LOCH, ELSENBAUMER, NEWTON & CO. A PROFESSIONAL CORPORATION

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1 LOCH, ELSENBAUMER, NEWTON & CO. A PROFESSIONAL CORPORATION ACCOUNTANTS AND CONSULTANTS INDIVIDUAL INCOME TAX ORGANIZER 2014 Taxpayer Name: Spouse's Name: Day Time Phone Number: Cell Phone Number: Address: Address (if different from last year): Local Municipality: Date Moved:

2 PLEASE ANSWER THE FOLLOWING QUESTIONS - Y(YES)/N(NO) IF THE ANSWER IS YES, PLEASE: 1. Did you receive any income from: Wages and salary Submit all Form W-2's Interest income Submit Forms 1099-INT Dividend income Submit Forms 1099-DIV Sale of stock or securities See summary on page 3 Installment sales See summary on page 4 Sale of other property See summary on page 3 Sale of principal residence Call us prior to your appointment IRA, pension or annuity distributions Submit Form(s) 1099R and see page 3 Unemployment compensation Submit Form(s) 1099-G Did you receive COBRA assistance payments Social security benefits Submit Form(s) SSA Refund of state or local income taxes Submit Form(s) 1099-G Alimony Enter amount received $ Business or farm activities See summary on pages 4 & 5 Rents See summary on page 6 Partnerships Please submit all Form K-1's Estates or trusts Please submit all Form K-1's "S" corporations Please submit all Form K-1's 2. Are you required to file a Business Privilege Tax Return? Would you like us to prepare the tax return for you? 3. Are you required to issue Forms 1099? Would you like us to prepare them for you? (due by January 31 st ) 4. Did you pay any of the following: Penalty on early withdrawal of savings Enter amount $ Alimony Enter amount paid $ Enter recipient's Soc. Sec. No. - - Education expenses Describe on page 7 5. Do you have any securities or loans which became Describe, and enter date of purchase worthless during the year? and original cost $ 6. Did you have any debts cancelled or forgiven? 7. Did you purchase a new vehicle, hybrid vehicle or make Describe energy-saving home improvements? Date of purchase, cost and sales tax: _ Attach invoice 8. Did you receive any Incentive Stock Options? If so, please provide us with any information that you received. -1-

3 PLEASE ANSWER THE FOLLOWING QUESTIONS - Y(YES)/N(NO) IF THE ANSWER IS YES, PLEASE: 9. Do you expect a significant change in your 2015 income? Please describe 10. Did you make gifts of more than $14,000 to an individual Please describe during the year? 11. Did you pay any household employees during the year? Enter amount paid $ 12. Did you have an interest in, signature or other authority If so, please provide us with details of accounts over a financial account in a foreign country or have any and amounts. relationship with a foreign trust? 13. Did you make any contributions to a Section 529 If so, please provide us with the names and Tuition account? social security numbers of each beneficiary and the amounts. 14. Sales and Use tax is now required to be reported on If so, describe and your state income tax return. Did you purchase items enter date of purchase and original cost. or services subject to sales tax for which the seller did not charge or collect sales tax? 15. Would you like us to help you determine if you are in compliance with the sales and use tax laws and regulations? 16. Does every member of your household have health insurance for the entire year? 17. Have you received any advance health care credits? DEPENDENTS Please list all social security numbers of dependents not previously submitted: Name Social Security Number Birth Date _

4 INCOME TAX PAYMENTS MADE FEDERAL STATE LOCAL Date Amount Date Amount Date Amount Prior year taxes paid in 2014 $ $ Prior year overpayment applied $ 4 th Qtr st Qtr nd Qtr rd Qtr th Qtr 2014 MOVING EXPENSES Mileage from former residence to: Expenses to transport household property New business Former business _ $ Traveling expenses & lodging incurred during move Reimbursement not reported on W-2 $ $ IRA DISTRIBUTIONS For IRA distributions received during 2014, please enter amount used for: Medical expenses $ General living expenses/other $_ First-time home purchase Rolled into a Roth IRA _ Post secondary education expenses Rolled into another qualified (tuition, books, supplies, etc.) retirement account/ira _ GAIN OR LOSS FROM SALE OF STOCKS, SECURITIES AND OTHER PROPERTY Please submit all 1099-B's and 1099-S's received and the following information for each item sold. Date Date Gross Selling Description Acquired Sold Sales Price Expense Cost $ $ $ $ $ $ $ $ $ -3-

5 INSTALLMENT SALES 2014 Sales Only Prior Year Sales Only Description Description_ Total sales price Downpayment $ Mortgage or note assumed Principal received in 2014 $ Note received Principal received in 2014 Interest received in 2014 $ Interest received in 2014 BUSINESS INCOME - TAXPAYER( ) SPOUSE ( ) Business Name Federal I.D. # Gross receipts $ Bank service charges $ (Please submit all 1099-Misc Forms) Office supplies Other Income Printing Postage Payroll processing Cost of goods sold: Outside services Beginning inventory Employee retirement plan Purchases contributions Materials and supplies Legal & accounting Freight Equipment rent Subcontract costs Real estate rent Other costs Repairs & maint. Ending inventory Supplies Advertising Licenses & permits Commissions Travel Vehicle expenses Meals and entertainment Employee medical & disability insurance Utilities Employer medical insurance Telephone Business insurance Gross wages Interest expense - Payroll taxes Business loan #1 Business priv. tax Business loan #2 Real estate taxes Business loan #3 Dues/publications Business loan #4 Other expenses: Mortgage interest business only (Form 1098) -4-

6 EQUIPMENT, VEHICLES AND OTHER CAPITAL EXPENDITURES DURING 2014 Date Total Cost (Including Acquired Description Taxes, Fees, Etc.) $_ $_ $_ BUSINESS USE OF HOME Area used regularly and exclusively for business or for inventory storage Total area of home sq. ft. sq. ft. Insurance $ Security costs $ Repairs & maint. Utilities BUSINESS RELATED VEHICLE EXPENSES Vehicle #1 Vehicle #2 Vehicle description Date vehicle placed in service Total miles driven during year Business miles driven during year Gas, oil, lube, insurance, tags $ $ Interest $ $ Lease payments $ $ Parking fees and tolls $ $ Amount reimbursed - not included in W-2 $ $ Average daily round trip commuting distance $ $ Miles that vehicle was used for commuting $ $ IF A BUSINESS AUTOMOBILE WAS PURCHASED IN 2014, PLEASE SUBMIT THE PURCHASE INVOICE. EMPLOYEE BUSINESS EXPENSES (FORM 2106) DESCRIPTION Travel (away from home overnight) Lodging (away from home overnight) Meals and entertainment Fares for airplane, boat, bus Education costs Dues and fees Telephone Work clothes, safety equipment Other -5- TOTAL EXPENSES $

7 RENTAL INCOME AND EXPENSES Residential Commercial Property #1 Address: _ ( ) ( ) Property #2 Address: _ ( ) ( ) Property #3 Address: _ ( ) ( ) Property #1 Property #2 Property #3 Rental income $ $ $ Rental expenses: Advertising Auto and travel Cleaning and maintenance Commissions Insurance Legal and accounting Interest expense - mortgage Interest expense - other Repairs Supplies Real estate taxes Business privilege tax Utilities Heat Water and sewer Bank service charges _ FURNITURE, FIXTURES, EQUIPMENT AND OTHER CAPITAL EXPENDITURES DURING 2014 Cost Date Acquired Description Property #1 Property #2 Property #3 _ UNREIMBURSED MEDICAL DEDUCTIONS (i.e. medicine, doctors, hospitals, hearing aids, eyeglasses, ambulance, equipment used for illness, additional costs of special diets, medical or long term care insurance) Description Amount Amount Other medical deductions $ Medical Insurance $ Total miles traveled Long Term Care Insurance TAXES Real Estate $ Occupation Privilege/EMST $ Personal Property Other Taxes: _ -6-

8 Original home mortgage interest (Form 1098) Home equity loan (Form 1098) Margin account interest Education loans INTEREST EXPENSE Interest Paid $_ $_ $_ $_ CHARITABLE CONTRIBUTIONS Miles driven for charitable purposes miles Cash contributions: Description Non cash contributions (clothing, furnishings, etc): Description Amount $ Amount $ If over $250, please submit receipt and/or description of donation. DEPENDENT AND CHILD CARE EXPENSES Provider Name E.I.N.: _ Address _ Amount of dependent and child care expenses paid in 2014 $_ INVESTMENT AND OTHER INCOME RELATED EXPENSES Tax preparation fees $ Professional dues $ Business publications Safe deposit box Investment expenses Union dues - Name: Legal fees - Amount: Employment agency fees Special tools & uniform IRA Taxpayer Spouse 2014 contribution made in 2014 SEP,Simple Reg Roth $_ $_ 2014 contribution made in 2015 SEP,Simple Reg Roth _ EDUCATION EXPENSES Please enter below the tuition and other fees required for enrollment at an eligible education institution for courses. Please submit Form 1098-T received from the education institution. Year Student Name Institution of School Amount Paid Date Paid CASUALTY, THEFT, MEDICAL SAVINGS AND OTHER IMPORTANT TAX INFORMATION -7-

JOYNER, KIRKHAM, KEEL & ROBERTSON, P.C INDIVIDUAL TAX ORGANIZER

JOYNER, KIRKHAM, KEEL & ROBERTSON, P.C INDIVIDUAL TAX ORGANIZER Please provide a copy of your 2013 federal and state tax returns, and complete pages 1 through 3. Other pages: complete only those sections that apply to you. Your Name SS# Occupation Birth Date Spouse