2015 DATA ORGANIZER. First Name and Initial Last Name Social Security Number. (Optional: E-file confirmation will be sent to this address.

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1 CLIENT CHECKLIST Cpy f Scial Security cards fr all individuals n the tax return Cpy f drivers licenses fr primary taxpayer and spuse (if applicable) Vided check if yu wuld like direct depsit r direct debit Cpy f previus years tax return Subsequent rganizer pages filled ut All tax frms received in the mail (W2, 1099, 1098, 1095, etc)

2 2015 DATA ORGANIZER First Name and Initial Last Name Scial Security Number Date f Birth Date f Death Spuse First Name and Initial Last Name Scial Security Number Date f Birth Date f Death All refunds and crrespndence frm the taxing authrities will be sent t yur mailing address. If yu live abrad, yu may want t use a U.S. address in care f a trusted friend r relative. Yu may als use c/ 25 Clumbia Heights, Brklyn, NY MAILING ADDRESS (This address will be used n yur tax return.) Street Address Apartment Number City State Zip Cde Freign Cuntry Phne Number (Optinal: E-file cnfirmatin will be sent t this address.) PHYSICAL ADDRESS (if different) Street Address Apartment Number City State Zip Cde Freign Cuntry If yu mved during the year, list yur residency using the chart belw: Address (Street, City, State) Date Frm MM/DD/YY Date T MM/DD/YY If yu cannt find yur PIN, see the website: v/individuals/get- An-Identity- Prtectin-PIN IDENTITY THEFT Have yu been a victim f identity theft? Yes N Has the IRS issued yu an identity prtectin PIN? Yes N If yes, please enclse all pages f any crrespndence yu have received frm the IRS regarding yur identity prtectin PIN. MISCELLANEOUS INFORMATION (If yu are being claimed as a dependent n smene else s tax return, please prvide details belw.) Persnal Infrmatin

3 DIRECT DEPOSIT This infrmatin will nly be used if yu are due a refund. Payment instructins will be prvided with yur tax return if yu are required t pay. If yu are filing a jint tax return with yur spuse, a jint checking r savings accunt must be prvided. Direct depsits cannt be made t freign bank accunts (bank accunts utside f the U.S.). BANK INFORMATION Wuld yu like t have yur refund directly depsited t yur bank accunt? Yes N If yes, please verify yur bank infrmatin by prviding a vided check fr checking accunts r a bank statement fr savings accunts. NOTE: If prf is nt prvided, yur refund will be issued as a paper check. Sme states may issue a debit card. Even if yur bank accunt infrmatin has nt changed, yu must prvide prf each year. Type f accunt: Checking Savings DID YOU Attach prf f yur bank accunt infrmatin? (D nt send riginal dcuments.) Direct Depsit

4 WAGES If yu are an emplyee, taxes are withheld frm yur grss pay. Yur incme is generally reprted t yu n a Frm W-2. 20XX GENERAL INFORMATION SCAN AND ATTACH ALL FORMS W-2. List yur emplyers this year. Cnsult the list n the next page fr a list f yur emplyers last year (if applicable). Emplyers fr MISCELLANEOUS INFORMATION DID YOU Attach cpies f all Frms W-2? (D nt send riginal dcuments.) Wages

5 HEALTH INSURANCE COVERAGE The federal gvernment requires all taxpayers living in the United States t have qualifying health care cverage (knwn as minimum essential cverage). Failure t cmply may result in penalties n yur incme tax return. DESCRIBE YOUR HEALTH CARE DURING 2015 Place a check mark fr each mnth yu had minimum essential cverage. SCAN AND ATTACH ALL FORMS 1095-A, 1095-B AND 1095-C. Health care prvided by the branch and Medicare Parts B and C d nt qualify as minimum essential cverage required by the Affrdable Care Act. Please cntact Health Care Supprt befre making changes t yur health care arrangements. Type Mnths f Cverage Yur Cverage Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nv Dec Medicare Part A Emplyer* Private purchase Marketplace* Spuse's Cverage Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nv Dec Medicare Part A Emplyer* Private purchase Fr mre infrmatin n the Affrdable Care Act, visit c/affrdable-care-act- Tax-Prvisins-fr- Individuals-and- Families. Marketplace* *If yu were cvered by an emplyer-spnsred plan r purchased yur plan frm the Health Insurance Marketplace, yu shuld receive Frm 1095-A, 1095-B, r 1095-C. MISCELLANEOUS INFORMATION DID YOU Attach all Frms 1095-A, 1095-B, and 1095-C yu received? (D nt send riginal dcuments.) Health Care 1

6 2016 Miscellaneus Infrmatin Name: SSN: Retirement Infrmatin Educatin Infrmatin Miscellaneus Infrmatin Preparer Ntes Did yu make cash dnatins t charity during the year? Did yu make nncash dnatins t charity (clthes, furniture, etc.) during the year? Did yu dnate a bat r vehicle during the year? If "Yes," attach Frm 1098-C. Did yu have any jb-related expenses that were nt reimbursed by yur emplyer (unifrms, safety equipment, etc.)? Did yu use yur vehicle n the jb ther than fr cmmuting t wrk? Did yu wrk ut f twn at any time during the year? Did yu have gambling lsses during the year? Did yu receive any payments frm a pensin, prfit sharing, r 401(k) plan during the year? Did yu make any withdrawals frm r cntributins t an IRA, Rth, Kegh, SIMPLE, SEP, 401(k), myra, r ther qualified retirement plan during the year? Did yu receive any Scial Security benefits during the year? Did yu pay tuitin expenses that were required fr attending cllege, university, r vcatinal schl fr yurself, yur spuse, r a dependent during the year (even if classes were attended in anther year)? Did anyne in yur husehld attend a pst-secndary schl during the year? Did yu make a cntributin t r receive a distributin frm an Educatin Savings Accunt r Qualified Tuitin Prgram during the year? Did yu pay student lan interest fr yurself, yur spuse, r yur dependent(s) during the year? Did yu incur a lss due t damaged r stlen prperty? If "Yes," prvide the incident date, value f the prperty, and amunt f insurance reimbursements. Did yu pay wages t any husehld emplyees (babysitter, nanny, husekeeper, etc.)? Did yu make any gifts t any ne persn in excess f $14,000 during the year? If "Yes," are yu splitting the gift with yur spuse? Did yu incur mving expenses due t a change in emplyment? Did yu make any energy-efficient imprvements t yur main hme during the year? Are yu a business wner wh paid health insurance premiums fr yur emplyees during the year? Did yu apply an verpayment f yur 2015 taxes t yur 2016 estimated taxes? If yu have an verpayment f 2016 taxes, d yu want the refund applied t yur 2017 estimated taxes? Did yu make any estimated payments tward yur 2016 taxes? D yu want t have any refund r balance due directly depsited r withdrawn? If "Yes," prvide a canceled checking r savings slip. Did yu receive any ntices frm the IRS r state taxing authrity? May the IRS discuss yur tax return with yur preparer? Wuld yu like a physical cpy r a PDF cpy f yur tax return? Miscellaneus Ntes Drake Sftware - Individual Organizer - Cpyright 2016 S_MISC.LD2

7 2016 Miscellaneus Infrmatin Name: SSN: Persnal Infrmatin Yes N Did yur marital status change during the year? Can yu r yur spuse be claimed as a dependent by smene else? Did yur address change during the year? Dependent Infrmatin Did yu have any changes in dependents during the year? Can anther persn qualify t claim the child? Did yu have any childcare expenses during the year? Did yu have any adptin expenses during the year? Did yu have any children under age 19 r a full-time student under age 24 with mre than $1900 f unearned incme? Prvide dcumentatin fr prf f dependent related credits (schl recrds, medical recrds, daycare recrds, etc.) Health Care Infrmatin Did any member f yur husehld NOT have healthcare cverage fr the entire year? Prvide cpies f all Frms 1095-A, 1095-B, 1095-C fr ALL members f yur husehld. If any member f yur husehld received an exemptin frm the marketplace, prvide the Exemptin Certificate Number (ECN). Did yu receive any distributins frm a Health Savings Accunt (HSA), Archer MSA, r Medicare Advantage MSA during the year? Incme, Purchases, Sales, and Debt Infrmatin Did yu have a financial interest in r signature authrity ver a financial accunt r asset lcated in a freign cuntry? Did yu receive a distributin frm, r were yu a grantr f, r transferr t, a freign trust? Did yu have any incme frm, r pay taxes t, a freign cuntry? Did yu receive any tips nt reprted t yur emplyer? Did yu receive any disability incme during the year? Did yu cash any U.S. Savings Bnds during the year? Did yu receive any ther incme nt prvided with this rganizer? Did yu start a new business r purchase any rental prperty during the year? Did yu sell an existing business, rental prperty, r ther prperty during the year? Did yu purchase any business assets r cnvert any assets t business use? If "Yes," prvide the cst f the asset, the date it was placed in service, and business use percentage. Did yu purchase any gasline, diesel, r special fuels fr nn-highway business use? Did yu buy r sell any stcks, bnds, r ther investments during the year? Did yu sell a principal residence during the year? If "Yes," prvide clsing dcumentatin fr the purchase and sale f the hme. Did yu freclse r abandn a principal residence r real prperty during the year? Did yu refinance yur principal hme r secnd hme r take ut a hme equity lan during the year? If "Yes," prvide all escrw, clsing, and ther pertinent dcumentatin and infrmatin. Did yu receive any principal r interest, during this year, frm prperty sld in prir years? Did yu rent ut yur hme r use it fr business? Did yu sell, exchange, r purchase any real estate during the year? Did yu acquire a new r additinal interest in a partnership r S crpratin? Did yu have any debts canceled r frgiven this year? Des anyne we yu mney that has becme uncllectible? Did yu purchase a new hybrid, alternative mtr, r electric mtr energy-efficient vehicle during the year? If "Yes," prvide the year, make, mdel, VIN, and date the vehicle was placed in service. Itemized Deductin Infrmatin Did yu pay ut-f-pcket medical r dental expenses (premiums, prescriptins, mileage, etc.) during the year? Did yu pay any lng-term care premiums fr yurself, yur spuse, r a dependent during the year? Did yu receive any state r lcal incme tax refunds frm prir years? Did yu make any majr purchases (vehicle, bats, etc.) during the year? Did yu pay any real estate prperty taxes r persnal prperty taxes during the year? Did yu pay mrtgage interest during the year? Drake Sftware - Individual Organizer - Cpyright 2016 S_MISC.LD