Atwood Tax Client Organizer Taxpayer Information First Name: ( ) Initial: ( ) Last Name: ( ) Date of Birth: ( / / ) SSN: ( - - ) Occupation: ( ) Address: ( ) State: ( ) Zip: ( ) City: ( ) Daytime phone: ( ) Evening phone: ( ) Email: ( ) Spouse Information First Name: ( ) Initial: ( ) Last Name: ( ) Date of Birth: ( / / ) SSN: ( - - ) Occupation: ( ) Daytime phone: ( ) Evening phone: ( ) Email: ( ) Dependents Name: DOB: SSN: Relationship: # Months @ Home: Wage/Salary Income (Provide W2 s) Employer Name: Gross Wages: Fed Withholdings: State Withholdings: Other Income Interest income (Provide 1099INT forms) Payer: Amount: Payer: Amount: ( )( ) ( ) ( ) ( )( ) ( ) ( ) 1 P age
Dividend income (Provide 1099DIV forms) Payer: Total: Capital Gains: Ordinary Dividend: ( ) ( ) ( ) ( ) ( ) ( ) ( ) ( ) ( ) ( ) ( ) ( ) Capital gains (Provide 1099B forms) Description: Date Acquired: Date Sold Cost: Sale Price: ( ) ( / / ) ( / / ) ( ) ( ) ( ) ( / / ) ( / / ) ( ) ( ) ( ) ( / / ) ( / / ) ( ) ( ) Pension / IRA Distribution (Provide 1099R forms) Payer: Gross Distribution: Taxable Amount: Roth Conversion: Reason for withdrawal: ( ) ( ) ( ) ( ) ( ) ( ) ( ) ( ) ( ) ( ) ( ) ( ) ( ) ( ) ( ) State tax refund (Provide 1099G form) Amount Received: ( ) Alimony Received (does not include child support) Payer Name: ( ) Payer SSN: ( - - ) Amount: ( ) Unemployment Received (Provide 1099G form) Amount Received: ( ) Social Security Received (Provide SSA-1099 forms) Amount Received Taxpayer: ( ) Spouse: ( ) Self Employed / Business Income (please fill out page 4): ( ) Income from Rental property (please fill out page 5): ( ) Miscellaneous Income Tips (not on W2): ( ) Gambling winnings (provide W-2Gs): ( ) Child Support: ( ) Scholarships/Grants: ( ) Jury Duty Pay: ( ) Other (Description and amount): ( ) 2 P age
Deductions Medical and Dental Expenses After Tax Insurance premiums: ( ) Medical miles driven: ( ) Out of pocket expenses: ( ) Did you have health insurance for every month of 2017? Yes ( ) No ( ) Please attach forms 1095 A, B and/or C Taxes Paid State and local income tax: ( ) Real estate taxes (personal residence): ( ) Real estate taxes (other non-rental property): ( ) Interest Paid (Provide 1098 Forms) Home Mortgage Interest Paid (1 st ): ( ) Home Mortgage Interest Paid (2 nd ): ( ) Home Mortgage Equity Line: ( ) Private Mortgage Insurance Premiums: ( ) Student Loan Interest: ( ) Contributions to Qualified Organizations/501C3s (Provide Documentation) Cash, Check, Credit Card: ( ) Value of donated items: ( ) Miscellaneous Deductions Unreimbursed Employee Business Expenses: ( ) Tax Return Prep Fees: ( ) Investment Fees: ( ) Safety Deposit Box Rental: ( ) Educator Expenses: ( ) Other: ( ) Child and Dependent Care Expenses Name of Care Provider: ( ) Address: ( ) SSN or Federal ID: ( ) Amount: ( ) Name of Care Provider: ( ) Address: ( ) SSN or Federal ID: ( ) Amount: ( ) Do you pay tuition to any primary or secondary private schools? Yes ( ) No ( ) Education Expenses Tuition (Attach 1098 T Forms) Student Name: ( ) Amount: ( ) Institution Name: ( ) Institution Federal ID: ( - ) Student Name: ( ) Amount: ( ) Institution Name: ( ) Institution Federal ID: ( - ) Amount Paid for required books/supplies: ( ) Taxpayer Traditional IRA Contributions: ( ) Spouse ( ) Roth IRA Contributions: ( ) ( ) SEP SIMPLE or KEOGH: ( ) ( ) 3 P age
Business Income (Self-Employed) Principal Business Activity/Profession: ( ) Business Name: ( ) Business Address: ( ) Cash Basis: ( ) Accrual Basis: ( ) First Year: ( ) Income Gross Receipts or Sales: ( ) Expenses Advertising: ( ) Commissions: ( ) Employee Benefit Programs: ( ) Insurance Other than Health: ( ) Health Insurance Premiums: ( ) Interest: ( ) Legal and Professional Fees: ( ) Office Supplies and Expense: ( ) Rent (property): ( ) Equipment Rental: ( ) Repairs: ( ) Supplies: ( ) Merchant Fees: ( ) Bank Fees: ( ) Software: ( ) Professional Development: ( ) Dues and Subscriptions: ( ) Postage and Delivery: ( ) Meals and Entertainment: ( ) Utilities: ( ) Wages: ( ) Web Expense: ( ) Phone: ( ) Internet: ( ) Taxes: ( ) *If deducting home office expense use page 6 Travel: ( ) Mileage: Business Miles: ( ) Total Miles: ( ) *If claiming actual automobile expenses: Repairs: ( ) Interest: ( ) Assets Purchased: Description: ( ) Date: ( / / ) Amount: Description: ( ) Date: ( / / ) Amount: Gas: ( ) Oil Changes: ( ) Insurance: ( ) License: ( ) 4 P age
Rental Property Property Address: % Ownership Property Type Property 1 ( ) ( ) ( ) Street City, State Zip Property 2 ( ) ( ) ( ) Street City, State Zip Property 1 Property 2 Income/Rent Received: Check if property was purchased or converted Expenses: Advertising: to rental property during the tax year: ( ) Association Dues: Number of Days Rented or Available for Rent: Cleaning: Property 1: Insurance: Property 2: Contract Labor: Yard Maintenance: Mileage: Professional Fees: Business Miles: ( ) Management Fees: Total Miles: ( ) Mortgage Interest: Other Interest: Repairs/Maint: Supplies: Property Taxes: Telephone: Utilities: Other: Depreciable Improvements/Assets: Date: ( / / ) Amount: Description: ( ) Date: ( / / ) Amount: Description: ( ) Date: ( / / ) Amount: Description: ( ) Date: ( / / ) Amount: Description: ( ) 5 P age
Home Office Deduction Property: Square feet of home: Square feet used for business: Expenses: Insurance: Internet: Mortgage Interest: Rent: Repairs/Maint: Property Taxes: Telephone: Utilities: Other: 6 P age
Miscellaneous Items Alimony Paid SSN of Payee: ( - - ) Amount Paid: Estimated Tax Payments Federal Overpayment previous tax year: ( ) Quarter 1: Amount ( ) Date Paid ( / / ) Quarter 2: Amount ( ) Date Paid ( / / ) Quarter 3: Amount ( ) Date Paid ( / / ) Quarter 4: Amount ( ) Date Paid ( / / ) State Overpayment previous tax year: ( ) Quarter 1: Amount ( ) Date Paid ( / / ) Quarter 2: Amount ( ) Date Paid ( / / ) Quarter 3: Amount ( ) Date Paid ( / / ) Quarter 4: Amount ( ) Date Paid ( / / ) Notes, Comments or Questions: 7 P age