1040 US Tax Organizer

Transcription

1 1040 US Tax Organizer CLIENT INFORMATION First name and initial..... Last name Title/suffix Social security number... Occupation Date of birth (m/d/y) Date of death (m/d/y) =blind Home phone Work phone Work extension Cell phone address Address DEPENDENTS First name Last name Title/suffix Date of birth (m/d/y) Date of death (m/d/y)..... Date of adoption (m/d/y).. Social security number... Relationship Months lived at home.... First name Last name Title/suffix Date of birth (m/d/y) Date of death (m/d/y)..... Date of adoption (m/d/y).. Social security number... Relationship Months lived at home.... Kathleen M. Zaffore, P.C E Pikes Peak Ave Ste 101 Parker, CO Telephone number: Fax number: address: In care of Street address Apartment number.. City State ZIP code (303) (303) kathyz@zaffore.com Taxpayer Dependent No. Dependent No. Tax Return Appointment Date: Time: Location: This tax organizer will assist you in gathering information necessary for the preparation of your tax return. Please enter all pertinent information. NOTE: If you claim the earned income credit, please provide proof that your child is a resident of the United States. This proof is typically in the form of: school records or statement, landlord or property management statement, health care provider statement, medical records, child care provider records, placement agency statement, social service records or statement, place of worship, Indian tribal office statement, or employer statement. NOTE: If your child is disabled, please provide one of the following forms of proof of disability: doctor statement, other health care provider statement, or social services agency or program statement. Spouse Dependent No. Dependent No. Tax Organizer

2 1040 US Tax Organizer Please enter all pertinent information. If you have attached a government form for an item, check the box and do not enter a amount. WAGES, SALARIES AND TIPS Employer name: Amount 2016 Amount Attach Forms W-2 INTEREST INCOME Payer name: Attach Forms 1099-INT DIVIDEND INCOME Payer name: Attach Forms 1099-DIV PENSIONS, IRA AND GAMBLING INCOME Payer name: Attach Forms 1099-R & W-2G Winnings not reported on W-2G Total gambling losses OTHER GOVERNMENT FORMS - INCOME Form 1099-B - Sales of stock (also include transaction history) Form 1099-MISC - Miscellaneous income Form 1099-K - Merchant card and third party network payments..... Form 1099-S - Sales of real estate (also include closing statements) Attach Forms 1099 Taxpayer: Form 1099-G - State tax refunds Attach Forms 1099 Form SSA Social security benefits Form 1099-G - Unemployment compensation Form 1099-Q (529 Plan) Attach Forms 1099 Spouse: Form 1099-QA/5498-QA (ABLE Accounts) Form SSA Social security benefits Form 1099-G - Unemployment compensation Form 1099-Q (529 Plan) Attach Forms 1099 Form 1099-QA/5498-QA (ABLE Accounts) Tax Organizer

3 1040 US Tax Organizer MISCELLANEOUS INCOME Taxpayer: Alimony received Other: Spouse: Alimony received RETIREMENT PLAN CONTRIBUTIONS Taxpayer: Traditional IRA contributions (1=maximum) Roth IRA contributions (1=maximum) Self-employed, SEP, SIMPLE, & qualified plan contributions (1=maximum) Spouse: Traditional IRA contributions (1=maximum) Roth IRA contributions (1=maximum) Self-employed, SEP, SIMPLE, & qualified plan contributions (1=maximum) OTHER GOVERNMENT FORMS - DEDUCTIONS Form 1098-E - Student loan interest Form 1098-T - Tuition and related expenses AFFORDABLE CARE ACT Form 1095-A - Health Insurance Marketplace Statement Form 1095-B - Health Coverage Form 1095-C - Employer-Provided Health Insurance Offer and Coverage ADJUSTMENTS TO INCOME Taxpayer: Self-employed health insurance premiums Educator expenses Other adjustments to income: Amount 2016 Amount Attach Forms 1098 Attach Forms 1095 Alimony paid - Recipient name & SSN Spouse: Self-employed health insurance premiums Educator expenses Other adjustments to income: Alimony paid - Recipient name & SSN MEDICAL AND DENTAL EXPENSES Prescription medicines and drugs Doctors, dentists and nurses Hospitals and nursing homes Insurance premiums Long-term care premiums - taxpayer Long-term care premiums - spouse Insurance reimbursement Out-of-pocket lodging and transportation expenses Number of medical miles Other: TAXES PAID State income taxes - 1/17 payment on 2016 state estimate Tax Organizer

4 1040 US Tax Organizer TAXES PAID (continued) State income taxes - paid with 2016 state extension State income taxes - paid with 2016 state return State income taxes - paid for prior years and/or to other states City/local income taxes - 1/17 payment on 2016 city/local estimate City/local income taxes - paid with 2016 city/local extension City/local income taxes - paid with 2016 city/local return State and local sales taxes (except autos and special items) Use taxes paid on purchases Use taxes paid on 2016 state return Sales tax on autos not included above Sales taxes paid on boats, aircraft, and other special items Real estate taxes - principal residence Real estate taxes - property held for investment Foreign income taxes Personal property taxes (including automobile fees in some states)... INTEREST PAID Home mortgage interest and points paid: Amount 2016 Amount Attach Tax Notice Attach Forms 1098 Home mortgage interest not on Form 1098 (include name, SSN, & address of payee): Points not reported on Form 1098: Mortgage insurance premiums on post 12/31/06 contracts Investment interest (interest on margin accounts): Passive interest CASH CONTRIBUTIONS NOTE: No deduction is allowed for cash or check contributions unless the donor maintains a bank record, or a written communication from the donee, showing the name of the organization, contribution date(s), and contribution amount(s). Volunteer expenses (out-of-pocket) Number of charitable miles NONCASH CONTRIBUTIONS NOTE: No deduction is allowed for contributions of clothing and household items that are not in good used condition or better, in addition, a deduction for any item with minimal monetary value may be denied. MISCELLANEOUS DEDUCTIONS Union and professional dues Tax return preparation fee Safe deposit box rental Investment expenses Estate tax, section 691(c) Unreimbursed employee expenses: Other: Tax Organizer

5 1040 US Direct Deposit & Estimates (Form 1040 ES) 3, 6 Please enter all pertinent information. DIRECT DEPOSIT / ELECTRONIC PAYMENT (3) 1=direct deposit of federal tax refund into bank account =electronic payment of balance due =electronic payment of estimated tax BANK INFORMATION Percent to Deposit Name of Bank (xx.xx) Routing Number Account Number Type of Account (Table 1) Type of Invest. (Table 2) ESTIMATED TAX / 1040-ES (6) Federal Amount Paid Date Paid TS Overpayment applied from st quarter payment nd quarter payment rd quarter payment th quarter payment Voucher Amount Additional Estimated Tax Payments Paid with extension Former spouse SSN if joint estimates State Overpayment applied from st quarter payment nd quarter payment rd quarter payment th quarter payment Amount Paid Date Paid TS Voucher Amount Additional Estimated Tax Payments Paid with extension Type of Account 2 Type of Investment 1 = Savings 2 = Checking 1 = Checking or savings (default) 2 = Taxpayer's IRA (next year limits) 3 = Spouse's IRA (next year limits) 4 = Health savings account (HSA) 5 = Archer MSA 6 = Coverdell savings account (ESA) 7 = Other 8 = Taxpayer's IRA (current year limits) 9 = Spouse's IRA (current year limits) Series: 5100, 5400 (t=taxpayer, s=spouse, blank=joint) 3, 6 Direct Deposit & Estimates (Form 1040 ES)

6 1040 US Direct Deposit & Estimates (Form 1040 ES) (cont.) 7.1 Please enter all pertinent information. APPLICATION OF OVERPAYMENT (7.1) If you have an overpayment of taxes, do you want the excess refunded?.. or applied to 2018 estimate?.... Other (please explain): 2018 ESTIMATED TAX INFORMATION Do you expect your 2018 taxable income to be different from? Yes No If "yes" explain any differences in income, deductions, dependents, etc.: Do you expect your 2018 withholding to be different from? If "yes" explain any differences: Yes No Series: 5400 (t=taxpayer, s=spouse, blank=joint) 7.1 Direct Deposit & Estimates (Form 1040 ES) (cont.)

7 No US Business Income (Schedule C) 16 Please enter all pertinent amounts. Last year's amounts are provided for your reference. GENERAL INFORMATION Principal business/profession Principal business code Business name, if different from Form Business address, if different from Form City, if different from Form State, if different from Form ZIP code, if different from Form Foreign region Foreign postal code Foreign country Employer identification number Other accounting method Accounting method: 1=cash, 2=accrual Inventory method: 1=cost, 2=lower cost/market, 3=other =change of inventory method =spouse, 2=joint =first Schedule C filed for this business If required to file Form(s) 1099, did you or will you file all required Form(s) 1099: 1=yes, 2=no.. 1=not subject to self-employment tax =did not "materially participate" =personal services is not a material income producing factor =investment =minister's Schedule C =single member limited liability company =trader in financial instruments or commodities INCOME Gross receipts or sales (Form 1099-MISC, box 7) Returns and allowances Other income: Amount 2016 Amount COST OF GOODS SOLD Inventory at beginning of the year Purchases Cost of items for personal use Cost of labor Materials and supplies Other costs: Inventory at end of the year Series: 51

8 No US Business Income (Schedule C) (cont.) 16 p2 Please enter all pertinent amounts. Last year's amounts are provided for your reference. EXPENSES Accounting Advertising Answering service Bad debts from sales or service Bank charges Car and truck expenses (not entered elsewhere) Commissions Contract labor Delivery and freight Dues and subscriptions Employee benefit programs Insurance (other than health) Mortgage interest (paid to banks, etc.) Other interest (not entered elsewhere) Janitorial Laundry and cleaning Legal and professional Miscellaneous Office expense Outside services Parking and tolls Pension and profit sharing plans - contributions Pension and profit sharing plans - admin. and education costs Postage Printing Rent - vehicles, machinery, & equipment (not entered elsewhere) Rent - other Repairs Security Supplies Taxes - real estate Taxes - payroll Taxes - sales tax included in gross receipts Taxes - other (not entered elsewhere) Telephone Tools Travel Total meals and entertainment in full (50%) Department of Transportation meals in full (80%) Uniforms Utilities Wages Amount 2016 Amount Other expenses: NOTE: If you purchased or disposed of any business assets, please complete Sheet p2 Series: 51 Business Income (Schedule C) (cont.)

9 1040 US Health Savings Accounts (8889) 32.1 HSA CONTRIBUTIONS Please enter all pertinent amounts & attach all 1099-SA forms. Last year's amounts are provided for your reference. NOTE:Contributions to an HSA are only eligible to persons covered under a high deductible health plan. For tax year, a high deductible health plan is one with an annual deductible that is not less than $1,300 for self-only coverage or $2,600 for family coverage, and the annual out-of-pocket expenses (deductibles, co-payments, and other amounts, but not premiums) do not exceed $6,550 for self-only coverage or $13,100 for family coverage. 1=self-only coverage, 2=family coverage HSA contributions you made or expect to make, except rollovers, employer contributions, and contributions made to an employee account through a cafeteria plan (1=maximum) Amount 2016 Amount Taxpayer Spouse Taxpayer Spouse Contributions included above that were made after you became eligible for Medicare Contributions made to date HSA DISTRIBUTIONS Total HSA distribution received (1099-SA, box 1).. Distributions included above that were rolled over to another HSA Total unreimbursed qualified medical expenses Series: 2800 Health Savings Accounts (8889)

10 1040 US Health Coverage Form 39.1 Please do not complete this information if coverage is indicated on Form 1095-A, 1095-B or 1095-C. Attach the document with this organizer if you have it. GENERAL INFORMATION 1=entire household covered for all months, 2=no months Date married (if in current year) COVERED INDIVIDUAL (#1) COVERED INDIVIDUAL (#2) (a) First name... (a) First name... (a) Last name... (a) Last name... (b) ID number (SSN or TIN).... (b) ID number (SSN or TIN).... (d) 1=covered all 12 months.... (d) 1=covered all 12 months... (e) Months of coverage: (e) Months of coverage: 1=November =November =December =December =January =January =February =February =March =March =April =April =May =May =June =June =July =July =August =August =September =September =October =October =November =November =December =December COVERED INDIVIDUAL (#3) COVERED INDIVIDUAL (#4) (a) First name... (a) Last name... (b) ID number (SSN or TIN).... (d) 1=covered all 12 months.... (e) Months of coverage: 1=November =December =January =February =March =April =May =June =July =August =September =October =November =December (a) First name... (a) Last name... (b) ID number (SSN or TIN).... (d) 1=covered all 12 months... (e) Months of coverage: 1=November =December =January =February =March =April =May =June =July =August =September =October =November =December Series: 4100 Health Coverage Form

11 1040 US Additional Information Please furnish any additional information or supporting details not provided elsewhere in this tax organizer. Series: Additional Information