DONALD A. DEVLIN & ASSOCIATES, PC

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1 DONALD A. DEVLIN & ASSOCIATES, PC 807 Bay Avenue Somers Point, NJ (P) (F) IDENTITY AUTHENTICATION Driver s License or State Issued Identification Government agencies are requesting additional information for electronically filed tax returns. This is an additional effort to combat stolen-identity tax fraud and protect you and your tax refund. We ask that you provide the driver license or state-issued identification card information when completing your tax return. Providing this information is voluntary. The tax agency will not reject your return if you do not provide the requested driver license or state-issued identification information. However, providing this information may help to process your tax return more quickly. TAXPAYER NAME FORM OF ID (1=Driver s license, 2=State issued ID card) LICENSE # ISSUED DATE (MM/DD/YYYY) EXPIRATION DATE (MM/DD/YYYY) STATE OF ISSUANCE SPOUSE NAME FORM OF ID (1=Driver s license, 2=State issued ID card) LICENSE # ISSUED DATE (MM/DD/YYYY) EXPIRATION DATE (MM/DD/YYYY) STATE OF ISSUANCE

807 Bay Avenue Somers Point, NJ 08244 (609)926-6400 Fax (609)926-6426 www.dadassociatesinc.com recept@dadassociatesinc.

2 807 Bay Avenue Somers Point, NJ (609) Fax (609) Client Tax Organizer For the year January 1 December 31, 2018 Taxpayer Last Name First Name M.I. Social Security # Spouse Last Name First Name M.I. Social Security # Verification and Signature: To the best of my knowledge the enclosed information is correct and includes all income, deductions, and other information necessary for the preparation of this year s income tax return for which I have adequate records. Date Date Please Attach: Copies of two preceding years tax returns (new clients only) All tax documents (W-2s, 1099s, 1099-Rs, K-1s, etc.) Any notes on changes in dependents, address, and marital status, home ownership, State residency, etc... Bring/Send original documents which we will copy and ret urn to you, or legible copies that you can leave with us. Please Complete the Following Survey to Determine Credit Eligibility: 1. Did your address change during the year? 2. Were there any changes in dependents from last year? 3. Are you a Veteran (If yes and NJ Resident, supply DD-214) 4. Did you buy or sell any stocks, bonds or other investment property? If yes, please provide statements. 5. Did you purchase, sell, or refinance your principal home or second home or take out a home equity loan? 6. Did you convert part or all of your traditional/sep/simple IRA to a ROTH IRA? 7. Could you be claimed as a dependent on another person's tax return? 8. Did you purchase any qualifying residential energy improvements? 9. Did you receive a distribution from or make a contribution to a retirement plan? 401(K)/IRA/SEP/SIMPLE 10. Did you give a gift of more than $14,000 to one or more people? 11. Did you go through bankruptcy, foreclosure, or reposession proceedings? 12. Did you incur a loss due to damaged or stolen property? 13. Were you notified or audited by either the IRS or a State Agency? 14. Did you work from a home office or use your car for business? (SELF-EMPLOYED ONLY) 15. Were you a citizen of, have income from, or live in a foreign country? 16. Did you buy any internet merchandise for which you did not pay sales/use tax? 17. If you or any of your dependents DID NOT have health insurance for any part of the year, do you qualify for one of the below exemptions? No need to specify if a-f. a) Coverage gap less than 3 months d) Member of Household Died g) OTHER (SPECIFY) b) Incarcerated e) Bankruptcy or Evicted in 2018 c) Lived Abroad during coverage lapse f) Substantial Debt related to past medical insurance. (Y/N)

3 Client Tax Organizer Please complete this Organizer and send with your documents. Please enter whole numbers only (no cents.) 1. Personal Information Last Name First Name, M.I. Social Security # Birth Date Occupation Taxpayer Spouse Street Address City State Zip Home Phone Work Phone Cell Phone Taxpayer Spouse Marital Status Blind Yes No Yes No Married Will file jointly Yes No Disabled Yes No Yes No Single Widow(er), Date of Spouse s Death 2. Dependents (Children & Others) Name (As Appears on Social Security card) Relationship to Taxpayer Date of Birth Social Security # Months Lived With You (0-12) Disabled Y/N Full Time Student Y/N 3. Estimated Taxes Paid (School District & Other Taxes, please list in part 10 - other taxes line) First Quarter Second Quarter Date Paid Third Quarter Fourth Quarter 4. Refund Direct Deposit - Would you like Direct Deposit of Any Refunds? Yes No(Checks Mailed) Bank Name Banking Routing Number (9-Digit Number) Account Number Account Type 5. Interest Income Please attach 1099-INTs & brokerage statements. State Checking Savings Payer T/S/J Bank or Credit U.S. Bonds/ Federal Tax Union T-Bills Withheld 6. Dividend Income from Mutual Funds and Stocks Please attach 1099-DIVs for each item listed below. Payer Federal T/S/J Total ordinary Dividends (Box 1a) Qualified Dividends (Box 1b) Capital Gain Distribution (Box 2a) Local Municipal or Tax-Exempt Federal Tax Withheld

4 7. Other Income Please list all other income. Payer/Source Taxpayer Spouse Federal Tax Withheld Alimony Received Divorce Date See 11 For Alimony Paid Prizes, Bonuses, Awards (Gambling Reported 1099-MISC) Jury Duty Worker s Compensation Social Security Benefits (Provide 1099-SSA) Medicare Premiums Withheld Unemployment Compensation Received (W-2G) Partnership / Trust / Estate Income (Attach K-1s) Gambling, Lottery (Gambling Reported on 1099-MISC) Self-Employment Income 1099s & Income Statement or (16) Rental Income Supply Rents & Expenses or(17) 8. Medical/Dental Expenses To be deducted, medical expenses must exceed 7.5% of your adjusted gross income, and then only the amount that exceeds a 7.5% floor is deductible. Example: Your income is $40,000 for the year; your medical expenses must exceed $3,000. Amount Amount Acupuncture, Chiropractic Lodging for Away-From-Home Medical Purposes Ambulance, Paramedics Long-Term Care Insurance Taxpayer Auto Travel for Medical Purposes miles Long-Term Care Insurance Spouse Braces Medical Equipment, Supplies Doctors, Dentists (discretionary cosmetic surgery is not deductible) Medical Insurance Premiums (paid by you) Glasses, Contact Lenses Nursing Homes, Nursing Care Handicapped Modification to Home Parking Fees for Medical Purposes Handicapped Placard Prescription Drugs Hearing Aid, Batteries Psychotherapy, Psychological Counseling Hospital Insulin Lab Fees & X-Rays Insurance Reimbursement ( ) 9. Home Mortgage Interest IF YOU PURCHASED/SOLD/REFINANCED YOUR HOME, PLEASE SUMBIT ESCROW PAPERS / SETTLEMENT SHEETS / CLOSING STATEMENTS. Paid to Banks Amount Paid Mortgage Company: Mortgage Company: Mortgage Company: Home Equity Loan: Paid to Individuals Name: Social Security # Address: Amount Paid: $ Name: Social Security # Address: Amount Paid: $ 10. Taxes Paid Real Estate Taxes Auto License fees (vehicle license fee portion only) Property taxes on investment property Personal property tax boat, etc. State Income Tax (We calculate) Other Taxes: 11. Alimony Paid (For 2019 forward, only those Agreements entered into prior to 12/31/2018 are Deductible to Payer / Taxable to Recipient) Do not include amount paid for child support. Child support is not deductible. Recipient Name Social Security Number Amount Paid

5 12. Charitable Contributions Church Payroll Deduction United Way Cancer Society Red Cross Scouts Other (please list): Cash Contributions Only Volunteer (no. of miles) Non-Cash Charitable Contributions Date & Description of Property Donated Donee Name & Address Fair Market Value 13. Child & Dependent Care Expenses Care must enable you to work (or look for work) or attend school FULL TIME. Care must be for a child under age 13 or a dependent who is physically or mentally incapable of self care. Address Identifying # Name of child cared Care Provider Name Phone # Amount Paid City, State, Zip SSN or EIN (REQUIRED for *If child care is for more than one child or dependent, please indicate how much was paid for each child or dependent. 14. Healthcare (ACA Penalty becomes $0 for 2019 Returns / NJ FILERS: THERE IS STILL A STATE INDIV. MANDATE & PENALTY) Taxpayer Spouse Dependents (List) Individual (Please Provide 1095s) Had Health Insurance All Year (Y/N) Received Health Insurance From The Marketplace (Y/N) List Months with no insurance (ex: j,f,m,a,m) 15. Unreimbursed Education Expenses (Tuition and Fees Only, ROOM AND BOARD NOT INCLUDED, Must provide 1098-T) Student s Name & Institution Type of Expense Year of 1st Semester of Higher Ed Amount Student Loan Interest Paid (1098-E) Taxpayer: $ Spouse: $ Dependent(s): $

6 16. Self Employment Information Business Name & EIN Total Sales Taxpayer Spouse Expenses Advertising Commissions/Fees Dues & Publications Interest Expense Insurance Legal & Professional Fees Office Expense Rent (office) Expense Equipment Rental Expense Auto Expense Auto Mileage Repairs Expense Supplies Expense Taxes Travel Expense Meals & Entertainment Telephone Utilities Wages (gross W-2) Postage Bank Charges Tools & Equipment Uniforms Assets Purchased Date Amount Asset Notes Cost of Goods Sold Inventory at beginning of year Purchases Cost of items for personal use Cost of labor Material & supplies Inventory at end of year 17. Rental Income Property #1 Property #2 Property #3 Property #4 Address City/State Rent Received Expenses Advertising Auto & Travel Auto Miles Cleaning & Maintenance Commissions Paid Grounds & Gardening Insurance Interest Expense Legal & Professional Management Fees Repairs & Maintenance Supplies Taxes Utilities Association Dues Pest Control

DONALD A. DEVLIN & ASSOCIATES, PC

DONALD A. DEVLIN & ASSOCIATES, PC CERTIFIED PUBLIC ACCOUNTANT 807 Bay Avenue Somers Point, NJ 08244 (P) 609-926-6400 (F) 609-926-6426 Dear Client: Thank you for choosing Donald A. Devlin & Associates,