Name: D o you have a f oreign bank account? If so, list interest income. Did you have any non- t axable interest income? If so, list amount. D id you sell or redeem any U.S. Savings Bonds? If so, list amount. D id you earn any D ividends? If so, attach 1099 DIV s. D id you earn any Capital Gains? If so, attach 1099B s. Did you take any Non- t axable Distributions? If so, attach 1099 B s. D id you receive any pension distributions? If s o, attach 1099 R s. D id you make contributions to your pension plan? H ave you recovered your contribution? D id you have any rollovers? If so, attach 1099 Rs rollover papers. D id you r eceive any Social Security Income? D id your spouse receive any Social Security Income? D id you or your spouse receive any alimony? O THER EARNED INCOME I ncome from Estate & Trusts Attach K-1 s J ury Duty Income from S-C orporations Attach K-1 s T ips I ncome from Partnerships Attach K-1 s P rizes / Awards I tem: I tem: G AINS or LOSSES FROM SALE OF PROPERTY, STOCK, ETC. I tem D ate Bought D ate Sold S ale Price C ost & Expense G ain or Loss / / / / / / / / / / / / O THER INCOME: 2 of

3 A DJUSTMENTS TO INCOME: C ontribution to IRA ( Traditional and SEP etc.. not Roth or Rollover) : E ducator Expenses: A limony Payments: H ealth Savings Account: M oving Expenses (Itemize by type under comments section): S tudent Loan Interest ( Attach E ): U S Armed Forces ( Active, Reserve, or National Guard) : D id you serve in the US Armed Forces this Year? I f yes, how many miles did you incur? P lease list any unreimbursed expenses you had: Prior Year Tax Return Carryovers (Check Previous Year R eturn if not sure) : D id you have any Tax Return Carryovers? C apital Loss Carryover C haritable Contribution Carryover C omments 3 of

4 I NFORMATION ON YOUR EXPENSES M INISTERIAL PARSONAGE & HOUSING EXPENSES ( or Business Home Office Expenses) F air Rental Value of Parsonage/Housing Allowance amount: M ortgage Payment / Rent Payment Own Rent M ortgage Interest D own Payment E xtra Payment towards Principal P roperty Taxes A larm & Security A ir Conditioning A ppliances Purchased A ppliances Repaired A ssessments C arpentry C arpet C arpet Cleaning C able or Satellite TV C leaning Supplies Purchased D ecorating E lectrical E lectricity F ilters F urniture Purchased G arbage G ardening, and other yard work G as I nsurance P ainting Inside P ainting Outside P est Control P lumbing R emodeling R epairs R oofing S ound & Video Items W ater & Sewer O ther Expense (Please Identify) O ther Expense (Please Identify) T OTAL D esignated Housing Allowance U nused Housing Allowance (For TCC Use Only) M INISTERIAL AUTO EXPENSE W hen was your vehicle placed in service for Ministerial purposes: T otal Miles Driven: T otal Pastoral M iles (TCC will determine if 90 day c onsecutive rule applies) C ommuting Miles: I nterest on Auto Loan: T olls Paid: B eginning Odometer Reading E nding Odometer Reading 4 of

5 MINISTERIAL TRAVEL & E NTERTAINMENT ( Keep receipts for three years) ( TCC will determine if Per Diem is best) P lane Fares B us & Trains T axi Fares M otels & Hotels O ut of Town Meals T ips E ntertaining Meals Out E ntertaining In Home M INISTERIAL CONTINUING EDUCATION ( Do not include expenses paid to become a minister) T uition B ooks S chool & Study Supplies T ransportation Expense M eals L odging E ducational Trip Expense E ducational Activity Expense MINISTERIAL E XPENSES A ccounting A dvertising B ank Charges B ibles C asual Labor ( Musicians, Drivers etc) C lergy Uniforms D ues & Professional Societies M inistry Reports (Required Offerings, Ordination Fees etc) E quipment Rent I nsurance (office o r professional) I nterest (professional) C hurch Bills (Unreimbursed) L aundry & Cleaning L egal Fees Telephone-M inistry long distance L icense & Professional Fees O ffice & Equipment Repairs O ffice Rent O ffice Supplies Office T elephone O ffice Utilities P eriodicals P ostage R eligious Books S ermon Material S upplies O ther Expense: (Identify) O ther Expense: (Identify) 5 of

6 B USINESS INCOME/SELF EMPLOYMENT B usiness Name B usiness Address Primary Business A ctivity I ncome earned from Business this year D id you both participate in this Business B USINESS EXPENSES B usiness #1 B usiness # 2 B usiness # 3 A dvertising B ad Debts B ank Service Charges Commissions/ Contracted Labor C osts of Goods (Beginning Inventory) C ost of Goods (Ending Inventory) D ues & Publications E quipment Rentals F reight & Shipping I nsurance (other than health) L aundry & Cleaning L egal & Professional Fees M aterials & Supplies M eals & Entertainment M erchandise M ortgage Interest ( Use only if you have a home office) O ffice Expenses B usiness I nterest Paid ( Loans, Credit cards etc) Non-R eal Estate Taxes & Licenses R eal Estate Taxes ( Use only if you have a home office) R ent on Business Property Repairs a nd Maintenance S upplies T elephone ( Business Cell phone, Landline) T ools T ravel (no meals) U niforms U tilities W ages & Salaries ( Employees/Contract labor) D id you Hire your child/spouse? (If See Accountant) H ome Office S quare Footage of Home Office S quare Footage of Entire Home E xpenses for Business Use of your Home ( Please complete P age 4 ) C ost of Office Furniture ( Specify Type) ( Existing or New) Other H ome Office E xpenses Not Listed 6 of

7 Note: If Vehicle is le ased only use Actual Operating Costs B USINESS AUTO EXPENSE ( Standard Mileage Rate) ( Recommended) W hen was Vehicle place in Service for Business Purposes: T otal Miles Driven: T otal B usiness Miles: C ommuting: I nterest on Auto Loan: W as the Vehicle available for Use during off duty hours: D o you or your Spouse have another vehicle available for Personal Use: B eginning Odometer Reading Ending O dometer Reading B USINESS AUTO EXPENSE (Actual Operating Costs) W hen was Vehicle place in Service for Business Purposes: T otal Miles Driven: T otal Business Miles: C ommuting: I nterest on Auto Loan: W as the Vehicle available for Use during off d uty hours: D o you or your Spouse have another vehicle available for Personal Use: B eginning Odometer Reading E nding Odometer Reading O perating Expenses: G asoline O il and Oil changes N ew Tires R epairs M aintenance L icense & Registration Fees Note: We are requesting greatest Tax Deduction. both Actual Miles and Actual Operating Costs to determine which method yields you the 7 of

8 R ENTAL INCOME AND INFORMATION P roperty 1 P roperty 2 P roperty 3 I ncome Earned T ype of Property Physical Address of Each P roperty D ate Purchased / / / / / / P urchase Price E stimated Land V alue P ROPERTY RENTAL EXPENSES P roperty 1 P roperty 2 P roperty 3 A dvertising Costs A ssociation Dues A uto & Travel C leaning & Maintenance C leaning Supplies C ommissions G ardening I nsurance L egal & Professional Fees L icenses & Permits M anagement Fees M iscellaneous M ortgage Interest O ther Interest Paid P ainting & Decorating P ainting Equipment P est Control P lumbing & Electrical R epairs S upplies T axes T elephone T ools U tilities W ages & Salaries O ther (list) O ther (list) 8 of

9 I NFORMATION ON YOUR DEDUCTIONS H EALTH INSURANCE COVERAGE (AFFORDABLE CARE ACT REQUIREMENTS) D id you have Health Insurance Coverage for the Full Year? I f, how many months out of the Year did you have Health Insurance? A re you claiming an Exemption from the Health Insurance Requirement? W hat was the Reason for t he Health Insurance Exemption? W hat is your Exemption Certificate Number (ECN) from the Marketplace? D id you purchase your Health Insurance from a State Based or Federally Facilitated Marketplace? D id you receive any Cost sharing S ubsidies or Tax Credits for your Health Insurance? I f you answered, what was your monthly Advanced Premium Tax Credit (APTC) H ow many months did you receive the APTC? Have you received the Health Insurance Marketplace Statement (Form A )? If, please attach ( Form A ) w ith Tax Intake Worksheet M EDICAL DEDUCTIONS (Out of Pocket Expenses) P renatal Care E yeglasses X-R ays M edical Lodging T herapy Equipment M edical Supplies & Appliances P rosthesis Expense P ostnatal H earing Aids L ab Fees B andages C rutches D iabetic Expense T herapy Pool M edicare O THER MEDICAL DEDUCTIONS (Out of Pocket Expenses) M edicine and Drugs H ospitals T ransportation & Lodging Miles f or medical purposes I nsurance Premiums 9 of

10 T AXES PAID S tate taxes paid this year for prior years P ersonal Property Taxes ( Look up Tax portion on vehicle registration documentation) R eal Estate Taxes First-T ime Homebuyer Credit Repayment O ther Taxes C HILD AND DEPENDENT CARE EXPENSES C hild s Name C are Provider s Name A ddress S SN or EIN A mounts Paid C HILD AND DEPENDENT CARE EXPENSES C hild s Name C are Provider s Name A ddress S SN o r EIN A mounts Paid E DUCATION TAX CREDITS I nstitution Name W here you Enrolled Full Time or Half Time H ow many years have you been in college? Please attach Form 1098-T L ist Educational Expenses ( R equired Books and materials) MORTGAGE & I NTEREST EXPENSE ( Please Attach 1098) Did You Purchase a new h ome? P roperty 1 P roperty 2 P roperty 3 M ortgage ( Interest) 2 nd Home Mortgage P rivate Mortgage Insurance P oints Paid C ONTRIBUTIONS MADE C hurches or M inisters ( Provide name of Church and Contribution statement if possible) M issions and Evangelism E vangelists M ISCELLANEOUS A doption Expense M oving Expenses I nvestment Expense S afety Deposit Box S afety Equipment S pouse Dues T ax Preparer Fee 10 of

11 P ROVIDER S DECLARATION N ame of Individual Client and/or Business: Tax Form(s) Year Ending: 2014_ T o protect you, the Client, this professional tax preparation firm follows accepted ethical procedures as specified by the Internal Revenue Code and/or applicable guidelines governing the conduct of professional tax preparers. After r eading each statement below carefully, please acknowledge your acceptance by signing the bottom of this form. Thank you for your cooperation and understanding of the responsibilities we must accept as professional tax p reparers. T he specified income tax returns have been prepared for me and/or my business at my direction by William V T hompson, T ax Consultant, o r Newsam T Mutamba, Tax Accountant, t hrough T he Church Coalition (TCC). I have reviewed the completed returns and understand their contents and have received a copy of the returns. I r ealize it is my responsibility to include in my files all documentation necessary to substantiate all income, deductions, and credits reflected on the returns for at least 7 y ears. A ll information on these returns is true and accurate according to the information furnished by me to Tax Firm. N othing has been added or deleted by the preparer that would understate my tax liability. All taxable income has been reported, including any bartering, any partnership interests, any sales of business or p ersonal assets, and all interest a nd dividend income from all sources. I have informed my tax preparer of any adjustments or correspondence between any taxing authority and me and/or m y business during the past years. I have been informed that I must have adequate written records for all deductions and specifically for: A ny travel or entertainment, A ny business use of a vehicle, A ny business use of listed property, Any non- c ash contributions to charity. I understand my professional tax preparer has based the entries on these returns according to present laws, regulations, and other applicable authority. I understand that tax law and its interpretation is subject to continual c hange and therefore the rules and principles followed in the preparation of these returns may not be applicable for a ny other tax year. My tax preparer has indicated any aggressive applications to me and I understand such a position may be questioned or overturned in the audit process. I agree to hold my preparer harmless from any examination and p ossible revers al on this (these) issues. T ax Consultant W illiam V Thompson O r T ax Accountant N ewsam T Mutamba A ccepted By Client(s): I ndividual Signature S pouse s Signature (if married) D ate Signed D ate Signed of

Personal Legal Plans Client Organizer 2018

Personal Legal Plans Client Organizer 2018 TAXPAYER NAME SOCIAL SECURITY NUMBER OCCUPATION DATE OF BIRTH EMAIL ADDRESS CELL PHONE SPOUSE Address: Home Phone: City: State: Zip: County: DEPENDENT CHILDREN & OTHER DEPENDENTS NAME SOCIAL SECURITY NUMBER