A. Scott Colby, PC Tax Organizer

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1 A. Scott Colby, PC Tax Organizer ***YOU MUST DOWNLOAD THIS ORGANIZER TO YOUR COMPUTER AND OPEN IT IN ADOBE SOFTWARE BEFORE FILLING OUT ANY INFORMATION OR ELSE YOUR INFORMATION WILL NOT BE SAVED.*** ***DO NOT FILL OUT THIS ORGANIZER IN YOUR WEB BROWSER. IT WILL NOT BE SAVED.*** - For all "/" questions (except the health insurance questions in Section #6) we assume the majority of these will be answered "". To save you time you only need to select an answer if you are answering "". - You can disregard the sections that do not apply to you. Thank you for completing our Tax Organizer. We provide this organizer to assist in gathering the information necessary to prepare your individual income tax return. Please fill in your responses as best you can. #1 Personal Data Filing Status Taxpayer: Full Name (First, Middle Initial, Last) Taxpayer: Birth Date Taxpayer: Occupation Taxpayer: Blind? 6. Spouse: Full Name (First, Middle Initial, Last) 7. Spouse: Birth Date 8. Spouse: Occupation 9. Spouse: Blind? #2 Contact Information Mailing Address City State Zip Home Phone 6. Work Phone 7. Mobile Phone 8. Address (if you don t have an please enter NA) 9. ***In an effort to prevent identity theft and fraudulent tax returns the IRS is requiring Driver's License information with each tax return.*** Taxpayer Spouse State Number Issue Date Expire Date 1

2 #3 Dependents Please add your dependents information to the following list: (if there are no changes from last year you can skip this section) Name Birth Date Social Security # Relationship Number of Months Lived at Home Last Year Are you entitled to a dependency exemption due to a divorce decree? Did any dependent child years of age attend school less than 5 months during the year? #4 Child Care Deductions Please provide Child Care/Day Care Provider's Information below Child's Name Provider's Name Provider's Address Provider's Tax ID Number Paid #5 Dependent Income Did any dependent children have more than $1050 in W-2 wages or $400 in self-employed income? Did any dependent children have investment income over $2100? #6 Health Insurance Did you and your entire family have health insurance coverage for the entire year? If so, please select how you obtained your health insurance: Colorado Marketplace Exchange Employer Individual Policy For CO Marketplace Exchange, did you receive a tax credit to lower your monthly premium? Did you receive any of the following IRS documents: 1095-A (Health Insurance Marketplace Statement), 1095-B (Health Coverage) or Form 1095-C (Employer Provided Health Insurance Offer and Coverage)? If so, please include them with your tax return information. If you or a member of your family didn t have health insurance coverage last year or a part of last year please explain why. Other 2

3 #7 Questionnaire - Income The questionnaire below could lead to helpful deductions. Please answer and provide supporting information. Did you receive income from any legal proceedings or have any debt cancelled? If so, please provide documentation. Do you or your spouse have any kind of pension, profit sharing, 401K, Keough, IRA or Roth IRA? If so, which ones? Please provide any retirement contributions you have made or plan to make by April 15th for last year? Retirement Contributions for Last Year Pension Profit Sharing Taxpayer 401K Keough IRA Roth IRA Spouse Traditional IRA Roth IRA SEP Did you withdraw or rollover any IRA funds during the year? If so, please provide form 1099-R. 6. Did you convert a traditional IRA into a Roth IRA? If so, please provide Form 1099-R. 7. Did you have income in multiple states? Please provide states and dates of residency on last page. 8. Did you receive any disability payments during the year? If so, please provide documentation. 9. Did you receive unemployment compensation during the year? If so, please provide form 1099-G. 10. Did you collect on any installment contract (loan payments received) during the year? If so please provide details in section (#27) at the bottom. 1 Did you receive any tip income that was not reported to your employer? 1 Did you have any securities that became worthless or loans that became uncollectible last year? 1 Did you have any interest in, or signature, or other authority over a bank, securities or other financial account in a foreign country? **NOTE: SEVERE PENALTY FOR NOT REPORTING** 1 Were you the grantor, transferor or beneficiary of a foreign trust? 1 Did you have any foreign income, pay any foreign taxes, or file any foreign information reporting or tax return forms? If so, please provide details in the tes section (#27) at the bottom. 16. Were you granted or did you exercise any stock options? If so, please provide documentation. 17. Were you granted any restricted stock? If so, please provide documentation. 18. Did you surrender any U.S. savings bonds? 19. Did you use proceeds from Series EE U.S. savings bonds purchased after 1989 to pay for higher education expenses? 20. Did you acquire any NEW ownership interests in a partnership, LLC, S Corporation, estate or trust? If so, provide Form K- 3

4 2 Did your college student receive educational benefits under a prepaid tuition program or a 529 education savings plan? If so, please provide Form 1099-Q. 2 Did you receive any alimony payments? 2 If so, how much? 2 Did you have any gambling winnings? If so, please provide Form W2-G and documentation of of any gambling losses? 2 Did you receive any Oil/Gas royalties? If so, please provide Form 1099-MISC. #8 Questionnaire - Expenses Did you purchase or acquire any real estate? If so, please provide settlement statements. Did you make any gifts during the year directly or in trust exceeding $14,000 per person? (Please note that changing names on a deed related to property would qualify as a gift) Did you incur any educational expenses on behalf of yourself, your spouse, or a dependent last year?if so provide form 1098-T from the school. Did you pay any interest on a student loan? If so, please provide Form 1098-E. Did you contribute to a qualified Colorado State Tuition 529 Plan last year? 6. If so, how much? 7. Did you pay alimony? 8. If so, to whom? 9. If so, provide payee's social security number. 10. If so, amount of alimony paid. 1 Did you have any adoption expenses last year? 1 If so, how much? 1 Do you wish to designate $3 of your taxes to the Presidential Campaign Fund? 1 Did you have a casualty or theft loss? 1 If so, provide an itemized list (including original cost and the value on date of loss), insurance information regarding coverage, reimbursement and police report. 16. Did you purchase an energy efficient or other new vehicle? If so, please provide the purchase invoice. 17. Did you pay any household employee over age 18 wages of $2,000 or more? 18. Did you incur any unreimbursed expenses as a school teacher? 19. If so, how much? If so, who is named as the account owner (normally a parent)? 4

5 20. Do you have records to support travel (including vehicle mileage), entertainment or gift expenses? The law requires that adequate records be maintained for travel, entertainment and gift expenses. The documentation should include amount, time and place, date, business purpose, description of gift (if any) and business relationship of recipient(s). #9 Tax Payments & Refunds If you paid estimated quarterly tax payments please provide information below. Quarter Payment Date Federal State 1st Quarter 2nd Quarter 3rd Quarter 4th Quarter Do you want any refund of taxes to be applied to next year's estimated taxes? Do you or your spouse have any outstanding child or spousal support payments or any other federal tax debt that could impact your receipt of a potential refund? If you owe federal tax upon completion of your return, are you able to pay the balance due in full? Has the IRS, or any state or local taxing agency, notified you of changes to a prior year's tax return?if so please provide copies of all notices received. 6. Do you expect a large fluctuation in your income, deductions or withholding next year? If so, please provide details in the tes section (#27) at the bottom. 7. Do you want any federal and state refunds deposited directly into your bank account? If so, please provide bank information below. o Bank Name Routing Number Account Number Checking or Savings 8. Do you want any balance due directly withdrawn from this same bank account on the due date? 9. Do you want this year's quarterly estimated tax payments withdrawn from this same bank account on the due dates? #10 Wage Income (Please send us all W-2 Forms) #11 Retirement Benefits Received (Please send us all 1099-R and Social Security Forms) 5

6 #12 Interest Income (Please send us all 1099-INT Forms) Total of interest income for last year from checking & savings account? (usually found on December statement) For seller financed mortgage, please provide the amount of interest collected during the year. For seller financed mortgage, please provide Buyers name. For seller financed mortgage, please provide buyers social security number. For seller financed mortgage, please provide Buyers address. #13 Dividend Income (Please send us all 1099-DIV Forms) #14 Capital Assets Sold (Securities, Real Estate, etc.) For security sales please provide all 1099-B forms and Gain/Loss reports. For real estate sales please provide closing statements from when you purchased the property and when you sold the property. * To qualify for long term capital gain rates, assets sold must have been held 12 months or more. #15 Improvements to Personal Residence Improvements to Personal Residence Description Date Purchased Cost #16 Sale of Personal Residence If you sold your personal residence please answer the questions below and send us a copy of closing/settlement statement. Date residence was originally acquired Original purchase price or construction cost of residence Cost of Improvements (landscaping, driveway, roof, etc.) Fixing Up Expenses (painting, repairs, etc.) to Prepare for Sale Was any part of the residence ever rented or used for business? 6. Was it your principal place of residence for 2 of the last 5 years, ending on date of sale? 6

7 #17 Medical Deductions Did you contribute to a Health Savings Account (do not answer if you contribute to an HSA through your employer as your contributions will be on your W-2)? Also, please provide tax form 1098-SA if you took out any HSA distributions. If so, how much? Medical Deductions Medical Medical & Dental Expenses Medical Insurance Premiums Long Term Care Insurance Premiums Eyeglasses/Hearing Aids Number of Medical Miles #18 Home Mortgage Interest Deductions (Please provide all 1098 Forms) Did you refinance your primary residence or rental property? If so, please provide settlement statement. Did you pay any home mortgage interest to an individual? If so, how much interest was paid? If so, please provide the individuals name, address and social security number? Did you pay any interest for a motor home or camper? 6. If so, how much interest was paid? 7. If so, please provide the payee's name, address and tax ID number. #19 Taxes Real Estate Taxes (if paid through mortgage company just provide Form 1098). Personal Property Taxes (vehicle "Own Tax" & "Prior OT" found on your registration) of sales tax paid on major items (Auto, Boat, Home Improvements, etc.) Please provide invoice and registration. 7

8 #20 Miscellaneous Deductions Subject to 2% AGI Miscellaneous Deductions Union & Professional Dues Safe Deposit Box Rental Tax Return Preparation Fee Investment Expenses Other #21 Charitable Contributions * Contributions of $250 or more require written substantiation from the organizations. List Cash Contributions - Checks, Credit Cards, Cash (with receipt only) Charitable Organization Charitable Organization List ncash Contributions (please provide documentation and if over $500 total please provide cost and date of purchase). Charitable Organization Miles for Charity 8

9 #22 Unreimbursed Employee Expense *** This section is ONLY to be filled out if you are considered an employee (not self employed) and you had work related expenses that were not reimbursed by your employer. *** Travel Expense Air Fares Auto Rentals Dues and Subscriptions Employment Related Education Garage Hotel/Motel Meals & Entertainment Parking Postage Road Tolls Taxi Telephone Tips Tools, Supplies or Equipment Other Expense Unreimbursed Employee Automobile Expense. *** This section is ONLY to be filled out if you are considered an employee (not self employed) and you had work related auto expenses that were not reimbursed by your employer. *** Automobile Expense Car 1 Car 2 Vehicle Year/Make/Model Total Miles Driven Personal Mileage Business Miles Driven Average Daily Commuting Are Written Records Available? Is another vehicle available for personal use? Is an employer-provided vehicle available for personal use? 9

10 #23 Moving Expenses - Please provide information below if you moved more than 50 miles due to employment related reasons. Number of miles from your old home to your new workplace Number of miles from your old home to your old workplace Date of Move Date of Arrival at New Location Moving Expenses Cost to Ship & Pack Household Goods Cost to Travel to New Home Cost of Lodging During Move Reimbursements (on W-2) Other (1) Other (2) #24 Business Income - Sole Proprietor & Single Member LLC Only (If you use Quickbooks you can give us a copy of your Quickbooks file rather than fill out this section) If you are a partner in a partnership, member of a multi-member LLC or shareholder in a S corporation you just need to give us a copy of your Quickbooks file (or other accounting records) if we are preparing the business tax return. If the business return was prepared by someone else please provide the Form K-1 you received. Please enter information related to your self-employment income below. (Submit all 1099-MISC received) Depreciable Asset Additions (Please enter any machinery & equipment, vehicles and fixtures & furniture that you purchased and cost more than $2500) Business Name (if you have more than one business) Description Date Purchased Cost Trade-In (if any) Depreciable Asset Deletions (Please enter any machinery & equipment, vehicles and fixtures & furniture that you sold.) Business Name (if you have more than one business) Description Date Sold Sales Price 10

11 Did you pay any independent contractors more than $600 for services provided to your business? If so, did you issue Form 1099? If you are self employed, did you pay any health insurance premiums for yourself or family? If yes, how much was paid for the premiums? 6. Did you use your home for Business? 7. If, what is the Total Area of Home? 8. If, what is the Total Area Used for Business? 9. If, what is Nature of Business Activity Performed in Home? 10. If, was Another Office Available to You Outside the Home? 1 If, please provide the following home office expenses: Expense Mortgage Interest Real Estate Taxes Rent (if you don't own home) Repairs & Maintenance Utilities Homeowner's or Renter's Insurance Trash Removal Snowplowing 1 Business Income & Expenses Description Business #1 Business #2 Business #3 Business #4 Business Name Federal ID Number Principal Activity or Product Gross Income Beginning Inventory Product Purchases Subcontract Labor Materials & Supplies Ending Inventory 11

12 Description (cont.) Business #1 Business #2 Business #3 Business #4 Advertising Auto/Truck Expense (Enter Below) Commissions Employee Benefit Programs Insurance (other than health) Interest - Mortgage Interest - Other Legal & Professional Fees Meals & Entertainment Office Expense Postage Rent - Vehicle, Machinery etc. Rent - Other Repairs Taxes & Licenses Telephone Travel Utilities Wages & Salaries Other Expenses Other Expenses 12

13 1 Self Employed Automobile Expense Automobile Expense Car 1 Car 2 Car 3 Car 4 Car 2 Car 3 Car 4 Vehicle Year/Make/Model Total Miles Driven Personal Mileage Business Miles Driven Average Daily Commuting Are Written Records Available? Is another vehicle available for personal use? Automobile Expense Car 1 Gas & Oil Expense Insurance Expense Licenses Repairs Tires Wash #25 Rental Property Information Please enter information related to your rental property below. Rental Income & Expense Property #1 Property #2 Property #3 Property #4 Property Description/Address Rental Income Advertising Expense Association Dues Auto & Travel Expense Cleaning & Maintenance Commissions & Mgmt Fees Insurance Expense Legal & Professional Fees Mortgage Interest (provide Form 1098) 13

14 Rental Expenses Cont. Property #1 Property #2 Property #3 Property #4 Other Interest Repairs Supplies Taxes - Property Utilities Other Exp Other Exp Other Exp Other Exp % Occupancy by Taxpayer #26 Farm/Ranch Income & Expenses Please enter information related to your farming and ranching activity below. (Submit all 1099 forms you received) Principal Product or Activity Income Sales of Livestock & Produce Bought Sales of Livestock or Produce Bought for Resale Cost of Livestock or Produce Bought for Resale Sales of Livestock & Produce Raised Feeders & Calves Pigs & Sheep Poultry & Eggs Hay & Straw Fruit Patronage Dividends Agricultural Program Payments Other Income 14

15 Farm/Ranch Expenses Breeding Fees Chemicals Conservation Expenses Custom Hire (Machine Work) Employee Benefits Feed Purchased Fertilizers & Lime Freight & Trucking Gasoline, Fuel, Oil Insurance Interest-Mortgage Interest-Other Labor Hired Pension & Profit Sharing Plans Rent of Farm, Pasture Repairs, Maintenance Seeds, Plants Purchased Storage, Warehousing Supplies Purchased Taxes Utilities Veterinary Fees, Medicine Other 1 Other 2 15

16 #27 tes & Additional Information Please use this area for any notes and additional information not covered by this tax organizer. #28 Designation Do you wish to designate your tax preparer to be contacted by the IRS in case any questions arise about your tax return? #29 Signature To the best of my knowledge the responses I have entered are correct and include all income, deductions and other information necessary for the preparation of this year's income tax returns for which I have adequate contemporaneous records? Please Enter the Name of the Individual Completing This Tax Organizer Today s Date You can submit this tax organizer to us via secure by first saving it (very important) and then by Clicking Here to open our upload site. You will then click on Choose Files to select the saved organizer from your computer. When you see that the organizer is in the large box you can click on Upload Files. We will automatically be notified that you have uploaded the organizer. Please feel free to contact us if you have any questions or concerns at (970)

National Society of Accountants Tax Organizer for Tax Year 2012

National Society of Accountants Tax Organizer for Tax Year 2012 Compliments of: Name: Taxpayer SS No. Birthdate/Age Spouse SS No. Birthdate/Age Address: Telephone (Home) ( ) Telephone (Work) ( ) Cell Phone: