Basic Taxpayer Information

Transcription

1 Basic Taxpayer Information ORG6 1 Single 2 Married filing jointly 3 Married filing separately PERSONAL INFORMATION TAXPAYER SPOUSE Last name... First name... Middle initial and suffix... MI... Suffix... MI... Suffix... Social security number... Occupation... Work phone/extension... Cell phone... address... Driver's License/Id issuing state... License /Id number... License/Id issue date... License/Id expiration date... Birthdate... MM/DD/YYYY... MM/DD/YYYY... Blind... Yes No Yes No Contribute to Presidential Election Campaign Fund... Yes No Yes No Eligible to be claimed as a dependent on another return... Yes No Yes No Street address... Apartment number... City... State... ZIP code... Home phone... Foreign country... Fax... Foreign phone... FILING STATUS Check this box if you did not live with spouse at any time during the year... G Check this box if you are eligible to claim spouse's exemption... G Check this box if your spouse itemizes deductions... G 4 Head of household If the qualifying person is a child but not your dependent, enter Child's name... Child's social security number... 5 Qualifying widow(er) Check the box for the year the spouse died... G 2014 DEPENDENT INFORMATION 2015 Full Name (first name, middle initial, last name, suffix) Social Security Number **Code Date of Birth Relationship +Months in U.S. *Not Citizen 2016Child Care Expense 2015Child Care Expense ** For the Dependent Code, enter the following: L = dependent child who lived with you N = dependent child who didn't live with you due to divorce or separation O = other dependent Q = not a dependent (but is a person who qualifies your client for the earned income credit and/or the credit for child and dependent care expenses) + Enter the number of months dependent lived with you, and/or your spouse if married filing jointly, in the U.S. * Check this box if dependent child is not a U.S. citizen or resident alien 1555 REV 12/08/16 PRO ORG6

2 Taxpayer(s) Tax Year Tax Questions 1 Did a lender cancel any of your debt last year? (Attach any Forms 1099-A or 1099-C) 2 Did you make energy efficient improvements to your home or purchase any energy-saving property last year? If yes, please attach details 3 Did you purchase a motor vehicle or boat last year? If yes, attach documentation showing sales tax paid 4 Did you purchase a hybrid or electric vehicle last year? If yes, provide the year, make, model, and date purchased 5 Did you donate a vehicle last year? If yes, attach Form 1098C 6 Did your marital status change last year? If yes, explain 7 Were you or your spouse permanently and totally disabled last year? 8 Do you have dependents who must file? 9 Do you have children who are under age 19 or a full time student under age 24 with investment income greater than $2,100? 10 Did you provide over half the support for any other person last year? 11 Did you incur adoption expenses last year? 12 Did you receive a total distribution from an IRA or other qualified plan that was partially or totally rolled over into another IRA or qualified plan within 60 days of the distribution? 13 Did you receive any disability payments last year? 14 Did you receive tip income not reported to your employer? 15 Did you buy, sell, refinance, foreclose or abandon a principal residence or other real property last year? If yes, attach closing HUD or escrow statements, 1099-S, 1099-C, or 1099-A forms 16 Did you incur any casualty or theft losses last year? 17 Did you incur any non-business bad debts? 18 Did you pay any individual for domestic services last year? 19 Did you buy or sell any stocks or bond last year? 20 Did you use the proceeds from Series EE or I U.S. savings bonds purchased after 1989 to pay for higher education expenses? 21 Did you incur any moving expenses for more than 50 miles for work? 22 Do you expect your income and deductions for this year to be the same as last year? 23 Did you and your dependents have health insurance coverage for the full year? Please attach the form you received A, 1095B or 1095C 24 Did you pay alimony last year? Please include the recipient's SSN and amount paid 25 Were you notified by the IRS or state taxing authority of changes to a prior year's return? If yes, please enclose agent's report or notice of change 26 Are you in an installment agreement with the IRS? 27 Do you owe back taxes to the IRS? 28 Did you make any estimated tax payments last year? Estimated tax payments made last year 29 The IRS is able to deposit refunds directly into your bank account, would you like a refund direct deposited to your bank account? If yes, please provide a copy of a voided check. Yes No Willa Jo Mills, CPA 740 N Fielder Rd, Arlington TX : (fax) Willa@wjm-cpa.com

3 Income Tax Return Checklist INCOME W-2 s 1099R Retirement and IRA Distributions 1099Int or 1099Div Interest Income/Dividend Income Owner financed interest income 1099B Brokerage statement for sale of investments 1099S Statement for sale of real estate 1099 Misc NonEmployee Compensation Social Security Administration K1 from Partnerships, Corporations or Trusts Unreimbursed Auto expense Total Miles and Business Miles Interest on Auto financing Parking/Tolls Unreimbursed Office Supplies/Cell Phone/Publications Unreimbursed Dues/Professional Meetings/ Continuing Education Rental and royalty income expenses Farm income and expenses. If there were animals sold, we would need to know the age of the animal when sold and if it was raised or purchased. Alimony Received W2G showing gambling winnings we will need documentation of gambling expenses to offset the winnings. We recommend using the facility key cards so to obtain win/loss statements 1099G Unemployment 1099C Forgiveness of Debt Other Income (Hobby, Awards, Class Action Settlement) ADJUSTMENTS TO INCOME Educator expenses (900 hours worked providing primary and secondary education) 1

4 IRA and SEP contribution statements (Traditional and Roth) Please indicate if any contributions are rollovers Self employed health insurance paid 1099HSA and 5498 SA for Health Saving Accounts Student Loan Interest Tuition Statements Form 1098T: If you have dependents in college, please also provide the costs of books and supplies and the status of the student (freshman, sophomore, junior, senior, graduate) 1099Q Payments from Qualified Education Program Alimony Paid Work related moving expenses transportation of household, travel and lodging, and miles moved and miles from old home to old work and old home to new work. Must be more than 50 miles. ITEMIZED DEDUCTIONS: Medical Expenses The medical expenses over 10% or 7.5% (65 or older) of your AGI is the allowed deductible amount for your itemized deductions. These expenses include Prescriptions (a statement of your prescriptions from your pharmacy is preferred), Eye care, Dental, Doctors, Labs, Hospitals. Request the medical checklist for extensive expenses. Health Insurance Premiums not paid through employer Long Term Care Premiums Health related improvements to home Medical equipment expense Travel for medical reasons and Parking Miles driven to doctor etc. Real Estate tax payments on home(s) or investment property Sales Tax we use the IRS provided sales tax table based on your income and number of dependents. We have found this table fairly accurate unless you are making purchases using savings or other non-income reporting sources. Sales tax on vehicles purchased 1098 Mortgage Interest Information To Include: Property Taxes Homeowners Insurance PMI Loan Insurance 2

5 Refinance of home? Please provide HUD closing statement Charitable Contributions Cash (Church, Heart Association, etc) Donated Goods (Goodwill, etc) Miles driven for volunteer services (volunteering at Night shelter, church, etc) Charitable Organization Related Expenses (uniform, supplies, convention) Unreimbursed Employee Expenses (the amount over 2% of AGI is deductible) Union Dues Care of employer required uniforms Employer required supplies, professional fees and license, publications Employer required use of cell phone and equipment Employer required home office Use of vehicle for Employer Auto mileage Total for year Business % or actual Commuting % or actual Other % or actual Investment expenses to include publications, advisor fees Tax Preparation Fees Safe Deposit Box Rental Agricultural Land Expense Purchase or sale of home: Closing statement of both purchase and sale, plus the cost of The capital improvements made to the property during ownership period. Dependent Care Providers (After school / Day Camps) For dependent under 13 Health Insurance Forms 1095 A B C Estimated Taxes Date Amount Please provide a copy of your prior income tax return. 3