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, PC to prepare your individual income tax returns. Please provide us with the following information so we may complete your tax returns accurately: 1) Copies of your last 2 years tax returns if available (if you are a new client this year) 2) You and your spouse s date of birth. 3) Names, dates of birth and social security numbers of all dependents. 4) You and your spouse s occupation. 5) All W-2 forms for wages, salaries & tips. 6) All interest and dividend forms (1099INT of 1099DIV). 7) Amount of alimony received. 8) All 1099 and 1098 forms. 9) All stock sale transactions (1099B) INCLUDING date stock was purchased and how much the stock was purchased for. 10) All K-1 forms. 11) All IRA and/or pension income (1099R). 12) Amount of unemployment income (1099G) You must go on unemployment website to print. They no longer mail. 13) Amount of social security income. 14) Any other income not mentioned above. 15) Amount of IRA contributions. 16) Amount of moving expenses. 17) Amount of alimony paid. 18) Amount of medical insurance and/or medical expenses paid. Please include all HSA Forms. 19) Amount of real estate taxes paid. 20) Amount of mortgage interest paid. 21) Amount of contributions (cash, goodwill, etc.). 22) Amount of unreimbursed employee business expenses. If your automobile was used for business and employer did not fully reimburse you for costs, please provide for mileage (noncommuting), fuel, tolls, etc. 23) If any of the following applies to you, please bring the appropriate information: a) You have rental property(ies) rent received and expenses b) You sold and/or bought a home settlement sheets. c) You are self-employed and/or received 1099MISC form(s) expenses related to the business. 24) Provide proof of health care insurance. Form 1095. 25) Copy of your Drivers License - See attached form 26) Child Care Expenses including amount, provider and ID#. 27) All student account printouts you MUST obtain them. Please submit your completed organizer and supporting documentation to the Client Portal. For more information on the client portal, please visit our website: www.dadassociatesinc.com Thank you for all your cooperation. If you have any specific questions, please do not hesitate to contact our office.
DONALD A. DEVLIN & ASSOCIATES, PC 807 Bay Avenue Somers Point, NJ 08244 (P) 609-926-6400 (F) 609-926-6426 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
Tax Year 2017 Client Tax Organizer Please complete this Organizer. Include all statements (W-2s, 1099s, 1098, 1098-T, 1095, HUD-1s etc.) 1. Personal Information Taxpayer Spouse First name & Initial Last name Social Security number Date of birth / Date of Death Occupation E-mail address Work phone Cell Work Cell Home phone City State ZIP Taxpayer Legally Blind... Taxpayer Disabled... Fax Direct Deposit of Refund? Checking Savings Apt/Suite Routing # Account # Spouse Legally Blind... Spouse Disabled... Pres. Campaign Fund (Spouse).. Pres. Campaign Fund (Taxpayer)... Filing status: Single Head of Household Married filing joint Married filing separate Widower Year of Spouse death? 2. Dependents (Children & Others) Name Relationship Date of Birth Social Security Number Months Lived With You Disabled Full Time Student Dependent's Gross Income Please answer the following questions to determine maximum deductions: 1. Did your marital status change 12. Did you receive a distribution from or during the year? make a contribution to a retirement 2. Did your address change during the year? plan (401(k), IRA, etc.)? 3. Were there any changes in dependents? 13 Did you give a gift of more than $14,000 to one or more people? 4. Did you receive unreported tip income of $20 or more in any month? 5. Did you receive any unemployment or disability income? (Attach 1099-G) 6. Did you buy or sell any stocks, bonds or other investment property? 7. Did you purchase, sell, or refinance your principal home or second home, or take out a home equity loan? 8. Did you convert part or all of your traditional/sep/simple IRA to a ROTH IRA? 9. Could you be claimed as a dependent on another person's tax return? 10. Did you pay anyone for domestic services in your home? 11. Did you pay anyone for childcare services? Did you purchase any qualifying residential energy improvements? 14. Did you go through bankruptcy, foreclosure, or repossession proceedings? 15. Did you incur a loss because of damaged or stolen property? 16. Were you notified or audited by either the IRS or State taxing agency? 17. Did you work from a home office or use your car for business? 18. May the IRS discuss your tax return with your preparer? 19 Were you a citizen of, have income from, or live in a foreign country? 20. Do you want to electronically file your tax return? 21. Did you buy any internet merchandise for which you did not pay sales/use tax? Donald A. Devlin & Associates, PC 807 Bay Avenue Somers Point, NJ 08244 (609) 926-6400 22. Health Insurance. Did you have ACA compliant health insurance during the year? (Attach Form 1095-A, 1095-B, and/or 1095-C)
3. Wage, Salary Income Attach Form(s) W-2's Employer name TP SP 8. Dividend Income Attach Form(s) 1099-DIV Form 1099-DIV Payer Ordinary Capital gain Tax-exempt? 4. Pensions, Annuities, Profit Sharing, IRA's, etc. Attach Form(s) 1099-R 1099-R Payer name TP SP 9. Property Sold Attach Form(s) 1099-S & closing statements Property Date acquired Cost & Imp 5. Social Security/Railroad Benefits Attach Form(s) SSA-1099 Taxpayer Spouse Social Security benefits Railroad Retirement benefits Medicare B premiums w/h Medicare D premiums w/h 6. Interest Income Attach Form(s) 1099-INT & Broker statements 1099-INT Payer name Tax-exempt? Amount 7. Partnership, Trust, Estate Income Attach Form(s) K-1 10. Other Income Alimony received... Gambling/lottery winnings(attach W-2G).. Jury duty... Disability income... State income tax refund... Other Other 11. Adjustments to Income Alimony paid... Name SS# IRA/SEP Contributions - Taxpayer... IRA/SEP Contributions - Spouse... Educator expenses... Student loan interest... Health Savings Account... 12. Investments Sold Attach Form(s) 1099-B & confirmation slips Investment Date acquired Date Sold Cost Sale Price
13. Medical/Dental Expenses Medical insurance premiums (paid by you).. Long Term Care insurance... Prescription drugs... Glasses, contacts... Hearing aids, batteries... Braces... Medical equipment, supplies... Nursing care... Medical therapy... Hospital... Doctor/Dental/Orthodontist... Mileage 14. Taxes Paid Real property tax (attach bills)... Personal property tax... 15. Interest Expense Mortgage interest paid (attach 1098's)... Interest paid to individual for your home (attach amortization schedule)... Paid to: Name Social Security. Investment interest... 16. Casualty/Theft Loss For property damaged by storm, water, fire, accident, or stolen. Location of property 18. Charitable Contributions (receipts required) Church... United Way... Scouts... Telethons... University, Public TV/Radio... Heart, Lung, Cancer, etc.... Wildlife Fund., Humane society... Salvation Army, Goodwill... n-cash City/State/Zip Value of goods (attach list if more than one) Volunteer mileage... 19. Miscellaneous/Unreimbursed Expenses Dues - union, professional... Books, subscriptions, supplies... Licenses... Tools, equipment, safety equipment... Uniforms (including cleaning)... Sales expense, gifts... Tuition, Books (work related)... Entertainment... Tax preparation fee... Safe deposit box... IRA custodial fees... Investment periodicals, advisory fees... Job search expense... Moving of household goods (job related).. 20. Day Care Expense (Form 2441) Description of property Amount of damage... Insurance reimbursement... Repair costs... Federal grants received... 17. Estimated Tax Payments Federal Amount LY - Jan 17 LY - Jan 17 Q1 - Apr 17 Q1 - Apr 17 Q2 - Jun 17 Q2 - Jun 17 Q3 - Sep 17 Q3 - Sep 17 Q4 - Jan 17 Q4 - Jan 17 State Amount Provider #1 City/State/ZIP EIN/SS# Amt Pd Provider #2 City/State/ZIP EIN/SS# Amt Pd Children cared for 17. Estimated Tax Payments (Cont.) Local Tax Payments School Tax Payments LY - Jan 17 LY - Jan 17 Q1 - Apr 17 Q1 - Apr 17 Q2 - Jun 17 Q2 - Jun 17 Q3 - Sep 17 Q3 - Sep 17 Q4 - Jan 17 Q4 - Jan 17
21. Unreimbursed Higher Education Expenses (only those you paid out of pocket) Attach Form(s) 1098-T & Education Account statement from College/University Bursar's or Student Accounts Office Has this student already taken 4 years of the Name of Student American Opportunity Credit on prior returns? Full Time Tuition & Fees Books Other (Specify) Total te: DO T INCLUDE ROOM & BOARD or HOUSING expenses. These are not deductible. Did you Purchase any qualifying residential energy efficiency improvements? Description Date Purchased Amount Description Date Purchased Amount Residential Energy Efficiency credit(s) previously claimed: Year Amount Type of Credit Year Amount Type of Credit Are you (and/or) your spouse a veteran who was honorably discharged or released during or before 2017? TP If so, Please attach form DD-214 for each eligible veteran. SP Health Care Coverage Questionnaire Did anyone besides taxpayer or spouse pay for health care coverage for anyone listed above? Did you pay for health care coverage for anyone not listed above? If you had coverage for any part of the year: Where was the policy obtained? Employer / Medicare / Medicaid / Marketplace(Exchange) / Other If you didn't have coverage part or all of the year: Answer if any of the questions below applies to any member of the household Was your previous insurance policy canceled in 2017? Do you have an Exemption from the Marketplace (also called the Exchange)? Was coverage offered by taxpayer's or spouse's employer? Are you a member of a federally-recognized Indian tribe? Are you eligible for services through an Indian health care provider? Are you a member of a health care sharing ministry? Did you live in the United States the entire year? Are you enrolled in TRICARE? Did you apply for CHIP coverage? Do any of the following apply to you? DO T INDICATE WHICH ONE. Became homeless, Evicted in the past six months or facing eviction or foreclosure, Received a shut-off notice from a utility company Recently experienced domestic violence, Recently experience and the death of a close family member, Filed for bankruptcy in the last six months Recently experienced a fire, flood, or other natural or human-caused disaster that resulted in substantial damage to your property, Incurred unreimbursed medical expenses in the last 24 months that resulted in substantial debt, Experienced unexpected increases in essential expenses due to caring for an ill, disabled, or aging family member.
Health Care Coverage Questionnaire for taxpayer and spouse 2017 PRIMARY TAXPAYER Insured through Marketplace (Exchange). MUST provide 1095-A Had health care coverage from another source Was exempt from health care mandate. Has Exemption Certificate Number? If yes, provide number. Employer offered health coverage which was declined SPOUSE Insured through Marketplace (Exchange). MUST provide 1095-A Had health care coverage from another source Was exempt from health care mandate. Has Exemption Certificate Number? If yes, provide number. All Year January February March April May June July August September October vember December All Year January February March April May June July August September October vember December Employer offered health coverage which was declined If what would be the cost for SELF coverage? Would the FAMILY policy have covered the spouse? Health Care Coverage Questionnaire for Dependents If All dependencts were covered all year, complete this form only once and list the Filing Requirements and AGI's of each dependent. Otherwise, complete this form for each dependent. Name of Dependent: All Year January February March April May June July August September October vember December Insured through Marketplace (Exchange). MUST provide 1095-A Had health care coverage from another source Was exempt from health care mandate. Has Exemption Certificate Number? If yes, provide number. Required to file a return? AGI of that return?
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 tes 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 Rental Income Property #1 Property #2 Property #3 Property #4 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