Individual Tax Engagement Letter In order to provide the best professional service and avoid unnecessary confusion or misunderstandings to Clients of Cynthia Pogue Baker, CPA, this document sets forth the terms and conditions of our engagement. This document also records Client's positive intention to comply with certain requirements of the income tax law. Cynthia Baker is engaged to prepare the returns listed below. I will use my judgment in evaluating the appropriate tax treatment under the circumstances. Client is responsible for disallowance of any doubtful deductions or any deductions unsupported by adequate documentation and resulting taxes, penalties, and interest. This engagement includes the current year as listed and continues for future periods, until terminated by either party. My responsibility does not include preparation of any other tax returns that may be due to any taxing authority. My services are not intended to determine whether you have filing requirements in taxing jurisdictions other than the one(s) you have informed me of. My firm is available under the terms of a separate engagement letter to provide a nexus study that will enable me to determine whether any other state tax filings are required. It is your responsibility to provide all the information required for the preparation of complete and accurate returns. You should retain all the documents, canceled checks and other data that form the basis of income and deductions. These may be necessary to prove the accuracy and completeness of the returns to a taxing authority. You have the final responsibility for the income tax returns and, therefore, you should review them carefully before you sign them. This engagement is subject to the Client's obligation to furnish, at least forty-five days prior to the due date of the tax return, complete and adequate information and records as required to complete the returns. I will rely solely on information furnished and there is no obligation to verify, check, inquire, analyze, or apply any procedures with respect to information furnished by Client. My maximum liability related to services rendered under this engagement is limited to the amount of fees paid for these services. This engagement is not an audit of Client's records and cannot be relied upon to disclose errors, fraud, or illegal acts that may exist. Client certifies that there are adequate contemporaneous records to support any deductions for meals, entertainment, travel expenses, including mileage on vehicles, and charitable donations, as required by law. This engagement may include elements of tax planning for future transactions or periods. Tax planning is based on existing tax laws and specific fact representations made by Client, both of which are subject to change. There is no guarantee, expressed or implied, that the tax plan will be approved by the tax authorities. The fee for this engagement does not include responding to tax authority inquiries or audits. However, as a separate engagement and at Client's request, I will respond to inquiries and represent Client before any tax authority. My fee for all services will be based upon the amount of time required at the firm's standard billing rates, plus out-of-pocket expenses. All invoices are due and payable upon receipt. I reserve the right to suspend work on this engagement if payments on my invoices are not timely. I reserve the right to withdraw from this engagement if conditions arise which conflict with professional standards. This document represents a joint understanding between Client and Cynthia Pogue Baker, CPA, for the purpose of clearly setting forth the professional relationship between them. By providing us with the information to prepare your returns, you are agreeing to the provisions of this letter, even if you do not sign it. Income Tax Returns for : FEDERAL OKLAHOMA OTHER: Taxpayer: Date: Spouse: Date: (Signature) (Signature)
Page 1 Client Information 1 Tax Return Appointment Cynthia Pogue Baker, CPA, PC 3845 S 103rd East Ave Suite 100 Tulsa, OK 74146-2443 Telephone number: 918-660-0887 Fax number: 918-664-9608 E-mail address: Date: Time: Location: This tax organizer will assist you in gathering information necessary for the preparation of your tax return. Please add, change, or delete information as appropriate. CLIENT INFORMATION Filing Status Taxpayer Spouse Address Foreign Address Filing status (table)................................................ 1married filing separate and lived with spouse...................... Year spouse died, if qualifying widow(er) (2016 or 2017)............. First name and initial...... Last name................. Title/suffix................. Social security number..... Occupation................ Date of birth (m/d/y)....... Date of death (m/d/y)...... 1blind.................... First name and initial...... Last name................. Title/suffix................. Social security number..... Occupation................ Date of birth (m/d/y)....... Date of death (m/d/y)...... 1blind.................... In care of................. Street address............. Apartment number......... City....................... State..................... ZIP code.................. Region.................... Postal code............... Country................... 1 Filing Status 1 2 3 4 5 Single Married filing joint Married filing separate Head of household Qualifying widow(er) 1 Series: Client Information
Page 2 Client Information (continued) 1 p2 Please add, change or delete information for. CLIENT INFORMATION Home phone.............. Work phone............... Work extension............ Taxpayer Contact Daytime phone (table)..... Information Mobile phone.............. Fax number............... E-mail address............ Home phone.............. Work phone............... Work extension............ Spouse Contact Daytime phone (table)..... Information Mobile phone.............. Fax number............... E-mail address............ Driver's license no......... Driver's license state....... Taxpayer Authentication Expiration date (m/d/y)..... Issue date (m/d/y)......... Theft protection PIN....... Driver's license no......... Driver's license state....... Spouse Authentication Expiration date (m/d/y)..... Issue date (m/d/y)......... Theft protection PIN....... Daytime Phone 1 1 Work 2 Home 3 Mobile 1 p2 Series: Client Information (continued)
Page 3 Miscellaneous Questions If any of the following items pertain to you or your spouse for, please check the appropriate box and provide additional information if necessary. PERSONAL INFORMATION Yes No Did your marital status change during the year? Did your address change during the year? Could you or your spouse be claimed as a dependent on another person's tax return for? Did you pay for childcare while you worked, looked for work, or attended college? DEPENDENTS Will any dependent you claimed on your last tax return claim themselves or be claimed by someone else on this year's return? Did any dependent child between 19 and 23 years of age attend school less than 5 months during the year? (If so, they may no longer be your dependent). Did you have any children under the age of 19 or full-time students under age 24 at the end of, with interest and dividend income in excess of $1050, or total investment income in excess of $2100? INCOME Did you receive unreported tip income of $20 or more in any month? Did you cash any Series EE U.S. savings bonds issued after 1989 and pay qualified higher education expenses for yourself, your spouse, or your dependents? Did you receive any disability income? Did you have any foreign income or pay any foreign taxes? Have you considered donating your retirement plan Required Minimum Distributions to charity to save income tax? SELF-EMPLOYED If you or your spouse have self-employment income, did you pay any health insurance premiums or long-term care premiums (not through your employer)? Miscellaneous Questions
Page 4 Yes Miscellaneous Questions No If you or your spouse are self-employed, are you or your spouse eligible to be covered under an employer's health plan at another job? If yes, how many months in were you covered? If you or your spouse have self-employment income, do you want to make a retirement plan contribution? Did you use any area of your home exclusively for your business? Did you acquire, lease or dispose of a vehicle for business during this year? If yes, enclose purchase and sales contract or lease agreement. HEALTH INSURANCE Did you, your spouse and your dependents, have health insurance coverage all 12 months of ("health insurance coverage" includes Blue Cross, Kaiser, Medicare, Medicaid, etc.)? We must report on your tax return, and calculate a penalty, if you, your spouse or any of your dependents did not have health insurance for any full month in. If you did NOT have health insurance for each month of, please provide details of insurance coverage for each family member by month. Did you receive any of the following IRS Documents? Form 1095-A (Health Insurance Marketplace Statement), 1095-B (Health Coverage) or Form 1095-C (Employer Provided Health Insurance Offer and Coverage) If so, please attach. PURCHASES, SALES AND DEBT Did you start a business or farm, purchase rental or royalty property, or acquire an interest in a partnership, S corporation, trust, or REMIC, or dispose of any of the above? Did you purchase or dispose of any business assets (furniture, equipment, vehicles, real estate, etc.), or convert any personal assets to business use? Did you buy or sell any stocks, bonds or other investment property in? Did you sell or do you plan to sell any dividend generating stocks or mutual funds during the first 60 days of 2019? Did you purchase, sell, or refinance your principal home or second home, or did you take out a home equity loan? If so, please provide the closing statements. Miscellaneous Questions (Continued)
Page 5 Yes Miscellaneous Questions No Did you purchase, sell, or refinance your principal home or second home, or did you take out a home equity loan? If so, please provide the closing statements. Did you use proceeds from a home mortgage, including a home equity loan, for a purpose other than to buy, build or improve your home? Did you make any residential energy-efficient improvements or purchases involving solar, wind, geothermal or fuel cell energy sources? Did you have any debts cancelled or forgiven, or abandon any property? Does anyone owe you money which has become uncollectible? During this year, did you have any securities that became worthless? RETIREMENT PLANS Did you receive a distribution from a retirement plan (401(k), IRA, SEP, SIMPLE, Qualified Plan, etc.)? Did you already make a contribution to a retirement plan (401(k), IRA, SEP, SIMPLE, Qualified Plan, etc.)? Did you transfer or rollover any amount from one retirement plan to another retirement plan? Did you convert part or all of your traditional, SEP, or SIMPLE IRA to a Roth IRA Did you receive grants of stock options from your employer, exercise any stock options granted to you, or dispose of any stock acquired under a qualified employee stock purchase plan? Did you withdraw any amounts from your IRA to pay for higher education expenses incurred by you, your spouse, your children or grandchildren? EDUCATION Did you, your spouse, or your dependents incur any college education expenses, such as tuition? If so, please provide the amount of tuition and course materials (which includes books, computers and supplies needed for those courses) paid by you and your dependents during the year, and Form 1098-T received from the educational institution. (Include vocational school tuition). Did you or a dependent pay any student loan interest? Did you receive a distribution from an Education Savings Account or a Qualified Tuition Program? Miscellaneous Questions (Continued)
Page 6 Yes Miscellaneous Questions No Did you incur expenses as an elementary or secondary educator? ITEMIZED DEDUCTIONS Did you incur a loss because of damaged or stolen property? Did you make any charitable contributions of non-cash items (anything other than cash, check, or credit card contributions)? Please provide receipts if your total for the year is $500 or more, or if any one contribution exceeded $250. Do you have an appraisal for all donations of a single item valued at over $5000? Did you pay to license, tag, or register a boat you own? Did you or your spouse have any Gambling Winnings or Losses? Please supply any Forms W2-G that have been received. PLEASE NOTE - Beginning, Oklahoma has changed the law - Gambling losses are an Itemized Deduction on the Federal Return but gambling losses are no longer an Itemized Deduction on the Oklahoma Income Tax Return. You will be taxed on the Gambling Winnings, which are reported as income on the Federal return unless you track your winnings and losses by sessions. A session is generally each time you go to a casino. You have to maintain a log tracking the winnings and losses for each individual session in order to offset the winnings on the front of the federal return (and get a deduction for Oklahoma). The log has to be attached to the federal and state income tax returns. If you do not maintain session documentation, you will pay Oklahoma Income Tax on the Forms W2-G that you receive. ESTIMATED TAXES Did you apply an overpayment of 2017 taxes to your estimated tax (instead of being refunded)? Do you expect your 2019 taxable income and withholdings to be different from? Did you receive a notice from the IRS or OTC regarding a prior year return? MISCELLANEO Do you or your spouse want to allocate $3 to the Presidential Election Campaign Fund? May the IRS discuss your tax return with Cindy Baker, CPA? Miscellaneous Questions (Continued)
Page 7 Yes Miscellaneous Questions No Did you have any interest in, or signature or other authority over, a bank, securities, or other financial account in a foreign country? (Foreign stocks or mutual funds held in a brokerage account do not count.) If you have a power of attorney or signature authority for someone else's foreign account, you should answer Yes. Did you receive a distribution from, or were you the grantor of, or transferor to, a foreign trust? Were you a resident of, or did you earn income in, more than one state? If yes, you may be required to file tax returns in those states. Which state tax returns would you like us to prepare? Did you use gasoline or special fuels for business or farm purposes (other than for a highway vehicle) during the year? If so, please provide the gallons of gasoline or special fuels used in non-licensed vehicles. Have you received a punitive damage award or an award for damages other than for physical injuries or illness? Are you currently utilizing a health savings account (HSA) or a medical savings account (MSA)? (This is NOT the same as a Flexible Spending Account or a cafeteria plan or a Health Reimbursement Account!) If so, please provide documentation on contributions and distributions. Did you incur moving expenses due to a change of military assignment? Did you pay in excess of $1000 in any quarter, or $2100 during the year for domestic services performed in or around your home to individuals who could be considered household employees? (Someone who sets their own hours, provides their own supplies, and provides services to more than one customer is probably not a household employee) Were you notified or audited by either the Internal Revenue Service or the state taxing agency? Did you or your spouse make any gifts to an individual that total more than $15,000, or any gifts to a trust? If so, a gift tax return should be filed. If you have an overpayment of taxes, do you want to receive your refund by direct deposit? If so, provide a copy of a voided check. Did your bank account information change within the last 12 months? May we email your organizer to you next year? If so, please provide your email address: Miscellaneous Questions (Continued)
Page 8 Miscellaneous Questions OKLAHOMA RESIDENTS ONLY Yes No Did you make any contributions to an Oklahoma 529 plan? If so, please enclose the annual statement. OKLAHOMA E TAX: Did you make any purchases where Oklahoma sales tax was not collected? If yes, please provide details of each purchase. If you had out-of-state purchases, but do not have records of the amounts, would you like us to calculate the use tax based on your federal adjusted gross income? If you did not answer the above two questions, we will assume you have zero use tax to report. Important Notice Regarding Use Tax Pursuant to provisions enacted by the Oklahoma Legislature, we are required to advise you that resident Oklahoma taxpay required to remit use taxes through the use tax remittance line on their individual income tax return or by filing a consumer use tax return. If you purchase items online or out-of-state, and the vendor doesn't charge sales tax, then you owe the Oklahoma use tax. You may pay the actual amount of use tax owed based on records you have maintained, such as receipts showing actual out-of-state purchases or you may pay an estimated use tax by using a table prepared by the Oklahoma Tax Commission. The amount of estimated use tax is determined based on the amount of your adjusted gross income. Miscellaneous Questions (Continued)
Page 9 Miscellaneous Questions FOR YOUR CHARITABLE DONATIONS Yes No Do You Meet The Following Requirements For Charitable Contributions Made During This Year? General Rules: The law requires that you have a receipt, letter, or other written communication from the charity (showing the name of the charity, the date and the amount of the contribution) documenting all charitable contributions made in cash and that you have a receipt or a bank record (cancelled check) documenting all contributions made by check or by other monetary means. For contributions of property, you generally need a receipt which contains the name of the charity, a description of the property, and the date and location of the contribution. The charitable receipt must indicate the value of goods or services received, even if that value is zero. Contributions of $250 or More. For all individual donations of $250 or more (contributions of cash or property), the law requires a receipt (written acknowledgement) from the charity to which you made the donation stating the date and amount of the contribution as well as a statement as to whether you received anything in return for your contribution. If you received goods and services in return for the contribution, the receipt should include a description and an estimate of the value of the goods or services received in return for the contribution. If the goods or services received consist solely of intangible religious benefits, the receipt should include a statement to that effect. Contributions of Vehicles, Boats, or Airplanes of more than $500. If you are claiming a deduction of more than $500 for a vehicle, a boat, or an airplane you contributed to charity, the law requires that you obtain a Form 1098-C (or other written acknowledgment containing the same information shown on Form 1098-C) from the charity in order to deduct your contribution. Contributions of Clothing or Household Items. Generally, a deduction is not allowed for a charitable contribution of clothing or household items unless the items are in good used condition or better. Household items generally include furniture, furnishings, electronics, appliances, linens, and other similar items. FOR YOUR BINESS Yes No Do You Have The Required Documentation For Travel, Entertainment, Gifts, and Listed Property Expenses for your business? The law disallows an otherwise allowable deduction for any expense for traveling (including meals and lodging), entertainment, gifts, or listed property (passenger vehicles, and computers (unless used exclusively at your place of business), unless the expense is substantiated by adequate records or by sufficient evidence corroborating your own statements. In addition, the regulations generally require you to maintain documentary evidence (such as receipts, paid bills, etc.) for (1) any lodging expenditure, and (2) any other expenditure of $75 or more. For business travel, the documentation should include the amount, date, place, and business purposes of the travel. For business meals and entertainment expenses, the documentation should include the amount, date, place, and business purpose of the entertainment as well as the business relationship of the person or persons entertained. For business gifts, the documentation should include the amount, date, description of gift, business purpose of gift, and business relationship of the recipient of the gift. For listed property (passenger vehicles and home computers), the documentation should include the cost, business or investment use based on mileage, etc., date of the expenditure, and business or investment purpose of the property. Miscellaneous Questions (Continued)
Page 10 Direct Deposit & Estimates (Form ES) 3, 6 Please enter all pertinent information. DIRECT DEPOSIT / ELECTRONIC PAYMENT (3) 1direct deposit of federal tax refund into bank account.................. 1electronic payment of balance due................................... 1electronic payment of estimated tax.................................. BANK INFORMATION Name of Bank Percent to Deposit (xx.xx) Routing Number Account Number ESTIMATED TAX / -ES (6) Federal Type of Account (Table 1) Type of Invest. (Table 2) Amount Paid Date Paid TS Voucher Amount Amount Paid Date Paid TS Voucher Amount Overpayment applied from 2017........... 1st quarter payment...................... 2nd quarter payment...................... 3rd quarter payment...................... 4th quarter payment...................... Additional Estimated Tax Payments Paid with extension....................... Former spouse SSN if joint estimates...... State Overpayment applied from 2017........... 1st quarter payment...................... 2nd quarter payment...................... 3rd quarter payment...................... 4th quarter payment...................... Additional Estimated Tax Payments Paid with extension....................... 1 Type of Account 1 Savings 2 Checking 2 Type of Investment 1 2 3 4 5 Checking or savings (default) Taxpayer's IRA (next year limits) Spouse's IRA (next year limits) Health savings account (HSA) Archer MSA 6 7 8 9 Coverdell savings account (ESA) Other Taxpayer's IRA (current year limits) Spouse's IRA (current year limits) 3, 6 Series: 5100, 5400 (ttaxpayer, sspouse, blankjoint) Direct Deposit & Estimates (Form ES)
Page 11 Direct Deposit & Estimates (Form ES) (cont.) 7.1 Please enter all pertinent information. APPLICATION OF OVERPAYMENT (7.1) If you have an overpayment of taxes, do you want the excess refunded?.. Other (please explain): or applied to 2019 estimate?.... 2019 ESTIMATED TAX INFORMATION Do you expect your 2019 taxable income to be different from?........................................... If "yes" explain any differences in income, deductions, dependents, etc.: Yes No Do you expect your 2019 withholding to be different from?............................................... If "yes" explain any differences: Yes No 7.1 Series: 5400 (ttaxpayer, sspouse, blankjoint) Direct Deposit & Estimates (Form ES) (cont.)
Page 12 Interest & Dividend Income 11, 12 Please enter all pertinent amounts & attach all 1099-INT, 1099-OID and 1099-DIV forms. Last year's amounts are provided for your reference. INTEREST INCOME (11) Name of Payer 1taxpayer Banks, No. (also enter SSN & address 2spouse S&Ls, C/Us, for seller-financed mortgage) etc. (Box 1) Interest Income SellerFinanced Mtg. (Box 1) Tax-Exempt Interest U.S. Bonds, T-Bills (Box 3) Total Municipal Bonds In-state Municipal Bonds Early Withdrawal Penalty (Box 2) 2017 Interest DIVIDEND INCOME (12) Dividend Income No. Name of Payer 1tp Total Ordinary 2sp Dividends (Box 1a) Qualified Dividends (Box 1b) Total Capital Gain Distrib. (Box 2a) Tax-Exempt Interest U.S. Bonds (% or amt.) Total Municipal Bonds In-state Muni-bonds (% or amt.) Foreign Tax Paid (Box 6) 2017 Dividends 11, 12 Series: 12, 13 Interest & Dividend Income
Page 13 Itemized Deductions 25 Please enter all pertinent amounts and attach all 1098 forms. Last year's amounts are provided for your reference. MEDICAL AND DENTAL EXPENSES NOTE:Enter self-employed health insurance premiums on Sheet 24 and Medicare insurance premiums on Sheet 14. Amount TS 2017 Amount Prescription medicines and drugs..................................... Doctors, dentists and nurses.......................................... Hospitals and nursing homes......................................... Insurance premiums not entered elsewhere (excl. LT care & amts. paid w/pre-tax dollars).. Long-term care premiums - taxpayer.................................. Long-term care premiums - spouse................................... Insurance reimbursement (enter as a positive number)................. Lodging and transportation: Out-of-pocket expenses.......................................... Medical miles driven.............................................. Other medical and dental expenses: TAXES PAID (State and local withholding and estimates are automatic.) State income taxes - 1/18 payment on 2017 state estimate............. State income taxes - paid with 2017 state return extension............. State income taxes - paid with 2017 state return....................... State income taxes - paid for prior years and/or to other state.......... City/local income taxes - 1/18 payment on 2017 city/local estimate...... City/local income taxes - paid with 2017 city/local extension............ City/local income taxes - paid with 2017 city/local return................ SALES AND E TAXES PAID State and local sales taxes (except autos and special items)........... Use taxes paid on purchases.................................... Use taxes paid with 2017 state return................................. Sales tax on autos not included above................................ Sales tax on boats, aircraft, other special items........................ OTHER TAXES PAID Real estate taxes - principal residence: Real estate taxes - property held for investment....................... Personal property taxes (including auto fees in some states. Provide a copy of tax notice)... Foreign income taxes................................................ Other taxes: 25 Series: 400 Itemized Deductions
Page 14 Itemized Deductions (continued) 25 p2 Please enter all pertinent amounts. Last year's amounts are provided for your reference. INTEREST PAID Home mortgage int. (Box 1) and points (Box 2) reported on Form 1098: Amount TS 2017 Amount Home mortgage interest not reported on Form 1098: Payee's name.......... Payee's SSN or FEIN... Payee's street address. Payee's city............ Payee's state.......... Payee's ZIP code....... Payee's region......... Payee's postal code.... Payee's country........ Amount paid................................................... Points not reported on Form 1098: Mortgage insurance premiums on post 12/31/06 contracts (Box 4)..... Investment interest (interest on margin accounts): Passive interest..................................................... Certain home mortgage interest included above (6251)................. NOTE: Points paid on loans other than to buy, build, or improve your main home are deductible over the life of the mortgage. For these types of loans also provide the dates and lives of the loans. CASH CONTRIBUTIONS NOTE: No deduction is allowed for cash or check contributions unless the donor maintains a bank record, or a written communication from the donee, showing the name of the organization, contribution date(s), and contribution amount(s). Churches, schools, hospitals, and other charitable organizations (60% limitation): Contributions by cash or check: Volunteer expenses (out-of-pocket)............................... Number of charitable miles....................................... Veterans' organizations, fraternal societies, nonprofit cemeteries, and certain private nonoperating foundations (30% limitation): Contributions by cash or check: Volunteer expenses (out-of-pocket)............................... Number of charitable miles....................................... 25 p2 Series: 400 (Ttaxpayer, Sspouse, Blankjoint) Itemized Deductions (continued)
Page 15 Itemized Deductions (continued) 25 p3 Please enter all pertinent amounts. Last year's amounts are provided for your reference. NONCASH CONTRIBUTIONS NOTE:Use Sheet 26 if total noncash contributions are over $500. No deduction is allowed for contributions of clothing and household items that are not in good used condition or better. In addition, a deduction for any item with minimal monetary value may be denied. 50% limitation (see above): Amount TS 2017 Amount 30% limitation (see above): 30% capital gain property (gifts of capital gain property to 50% limit orgs.): 20% capital gain property (gifts of capital gain property to non-50% limit orgs.): STATE MISC. DEDS. IF NON-CONFORMING TO TAX CUTS & JOBS ACT (subject to 2% AGI limit) Union and professional dues.............................................. Other unreimbursed employee expenses (uniforms and protective clothing, professional subscriptions, employment agency fees, and certain edu. expenses): Investment expense: Tax return preparation fee.............................................. Safe deposit box rental.................................................. Miscellaneous deductions (2% AGI) (certain legal and accounting fees, and custodial fees): 25 p3 Series: 400 (Ttaxpayer, Sspouse, Blankjoint) Itemized Deductions (continued)
Page 16 Itemized Deductions (continued) 25 p4 Please enter all pertinent amounts. Last year's amounts are provided for your reference. OTHER MISCELLANEO DEDUCTIONS Amount TS 2017 Amount Estate tax, section 691(c)................................................ Other miscellaneous deductions: 25 p4 Series: 400 (Ttaxpayer, Sspouse, Blankjoint) Itemized Deductions (continued)
Page 17 Itemized Deductions (continued) 25 p5 If either of the following conditions below apply to you, your home mortgage interest deduction may need to be limited and the input section provided below should be completed. If neither condition applies, enter home mortgage interest amounts on organizer sheet 25 p2. 1. Total home equity debt exceeded $100,000 at any time during ($50,000 if married filing separate). For this purpose, home equity debt is defined as any mortgages taken out in which the proceeds were used to buy, build, or improve your home. 2. Total home acquisition debt exceeded $750,000 at any time during ($375,000 if married filing separate). For this purpose, home acquisition debt is defined as any mortgages taken out after October 13, 1987 in which the proceeds were used to buy, build, or improve your home. NOTE: When completing the input section below, grandfather debt represents loans taken out prior to October 14, 1987. Please enter all pertinent amounts and attach all 1098 forms. Last year's amounts are provided for your reference. Amount TS 2017 Amount Fair market value of the property on the date that the last debt was secured. Home acquisition and grandfather debt on the date that the last debt was secured............ LOAN INFORMATION Loan #1 Lender's name....................................................... Form (see table)..................................................... Number of form...................................................... 1taxpayer, 2spouse, blankjoint.................................... Interest paid......................................................... Points paid.......................................................... Total principal paid................................................... Lump sum principal payment (if paid off).............................. Months outstanding (if not 12)........................................ Home acquisition debt balance - beginning of year..................... Home acquisition debt borrowed in............................... Home equity debt balance - beginning of year.......................... Home equity debt borrowed in................................... Grandfather debt balance - beginning of year.......................... Loan #2 Lender's name....................................................... Form (see table)..................................................... Number of form...................................................... 1taxpayer, 2spouse, blankjoint.................................... Interest paid......................................................... Points paid.......................................................... Total principal paid................................................... Lump sum principal payment (if paid off).............................. Months outstanding (if not 12)........................................ Home acquisition debt balance - beginning of year..................... Home acquisition debt borrowed in............................... Home equity debt balance - beginning of year.......................... Home equity debt borrowed in................................... Grandfather debt balance - beginning of year.......................... Form 1 Schedule A (default) 2 Business use of home 3 Schedule E 25 p5 Series: 400 Itemized Deductions (continued)
Page 18 Noncash Contributions (Form 8283) 26 If your total noncash contributions are in excess of $500 in, please complete the information below for each donee using the following guidelines: * If you contributed a motor vehicle, boat, or airplane with a claimed value of more than $500, attach Form 1098-C or other written acknowledgement received from the donee organization. * A deduction for contributions of clothing or other household items that are not in good used condition or better is not allowed. In addition, a deduction for any item with minimal monetary value may be denied. However, these rules do not apply to any contribution of a single item for which a deduction of more than $500 is claimed, if a qualified appraisal for the donated property is provided. DONATED PROPERTY INFORMATION No. Name of charitable organization (donee)....................... Street address............................................... City.......................................................... State........................................................ ZIP code..................................................... 1spouse, 2joint............................................ Property description (other than vehicle)....................... Identification number (VIN)....................... Year (yyyy)...................................... Vehicle Make and model................................. Condition and mileage........................... Date of contribution (m/d/y)................................... Date acquired by donor (m/y).................................. How acquired by donor (Table 1 or describe)................... Donor's cost or basis......................................... Fair market value............................................. Method used to determine FMV (Table 2 or describe)........... No. Name of charitable organization (donee)....................... Street address............................................... City.......................................................... State........................................................ ZIP code..................................................... 1spouse, 2joint............................................ Property description (other than vehicle)....................... Identification number (VIN)....................... Year (yyyy)...................................... Vehicle Make and model................................. Condition and mileage........................... Date of contribution (m/d/y)................................... Date acquired by donor (m/y).................................. How acquired by donor (Table 1 or describe)................... Donor's cost or basis......................................... Fair market value............................................. Method used to determine FMV (Table 2 or describe)........... 1 How Property was Acquired 1 Purchase 2 Gift 3 Inheritance 4 Exchange 2 Method Used to Determine FMV 1 Appraisal 2 Thrift shop value 3 Catalog 4 Comparable sales For other methods, see IRS Pub. 561. 26 Series: 21 Noncash Contributions (Form 8283)
Page 19 Health Coverage Form 39.1 Please do not complete this information if coverage is indicated on Form 1095-A, 1095-B or 1095-C. Attach the document with this organizer if you have it. GENERAL INFORMATION 1entire household covered for all months, 2no months................... Date married (if in current year).......................................... COVERED INDIVIDUAL (#1) COVERED INDIVIDUAL (#2) (a) (a) (b) (d) (e) (a) (a) (b) (d) (e) First name... Last name... ID number (SSN or TIN).... 1covered all 12 months.... Months of coverage: 1November 2017......... 1December 2017......... 1January................. 1February................ 1March.................. 1April.................... 1May.................... 1June.................... 1July.................... 1August.................. 1September.............. 1October................. 1November............... 1December............... First name... Last name... ID number (SSN or TIN).... 1covered all 12 months... Months of coverage: 1November 2017......... 1December 2017......... 1January................. 1February................ 1March.................. 1April.................... 1May.................... 1June.................... 1July.................... 1August................. 1September.............. 1October................. 1November.............. 1December.............. COVERED INDIVIDUAL (#3) COVERED INDIVIDUAL (#4) (a) (a) (b) (d) (e) (a) (a) (b) (d) (e) First name... Last name... ID number (SSN or TIN).... 1covered all 12 months.... Months of coverage: 1November 2017......... 1December 2017......... 1January................. 1February................ 1March.................. 1April.................... 1May.................... 1June.................... 1July.................... 1August.................. 1September.............. 1October................. 1November............... 1December............... First name... Last name... ID number (SSN or TIN).... 1covered all 12 months... Months of coverage: 1November 2017......... 1December 2017......... 1January................. 1February................ 1March.................. 1April.................... 1May.................... 1June.................... 1July.................... 1August................. 1September.............. 1October................. 1November.............. 1December.............. 39.1 Series: 4100 Health Coverage Form