TAX ORGANIZER. If you answer 'Yes' to any of the General Business and Investment questions, please provide detailed information with your answer.

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1 TAX ORGANIZER Enclosed is your Tax Organizer for tax year Your Organizer contains several sections that include common expenses and deductions that many taxpayers overlook. Please review these sections carefully. Depending upon your tax bracket, you may save as much as $35 for each $100 in deductible expenses you find in your 2011 records. If my firm prepared your return last year, your prior year amounts are included in the Prior Year Amount column of your Organizer. Use this information to help you remember the types of income and deductions you reported last year. To complete the Organizer, enter all relevant information in the designated areas on each page. Please add any notes or questions that will help me prepare a complete and accurate return for you and to plan with you how to manage your tax situation in future years. If you answer 'Yes' to any of the General Business and Investment questions, please provide detailed information with your answer. When you arrive for your appointment, please bring your Organizer and any of the following that apply to your tax situation: Last year's tax return (if not in our possession) Original Form(s) W-2 Schedule(s) K-1 from partnerships, S-corporations, estates or trusts Information about contributions to a pension or other retirement plan if this is the first year you received income from the plan Form(s) 1099 or statements reporting dividend, interest, retirement or other income Broker statements providing details of capital gains transactions Form(s) 1098 and copies of real estate tax bills, etc. Legal documents pertaining to the sale or purchase of real property Mark Iffrig Mark Iffrig, CPA, PLLC Lake City Way NE, Suite 205 Seattle, WA (206)

2 General Information First Name Middle Initial Last Name Suffix Social Security Number... Date of Birth Taxpayer Spouse Home Phone Work Phone Cell Phone Fax Number Check ("X") which phone number to list on return. Legally Blind Totally Disabled Claimed as a Dependent... Presidential Election Fund ($3) Occupation address State of Residence as of 12/31.. County of Residence as of 12/31. School District as of 12/31.. Sales tax rate of locality in % % If Part Year, Period of Residency. to to Filing Status Status on 2010 return : Status as of 12/31/2011 : 1 Single Enter ("X") in the box 2 Married filing joint 3 Married filing separately Address (Enter spouse's name and above) 4 Head of Household Non-dependent name: Non-dependent : 5 Qualifying widow(er) with minor child Year spouse died Street Apt/Suite : City State Zip Code If address is in a foreign country, enter that country... If a bona fide resident of a U.S. territory, enter territory.

3 Questions If any of the following items apply to you or your spouse, please "X" the appropriate box and if possible, include details. Yes Yes No No 1 Did your marital status change since last year? Basic Information 2 Are there any changes in your dependents from last year? 3 Did you have any children under 19 (or 24 if a full time student) who received more than $950 in investment income? 4 Are all your dependents either US residents or citizens? 5 Did you provide over half of the support for someone you aren't claiming as a dependent? 6 Are you being claimed (or are eligible to be claimed) as a dependent on anyone else's return? 7 Were either you or your spouse in the military or National Guard? 8 Did you purchase or sell your principal residence? 9 Have you been notified by the IRS of changes to a prior year's return, or received any other tax correspondence? 10 Were there any changes to a prior year's income, deductions, or credits? 11 Did you make gifts of more than $13,000 to any one person? 12 Did you file Form 8839, Adoption Credit, in a previous year or incur adoption expenses in 2011? 13 Did you claim a First-time Homebuyer Credit for a home purchased in 2008? 14 Did you have a disposition or change in use of your main home for which you claimed the First-time Homebuyer Credit in 2008, 2009 or 2010? 15 Do you want to e-file your return? 16 If you are due a refund, how do you want to receive it? Check sent to you in the mail Western Union Reloadable MoneyWise Prepaid MasterCard Apply to next year's estimates Other quick refund via a bank product Direct deposit (please provide a voided blank check) Type of account: Checking Savings If you owe taxes, how do you want to pay them? Paper check sent with my return Credit card Direct debit from my bank account (please provide a voided blank check) Income Type of account: Checking Savings 17 Did you have an interest in or signature authority over a financial account in a foreign country? 18 Were you the grantor of or transferor to a foreign trust? 19 Did you receive income from a foreign source or pay taxes to a foreign government? 20 Did you barter your services for goods or services from someone else? 21 Did you receive any tax-exempt income, such as interest or dividends from municipal bonds or a mutual fund account? 22 Did you make a loan to someone at an interest rate below market rate? 23 Did you receive, or expect to receive, a Schedule K-1 (or substitute K-1) from a trust, estate, partnership, or S corp? 24 Did you cash in any U.S. savings bonds? 25 Did you own an interest in a Real Estate Mortgage Investment Conduit (REMIC)? 26 Did you itemize your deductions in a previous year and receive a state or local refund, or a refund of any other deduction you itemized, in 2011? (If yes, attach Form 1099-G) 27 Did you receive disability income? 28 Do you have gambling winnings? (If yes, be sure to include in gambling expenses) 29 Did you receive any unemployment benefits? 30 During 2011, did you receive payments from a Long-Term Care insurance contract? 31 Did you receive employer-provided adoption benefits for a previous year? 32 Did you receive any distributions from a retirement plan? (If Yes, attach all 1099-Rs) 33 Did you "rollover" a retirement plan distribution into another plan? 34 Did you receive Social Security benefits?

4 Questions (Cont.) If any of the following items apply to you or your spouse, please "X" the appropriate box and if possible, include details. Yes No 35 Did you convert a traditional IRA to a Roth IRA? 36 Did you exchange any securities or investments for something other than cash? 37 Do you have any short sales, commodity sales, or straddles? 38 Did you receive Form 2439? 39 Did you buy or sell any bonds? 40 Did you receive stock from a stock bonus plan with your employer? 41 Did you sell any other personal assets at a gain? 42 Did you sell any real estate (other than your home) during the year? 43 Did you sell any assets using the installment method? 44 Did you receive proceeds from a prior year installment sale? 45 Did you purchase a rental property? 46 Did you exchange any property for other property? 47 Did you receive any income not reported in this Organizer? Yes Yes Yes No No No Business and Rental Property Income 48 If you own rental property, do you qualify as a Real Estate Professional? 49 Did you start or acquire a new business? 50 Did you sell any part of an existing business, or sell business assets? 51 Did you cease operating any business or rental property? 52 Did you remove any of your business assets for personal use? Business and Rental Property Deductions 53 Did you use part of your home for business purposes? 54 Did you make any contributions to a Keogh or a self-employed SEP plan for 2011? 55 Do you pay for any health or long term care insurance through your business? 56 If you or your spouse are self-employed, are either of you covered under an employer's health plan? 57 Did you purchase any furniture or equipment for your business? Other Deductions 58 Did you make any contributions, or plan to make contributions, to a traditional or Roth IRA for 2011? 59 Did you make any contributions to HSA (Health Savings Account) in 2011? 60 Did you use your car on the job (other than to and from work)? 61 Did you work out of town for part of the year? 62 Did you incur any travel and entertainment expenses for business purposes? 63 Did you pay expenses for the care of your child or other dependent so you could work? 64 Did you lose property or have damage to a property due to a casualty, theft, or condemnation? 65 Did any security become worthless during 2011? 66 Did any debts become uncollectible during 2011? 67 Did you purchase a 'clean fuel' or electric hybrid vehicle in 2011? 68 Did you contribute less than an entire interest in any property to charity? 69 Did you refinance a mortgage or take out a home equity loan during 2011? 70 Did you incur moving expenses during the year due to a change of employment? 71 Did you pay any educational tuition or fees for you or a dependent? 72 Did you pay any student loan interest? 73 Did you make any federal or state estimated payments? 74 Did you make any energy efficient improvements to your main home in 2011?

5 Comments

6 Federal, State and Local Estimated Taxes Paid Federal Estimates Filer and/or Joint Payments Spouse Only Payments Enter Payment Information Date Paid Amount Date Paid Amount 1 Overpayment from last year First quarter payment Second quarter payment Third quarter payment Fourth quarter payment State Estimates Enter two-letter state abbreviation State State State State Enter Payment Information Date Paid Amount Date Paid Amount Date Paid Amount Date Paid Amount 1 Overpayment from last year. 1 2 First quarter payment Second quarter payment Third quarter payment Fourth quarter payment Local Estimates Enter locality name Enter Payment Information Date Paid Amount Date Paid Amount Date Paid Amount Date Paid Amount 1 Overpayment from last year. 1 2 First quarter payment Second quarter payment Third quarter payment Fourth quarter payment

7 Dependent Information Enter "X" if applicable No. of months Amount Paid US Full- time Paid Not a in home Date of for Dependent Citizen Student or Education dependent First name Last name In 2011 Relationship Birth Care for 2441 Disabled Expenses this year

8 Wages and Retirement Income W-2 Information Enter "X" Box 1 Box 2 Box 16 Box 17 if spouse Wages, Tips Federal Income State State Income W-2 Employer's Name Other Comp Tax Withheld Wages Tax Withheld R Information Box 1 Box 4 Box 12a Box 10a Gross Federal Income State State Income Payer's Name Distribution Tax Withheld Distribution Tax Withheld

9 Interest Income Please provide copies of all Form 1099-INT or other statements reporting interest income. * F/S/J - enter ownership (F)iler, (S)pouse, Taxable Interest Income Tax Exempt Interest Specified Priv Act Interest or (J)oint. Current Year Prior Year Current Year Prior Year Current Year Prior Year *F/S/J Payer Amount Amount Amount Amount Amount Amount Dividend Income Please provide copies of all Form 1099-DIV or other statements reporting dividend income. * F/S/J - enter ownership (F)iler, (S)pouse, Ordinary Dividends Qualified Dividends Capital Gains or (J)oint. Current Year Prior Year Current Year Prior Year Current Year Prior Year *F/S/J Payer Amount Amount Amount Amount Amount Amount

10 Self-Employed Business Income and Expenses (Schedule C) Enter "X" in one box: Filer Spouse General Information 1 Employer Identification Number (do not enter Social Security Number) 2 Principal business or profession 3 Business name Business address City State Zip General Check Boxes (Enter "X" where applicable) 6 Accounting Method Cash Accrual Other - (Specify) 7 Did you "materially participate" in this business? Yes No 8 Check ('X') if you started or acquired this business in Did you make any payments in 2011 that would require you to file Form(s) 1099? Yes No Business Income Current Year Prior Year * Report statutory income as W-2 income. Amount Amount 10 Income reported on 1099 MISC Gross merchant card and third party network receipts and sales Gross receipts or sales not reported on Form 1099 or Form W Returns and allowances Other income Inventory (Enter "X" where applicable) 18 Method(s) used to value closing inventory.. Cost Lower of cost or market Other 19 Any change in determining quantities, costs, or valuations between opening and closing inventory? Yes No 20 Inventory at the beginning of year Purchases less cost of items withdrawn for personal use Cost of labor Materials and supplies Other Costs Inventory at end of year Current Year Amount Prior Year Amount Assets Placed in Service This Year Date Placed Purchase Description: In Service Amount A A B B C C D D E E F F G G

11 Business Self-Employed Business Expenses Cont. (Schedule C) Current Year Prior Year Expenses Amount Amount 41 Advertising Contract labor Commissions and fees Depletion Employee benefit programs (other than on line 51) Insurance (other than health) Interest: 47 Mortgage (paid to banks, etc.) Other Legal and professional services Office expense Pension and profit-sharing plans Rent or Lease: 52 Machinery rental or lease Equipment rental or lease Other business property rental or lease Repairs and maintenance Supplies (not included in inventory cost of goods sold) Taxes and licenses Travel, Meals, and Entertainment: Travel Meals and entertainment 67 Enter "X" in the box if subject to DOT hours of service limits Utilities Wages Other Expenses

12 Business Vehicle Information (Schedule C) 1 Date vehicle was placed in service Cost of vehicle Total miles driven for the year Business miles driven during the year. 4 January 1 to June July 1 to December Commuting miles included on line Parking fees and tolls Vehicle Interest Vehicle Personal Property tax Actual Expenses 9 Gasoline, oil and repairs Vehicle Insurance Vehicle registration fees Vehicle lease or rental Vehicle 1 - Vehicle 2 - Current Year Prior Year Current Year Prior Year Amount Amount Amount Amount 1 Date vehicle was placed in service Cost of vehicle Total miles driven for the year Business miles driven during the year. 4 January 1 to June July 1 to December Commuting miles included on line Parking fees and tolls Vehicle Interest Vehicle Personal Property tax Actual Expenses 9 Gasoline, oil and repairs Vehicle Insurance Vehicle registration fees Vehicle lease or rental Vehicle 3 - Vehicle 4 - Current Year Prior Year Current Year Prior Year Amount Amount Amount Amount

13 Business Copy Self-Employed Office in Home Expenses Current Year Prior Year Area of Home Amount Amount 1 Area used regularly and exclusively for business, regularly for daycare Total area of home Daycare only 3 Multiply days used for daycare during year by hours used per day 3 Expenses related to entire home including business portion 4 Casualty losses Excess mortgage interest Insurance Rent Repairs and maintenance Utilities Other expenses Additional expenses related to business portion only 11 Casualty losses Excess mortgage interest Insurance Rent Repairs and maintenance Utilities Other expenses

14 Real Estate Rentals and Royalties Kind of Property Address City State Zip 1 Owner of property (Enter Filer, Spouse, or Joint) Current Year Info Prior Year Info 2 Enter "X" If you actively participated? Enter "X" if property was used for personal use by you or your family for more than 14 days or 10% of the total days rented? a If entered ("X"), enter the number of days of personal use? a 3b If entered ("X"), enter the number of days rented? b Income Current Year Prior Year Amounts Amounts 4 Royalty received Rent received a 5b If rental real estate, enter the percent of ownership if less than 100%... 5a Rental use percentage for property used partially for personal use only.. 5b Property Expense Current Year Prior Year Amounts Amounts 6 Advertising Cleaning and maintenance Commissions Insurance Legal and other professional fees Management fees a Qualified mortgage interest paid to banks, etc a b Other mortgage interest paid to banks, etc b 13 Other interest Repairs Supplies a Real estate taxes a b Other Taxes b 17 Utilities A B C D E F G Assets Placed in Service This Year Date Placed Purchase Description: In Service Amount A B C D E F G

15 Property Other Expenses (Schedule E) Other Expense Current Year Prior Year Travel Expenses Meals and Entertainment Expense Current Year Current Year Prior Year Prior Year

16 K-1 Income Please provide copies of all Schedule K-1s, or other statements, reporting income from partnerships, S corporations, or estates and trusts. Enter "S" if K1 (1120S) Unreimbursed * F/S/J - enter ownership (F)iler, (S)pouse, or (J)oint. Enter "P" if K1 (1065) Partnership Exp. *F/S/J Entity Name Enter "E" if K1 (1041) Current Year

17 IRA Contribution Information Traditional IRA Contributions Current Year Prior Year Filer Amount Amount 1 Enter total traditional IRA contributions made for Enter contributions, on line 1, made after 12/31/2011 and before 04/15/ Enter value of all traditional IRAs as of 12/31/ Spouse 4 Enter total traditional IRA contributions made for Enter contributions, on line 4, made after 12/31/2011 and before 04/15/ Enter value of all traditional IRAs on 12/31/ Roth Contributions Current Year Prior Year Filer Amount Amount 1 Enter 2011 Roth IRA contributions Enter value of all Roth IRAs on 12/31/ Spouse 3 Enter 2011 Roth IRA contributions Enter value of all Roth IRAs on 12/31/ SIMPLE IRA Current Year Prior Year Filer Amount Amount 1 Enter value of all SIMPLE IRAs on 12/31/ Spouse 2 Enter value of all SIMPLE IRAs on 12/31/ Education IRA (Coverdell ESA) Current Year Prior Year Filer Amount Amount 1 Enter 2011 Coverdell ESA contributions Enter value of the Coverdell ESA on 12/31/ Spouse 3 Enter 2011 Coverdell ESA contributions Enter value of the Coverdell ESA on 12/31/

18 Medical and Dental - Itemized Deductions 1 Prescription medications Fees for doctors, dentists, etc Fees for hospitals, clinics, etc Lab and X-ray fees Medical aids such as glasses, contacts, hearing aids, wheelchair, etc Medical equipment and supplies Medical mileage (number of miles driven) 7 January 1 to June July 1 to December Medical parking, tolls and local transportation Lodging for medical purposes (up to $50 per night per person) Health/Dental/Other ins. premiums (do not include self-employed plans) Long Term Care insurance premiums (taxpayer) Long Term Care insurance premiums (spouse) Expenses to stop smoking Health insurance premiums - coverage established under your business (1) Health insurance premiums - coverage established under your business (2) Long Term Care insurance premiums - coverage est. under your business (1) Long Term Care insurance premiums - coverage est. under your business (2) Insurance reimbursement for any medical and dental expense listed above 22 Current Year Amount Prior Year Amount

19 Taxes - Itemized Deductions Current Year Prior Year Real Estate Taxes Amount Amount 23 Principal residence Real Estate Not Held For Investment Real Estate Held For Investment Personal property taxes Other Taxes

20 Interest - Itemized Deductions Current Year Prior Year Home Mortgage Interest and Points Reported on Form 1098 Amount Amount 38 Lender Lender Lender Lender 41 Home Mortgage Interest Not Reported on Form Name: 42 Address: : 43 Mortgage insurance paid on 2011 acquisition indebtedness for principal residence Refinancing Points 44 Description Points paid Date of loan Total number of scheduled loan payments Number of payments made in Description Points paid Date of loan Total number of scheduled loan payments Number of payments made in Description Points paid Date of loan Total number of scheduled loan payments Number of payments made in Investment interest paid

21 Unreimbursed Employee Expenses - Itemized Deductions Current Year Amount List car, truck, transportation, meals and entertainment expenses on Employee Expenses tab 48 Union dues Professional journals and subscriptions Uniform and protective clothing costs and cleaning Job search costs (resumes, travel, postage, etc.) Prior Year Amount Other Miscellaneous Expenses - Itemized Deductions If investment Current Year Prior Year related enter "X" Amount Amount 59 Certain attorney and accounting fees Safe deposit box rental IRA Custodial fees Investment counsel and advisory fees Other Miscellaneous Deductions 75 Tax preparation fees Gambling losses (if gambling income) Amortizable bond premiums on bonds acquired before 10/23/ From K1 Input Worksheet (1065 & 1120S) - Portfolio deduction

22 Charity - Itemized Deductions Current Year Prior Year * Total contributions $500 or less. See Non-Cash Charity if over $500. Amount Amount 1 Gifts To Charity Other Than By Cash or Check* Total Miles driven for charitable activities Parking fees, tolls and local transportation for charitable activities Gifts To Charity By Cash or Check

23 Noncash Charitable Contributions (Total of Contributions more than $500) Information on Donated Property (a) Name and Address of the Donee Organization 1 Name Address (b) Description of Donated Property City State Zip Code 2 Name Address City State Zip Code 3 Name Address City State Zip Code 4 Name Address City State Zip Code 5 Name Address City State Zip Code Note: If the fair market value for an item is $500 or less, you do not have to complete columns (d), (e), and (f). (c) Date of the (d) Date Acquired (e) How (f) Cost or (g) Fair Market Value (h) Method Used to Contribution mm/dd/yyyy Acquired Adjusted Basis F. M. V. Determine the F. M. V

24 Child and Dependent Care Expenses 1 Amount of dependent care benefits forfeited Amount of dependent care expenses incurred in 2010 and paid in Note: Enter qualified expenses for dependents on the Organizer dependent sheet. Non-Dependent Information and Qualifying Expenses Amount incurred First Name Last Name Birthdate and paid in Persons or Organizations Who Provided the Care Amount incurred Name Address /EIN and paid in 2011 First: Last: City: : 6 Business: State: Zip: EIN: First: Last: City: : 7 Business: State: Zip: EIN: First: Last: City: : 8 Business: State: Zip: EIN: First: Last: City: : 9 Business: State: Zip: EIN: First: Last: City: : 10 Business: State: Zip: EIN:

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