Rukosky & Associates Financial Group, Inc. Tax Organizer

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1 Rukosky & Associates Financial Group, Inc. Tax Organizer Please complete this form and fax, , or drop if off at least three full days before your scheduled appointment, along with applicable forms listed in Section Personal Information IF any of the information below has changed, please update in the appropriate fields Name Social Security # Date of Birth Occupation Taxpayer Spouse Address City State Zip Home Cell # Work Work # Taxpayer Spouse Marital Status Blind No Blind No Married Disabled No Disabled No Single Pres. Campaign Fund No Pres. Campaign Fund No Legally Separated 2. Dependents (Children and Others) list ONLY new additions or deletions Name (First, Last) Relationship To You DOB SSN Months Lived With You Disabled? Full Time Student? Gross Income 3. Miscellaneous Income and Expense please answer ALL questions 1. Are you self-employed or do you receive hobby income? 2. Did you receive rent from real estate or other property? 3. Did you make any withdrawals from a mutual fund or did you sell stocks/bonds? 7. Were there any births, deaths, marriages, divorces, or adoptions in your immediate family? 8. Did you give a gift of more than $14,000 to one or more people? 9. Did you have any debts cancelled, forgiven, or refinanced? Was your home foreclosed on? 4. Do you have a foreign bank account, trust, or business? 10. Did you go through bankruptcy proceedings? 5. Did you provide a home for or help support anyone not listed in Section 2? 6. Did you pay expenses or tuition for you, your spouse, or your dependent(s) to attend classes beyond high school this past year? 11. Did you pay interest on a student loan for you, your spouse, or a dependent during the year? 12. Did you receive correspondence in 2015 from the IRS or your State Revenue Dept? Rukosky & Associates Financial Group, Inc. Page 1 of 2

2 13. Did you have any children under the age of 19, or a student age 19-23, with unearned income (stocks, dividends) of more than $2,100? 18. Did you receive an inheritance in 2015? 14. Did you refinance your home in 2015? 19. To your main residence, did you install a solar water heater, solar panels, generator, or energy efficient home improvements such as exterior doors, windows, insulation, heat furnaces, central air conditioners, or water heaters? 15. Were you required to take a Required Minimum Distribution in 2015? 20. Were you on active military duty in 2015? 16. Did you incur job search expenses in 2015? 21. Did all members of your household have health insurance for all of 2015? 17. Did you or your spouse purchase health insurance in 2015 and receive a subsidy from the Federal government to help pay for the insurance? 4. Forms Checklist please collect all forms BEFORE making an appointment W-2 forms Bank interest income (Form 1099-INT) Dividend income (Form 1099-DIV) Stock reports (Form 1099-B) Partnership income (schedule K-1) Pension distributions (Form 1099-R) Mortgage interest (Form 1098) Tuition (Form 1099-T) Self-employed income (Form 1099-MISC) Spreadsheets, QB file(s), bank statements (for self-employed) Vehicle property tax Home property tax IRS contribution (Form 5498) Other 5. Business Owners Only please be sure to bring this information with you! Date, cost, and description of new equipment (or auto) purchased Date, cost, and description of any equipment (or auto) sold Auto mileage: total miles driven on each vehicle and business miles driven on each vehicle S Corp owners: the balance in your checking account on 12/31/2015 and if you took out business loans, we need the original amount of the loan, the amount of interest paid on the loan, and the loan balance on 12/31/2015 Please thoroughly review this form and gather your documents before scheduling an appointment. Should you have questions, please contact us. Thank You! Office: (919) Fax: (919) mytaxdocs@rafginc.com Address: 4904 Professional Court, Suite 102 Raleigh, NC Rukosky & Associates Financial Group, Inc. Page 2 of 2

3 Rukosky & Associates Financial Group, Inc. Is Focused On Your Financial Well-Being If you aren t already aware, the future pensions, Social Security, and 401(k) employer-matching is poised for change. You come here for our tax expertise; however, did you know that we also prepare over 25 Retirement, Debt Elimination, and College Education plans for our clients each year? This tax season, look after your future at no cost to you! You can either provide us with your retirement savings reports when you come in (401(k), 457, 403(b), IRA, annuities, stock reports, etc.) or fill out the form below. You will receive a tailored Retirement Plan as well as have the option to receive a 40 minute consultation at no cost to you. Click or cut and paste this link to see an example Retirement Report Current Balance Investment Type Yours or Your Spouses? Work or Personal Investment To Be Used For Example $10,000 Roth IRA Spouse Personal Mortgage Payoff Example $35,000 IRA Mine Personal Retirement Example $15,000 Certificate of Deposit Spouse Personal Home Repairs Example $25,000 Stocks Mine Personal Second Home Example $65,000 Annuity Spouse Personal Grandchildren Example $25,000 Savings Account Mine Personal Emergencies Example $100, (k)/403(b)/457 Mine Work Retirement Example $5,000 Bonds Mine Personal Child Education At What Age Will You Retire? At What Age Will Your Spouse Retire? Current Balance Investment Type Yours or Your Spouses? Work or Personal Investment To Be Used For Investment #1 Investment #2 Investment #3 Investment #4 Investment #5 Investment #6 Investment #7 Investment #8 Investment #9 Investment #10 Rukosky & Associates Financial Group, Inc.

4 VALUATION GUIDE FOR DONATED PROPERTY Merchandise Donated By: Last Name First Name Name of Charity Date of Donation Street Address City/State/Zip The following price ranges are provided for your convenience in recording your donation(s). The values are obtained from annual surveys of consignment and/or thrift stores, conforming to IRS requirements for valuing donated items. ASSIGNING VALUES FOR TAX PURPOSES IS THE DONOR S RESPONSIBILTY CHILDREN S CLOTHING MEN S CLOTHING Description Good Condition Fair Condition Total Description Good Condition Fair Condition Total Qty. Price Qty. Price Qty. Price Qty. Price Blouses Jackets Boots Overcoats Coats Pajamas Dresses Pants/Shorts Jackets Raincoat Jeans Suits Pants Slacks Snowsuits Shirts Shoes Sweaters Skirts Shoes Sweaters Swim Trunks Slacks Tuxedo Shirts Undershirts Socks Undershorts Underwear Belts/Ties Total Total Rukosky & Associates Financial Group, Inc. Page 1 of 2

5 VALUATION GUIDE FOR DONATED PROPERTY LADIES CLOTHING HOUSEHOLD ITEMS AND FURNITURE Description Good Condition Fair Condition Total Description Good Condition Fair Condition Total Qty. Price Qty. Price Qty. Price Qty. Price Blouses Bedroom Sets Bathrobes Dining Rooms Boots Kitchen Sets Bras Double Beds Bathing Suits Single Beds Coats Air Condition Units Dresses Bars Evening Dresses Bar Stools Fur Hats Bicycles Fur Coats Conventional Sofas Undergarments Cribs Hats Strollers Jackets Coffee Tables Nightgowns Dressers/ Mirrors Pant Suits Desks Socks Dryers Suits Stoves Shoes End Tables Skirts Lamps Sweaters Heaters Slips High Chairs Slacks Kitchen Tables Handbags Pianos Paintings Total Pool Tables MISCELLANEOUS Play Pens Description Good Condition Fair Condition Total Stereo Equip Blankets/ Comforters Qty. Price Qty. Price Rugs Refrigerators Computers Sofas Lawn Mowers Televisions Sewing Machines Vacuum Cleaners Washer/ Dryers Total Total Rukosky & Associates Financial Group, Inc. Page 2 of 2

6 UNREIMBURSED MEDICAL EXPENSE WORKSHEET Last Name First Name Tax Year Note: It may be POSSIBLE to deduct these expenses; however, your ability to deduct these items depends on your personal situation. ONLY your tax advisor can assist you in making the proper determination. Out of Pocket Medical Expense Taxpayer Spouse Prescription medications Health insurance premiums (NOT out of paycheck) Gross LTC premiums Dependent and/or child under 27 health insurance Doctor and/or dentist (expenses and/or co-pays) Hospitals and/or clinics (expenses and/or co-pays) Labs and/or x-rays Long-Term Care Eyeglasses and/or contacts Medical equipment and/or supplies Other medical expense (ambulance, etc.) Lodging for medical purpose Birth Control Legal Abortion Acupuncture Alcoholism for inpatient s treatment at a therapeutic center, INCLUDING meals/lodging Amounts paid for transportation to/from REQUIRED Alcoholics Anonymous meetings (not mileage expense, see below) Annual physical examination Artificial teeth Bandages Electronic body scans Breast pump and/or supplies (that assist lactation) Breast reconstructive surgery and/or breast prosthesis, FOLLOWING a mastectomy due to cancer. Home construction pertaining to medical needs (e.g. installation of entrance/exit ramps, installing railings, support bars, modifying stairs, installing porch lifts and other forms of lifts, etc.) Car modifications for special hand controls and/or other special equipment for MEDICAL reasons Chiropractor Crutches Diagnostic devices Rukosky & Associates Financial Group, Inc. Page 1 of 2

7 UNREIMBURSED MEDICAL EXPENSE WORKSHEET Drug addiction for an inpatient s treatment at a therapeutic center for drug addiction, INCLUDING meals/lodging Eye surgery Fertility Enhancement (e.g. procedures such as in vitro fertilization, INLCUDING temporary storage or eggs/sperm and surgery, INCLUDING operation to reverse prior surgery that prevented that person from having children Founder s Fee you pay monthly or as a lump sum under an agreement with a retirement home Guide Dog expense including buying, training, and maintaining a guide dog or other service animal (e.g. vet bills, food, grooming, etc.) HMO expense you pay to entitle you, your spouse, and/or dependent to receive medical care Hearing aids Nursing services (e.g. services connected with caring for the patient s condition, giving medication or changing dressings, and bathing/grooming for the patient) Lead-based paint removal from surfaces in the home to prevent a child who has or has had lead poisoning (paint MUST be in poor repair - e.g. cracked walls) Special education expense paid for a child s tutoring by a specially trained learning disabilities teacher Cost of legal sterilization Stop-smoking programs (e.g. REQUIRED referral from doctor) Cost of therapy as a medical treatment Cost of transplants (e.g. a possible donor of a kidney or other organ, INCLUDING transportation) Tuition expense for a special education (e.g. special needs) A legal vasectomy Weight-Loss program for a disease diagnosed by a physician (e.g. you CANNOT DEDUCT gym fees, health clubs, or spas) An autoette and/or wheelchair A wig expense upon advice of a physician (e.g. a patient that has lost all of his/her hair from disease) Other Other Other Other Other Total Total medical mileage (e.g. doctor visits, going to the pharmacy, etc.) Rukosky & Associates Financial Group, Inc. Page 2 of 2

8 THESE WORKSHEETS ARE USEFUL FOR SELF-EMPLOYED INDIVIDUALS, CLIENTS WHO RECEIVE 1099-MISC FORMS FROM SIDE-JOBS, OR S CORPORATION OWNERS Last Name First Name Tax Year Note: It may be POSSIBLE to deduct these expenses; however, your ability to deduct these items depends on your personal situation. ONLY your tax advisor can assist you in making the proper determination. EXPENSES PAID EXAMPLES Equipment/Computer Repairs $ Did you have to repair any equipment? Maintenance $ Did you buy anything to maintain equipment? Rent $ Do you pay rent for an office or storage space to conduct business? Taxes and Licenses $ Did you have to obtain any licenses or pay any taxes to perform your job? Interest $ Do you pay credit card interest or other loan interest? Advertising $ Did you pay someone or do any advertising for your business? Accounting $ Did someone charge you to perform accounting duties? Bank Fees $ Did the bank charge you any fees? Cleaning Supplies $ Did you pay for cleaning supplies? Commissions $ Did you have to pay anyone commissions for buying or selling something? Computer Services $ Did you need an IT person to perform services on your computer equipment? Office Supplies $ Pens, paper, ink cartridges Credit and Collection Costs $ Did you incur any fees to collect outstanding invoices owed to you? Delivery and Freight $ Did you have any shipping, postage, or receiving expenses? Discounts $ Did you have to discount something to get it off your shelf? $ Did you have any professional dues, magazine, or computer Dues and Subscription Expense service subscriptions? Total Small Equipment Expense (Under $ Did you buy any small equipment that is under $500 each? $500/per item) $ Did you have to rent any equipment (e.g. Equipment Rental Fees machinery/computers)? Gifts Expense $ Did you buy any gifts for your clients to perform business? Insurance Costs $ Do you have to obtain insurance to perform your job? Job Materials $ Did you have to buy any materials to complete a job? Janitorial Costs $ Did you perform or pay for any janitorial fees or supplies? Laundry and Dry Cleaning $ Did you wash laundry at your home (e.g. laundry detergent costs) for business attire? Legal and Professional Expense $ Did you have to pay any legal, accounting or professional fees? Meals and Entertainment 50% Limit $ Did you take existing or potential clients our for meals or entertainment? Outside Services/Independent Contractors $ Did you pay for any outside services or pay for independent contractors? Parking Fees and Tolls $ Highway tolls, parking garage fees Permits and Fees $ Did you pay for any permits? Postage $ Sending letters/packages Printing $ Kinko s, Office Depot, UPS Store, etc. Security $ Security system monthly or installation fee Supplies $ File folders, envelopes, ink, paper, etc. Rukosky & Associates Financial Group, Inc. Page 1 of 3

9 THESE WORKSHEETS ARE USEFUL FOR SELF-EMPLOYED INDIVIDUALS, CLIENTS WHO RECEIVE 1099-MISC FORMS FROM SIDE-JOBS, OR S CORPORATION OWNERS Telephone Expense $ Mobile phone or office phone Internet Expense $ Internet access Training/Continuing Education $ CE fees, training classes Travel (lodging/airfare) $ Plane tickets, train tickets, hotel/motel expenses. Separate into categories, please! Uniforms Expense $ Did you buy any work-related uniforms or dedicated work clothing (jeans, shirts) Uniform Cleaning $ Did you have to pay to clean the uniforms you have or purchased (either you or an outside service)? Utilities Expense $ Electric/Gas for your home office. Separate charges, please! Other $ Other $ Other $ Other $ Other $ HOME OFFICE AND STORAGE DAYCARE OUT-OF-HOUSE Date you began using your home office for this business Number of weeks used for daycare Square footage of your home regularly used Number of days used for for your business OR for storage of business daycare each week items, or both Total square footage of your home Number of days closed during the year Number of hours office used during the year Number of hours used for daycare each day DIRECT EXPENSE INDIRECT EXPENSE SQUARE FOOTAGE FOR DAYCARE These expenses are specifically for the office part of your home office These expense affect the entire house Area used exclusively for daycare Real Estate Taxes $ $ Area used only partly for Real Estate Taxes daycare Insurance $ $ Total square footage of Insurance home Rent $ $ Total hours available for Rent use during the year Repairs/Maint. $ Repairs/Maint. $ UTILITIES Home Phone $ Home Phone $ DIRECT EXPENSE INDIRECT EXPENSE Internet $ Internet $ Electric $ Electric $ Security $ Security $ Gas $ Gas $ HOA Dues $ HOA Dues $ Water $ Water $ Other $ Other $ Other $ Other $ Total $ Total $ Other $ Other $ LARGE EQUIPMENT (Items costing over $500 for EACH piece of equipment) Purchase Date Description Cost Rukosky & Associates Financial Group, Inc. Page 2 of 3

10 VEHICLE WORKSHEET Last Name First Name Tax Year This worksheet is only to be filled out if you use your vehicle(s) for BUSINESS purposes. This worksheet applies to the following: Self-employed individuals, clients who receive 1099-MISC forms for side-jobs, or S Corporation owners, ow W-2 workers who have a second (or third) job and incur mileage going from their first job to their second job (and their second job to their third job) in the same day. VEHICLE INFORMATION CAR INFORMATION Vehicle 1 Vehicle 2 Vehicle 3 Year/Make/Model Date you began using vehicle for business Ending mileage reading Beginning mileage reading TOTAL miles put on the vehicle for the year BUSINESS miles put on the vehicle for the year Is another vehicle available for personal use? No No No Was the vehicle available for personal use during off-duty hours? Was the vehicle used primarily by a more than 5% owner or related individual? Was the vehicle leased? No No No No No No No No No ACTUAL EXPENSES Vehicle 1 Vehicle 2 Vehicle 3 Gasoline, Oil, Repairs, Insurance, etc. $ Vehicle Registration, License (excluding property taxes) $ BUY OR SELL INFORMATION Vehicle 1 Vehicle 2 Vehicle 3 Cost of your old vehicle $ Did you trade-in or sell this vehicle during this year? No No No If you bought a vehicle, is your recently purchased vehicle a No No No new model (2015)? Did you trade-in or sell a vehicle that was previously listed for No No No business use? Did your employer reimburse you for any auto expenses? No No No If your employer did, how much were you reimbursed? $ Rukosky & Associates Financial Group, Inc. Page 3 of 3

11 MILITARY PERSONNEL WORKSHEET Last Name First Name Tax Year Note: It may be POSSIBLE to deduct these expenses; however, your ability to deduct these items depends on your personal situation. ONLY your tax advisor can assist you in making the proper determination. UNIFORMS VEHICLE AND TRAVEL Uniforms $ See Vehicle. Travel, and Entertainment Worksheet Belts $ EQUIPMENT Boots/Shoes $ Badges/Name Tags $ Gloves $ Briefcase/Backpack $ Hat/Helmet $ Binoculars $ Jacket/Rain Gear $ Flashlight/Bulbs/Batteries $ Pants $ Maps/GPS $ Shirts/Socks/UA $ Notebook(s) $ Ties $ Equipment Repairs $ Emblems/Insignias/Patches $ Safety equipment $ Dry Cleaning $ Tape Recorder $ Laundry Products $ Tapes/CD s/mp3 s (work related) Protective Eyewear $ Whistle $ Uniform Alterations $ Ammo Pouch $ TOTAL $ Ammunition $ PROFESSIONAL Baton $ Union Dues $ Bulletproof Vest $ Association Dues $ Ear Protectors $ Professional Dues $ Camera $ Range Dues $ Guns $ Fingerprinting $ Mace $ Licenses/Permits $ TOTAL $ Subscriptions $ MISCELLANEOUS Textbooks/Manuals $ Cellular Phone $ Supplies $ 2 nd Line/Fax Line $ Internet Access $ Long Distance $ Equip. (Computer, etc.) $ Pay Phone/Skype/etc. $ TOTAL $ Bed Linens $ INSURANCE Hygiene Supplies $ Errors and Omissions $ Haircuts $ Bond Insurance $ Other $ Other $ Other $ TOTAL $ TOTAL $ $ Rukosky & Associates Financial Group, Inc.

Charitable Donations Value Guide

Charitable Donations Value Guide The Donation Value Guide below helps you determine the approximate tax-deductible value of some of the more commonly donated items. It includes low and high estimates.