ROR TAX PROFESSIONALS, LLC 4500 Park Glen Road, Suite 100 St. Louis Park, MN 55416 Phone: (612) 822-7177 Fax: (612) 822-2163 http://www.rortax.com Subject: Your Tax Returns - The Fine Print! Thank you for choosing ROR Tax Professionals to assist you with your tax preparation. This engagement letter expresses the terms and conditions under which we will provide you with tax services and outlines responsibilities for each of us. Tax Preparation: We will prepare your federal and state tax return(s) with supporting schedules for the tax year based on the information you provide us. You will provide legible records needed in order to complete the tax return(s) preparation in a timely fashion. We do not keep original documents. We will scan original documents and immediately return them to you. If you have a business or rental property we require that you provide us with a summary of the income and expenses in a common Profit & Loss Statement format. During tax season we simply do not have time to do your bookkeeping. It is your responsibility to be organized. Unorganized documentation, or loose receipts, will be returned as unused in our preparation process and the return will be placed on hold until the proper information format is received. We will not audit or otherwise verify your records to discover errors or omissions, should any exist. However, if we find irregularities or unusual items, we will bring them to your attention and/or ask for clarification. You attest that income and expense items you claim are substantiated by proper records and receipts, and can furnish such documentation in the event of an audit and attest that the information provided is accurate and complete to the best of your knowledge. You are ultimately responsible for the accuracy of your tax return(s) and you should review all documents carefully before signing and authorizing the filing. If you have questions about the information on your return, please contact us. Your completed tax return is accompanied by a letter which may contain instructions for you to follow. It is your responsibility to read this letter and follow any such instructions. Please be aware that you are responsible for paying any and all tax that you owe. Should we encounter instances of unclear tax law, or of potential conflicts in interpretation of the law, we will outline the reasonable course of action and the risks and consequences of each. Should we feel that the course of action you choose is unreasonable, we may decline to complete your return(s). Fees & Payment: Our tax prep fee is based on the time it takes to produce your return(s), the complexity of your tax return(s), as well as any out-ofpocket expenses, subject to a minimum. If you have requested a paper copy, we ask that you pick up your return as soon as possible after it is complete. Past due balances exceeding 7 days will be charged a $25 late fee. Past due balances exceeding 20 days will be charged an additional $25 late fee, unless mutually agreed upon arrangements are made. If you terminate this engagement before completion you agree to pay for time and expenses incurred prior to the date of termination, even if the tax return(s) is not completed. Please sign and return this letter by email, fax, mail, or SmartVault portal and keep a copy for your records. We want to express our appreciation for this opportunity to work with you. Sincerely, ROR Tax Professionals, LLC Taxpayer Signature Spouse Signature Taxpayer Name (please print) DATE Spouse Name (please print) DATE
ROR TAX PROFESSIONALS, LLC 4500 Park Glen Road, Suite 100 St. Louis Park, MN 55416 Phone: (612) 822-7177 Fax: (612) 822-2163 http://www.rortax.com Subject: ROR Tax Professionals Privacy Policy Your privacy is important to us. Please read the following privacy policy. We collect nonpublic personal information about you from various sources, including: Interviews regarding your tax situation Applications, organizers, or other documents that supply such information as your name, address, telephone number, Social Security Number, number of dependents, income and other tax-related data Tax-related documents you provide that are required for processing tax returns, such as Forms W-2, 1099R, 1099-INT, and 1099- DIV, and stock transactions We do not disclose any nonpublic personal information about our clients or former clients to anyone, except as requested by our clients or as required by law. We restrict access to personal information concerning you to our employees who need such information in order to provide products or services to you. We maintain physical, electronic, and procedural safeguards that comply with federal regulations to protect your personal information. If you have any questions about our privacy policy, please contact us. Sincerely, ROR TAX PROFESSIONALS LLC
DISCUSSION POINTS Please complete the questionnaire and return to ROR with your Tax Documents PERSONAL INFORMATION Taxpayer Name: Spouse s Name: Taxpayer Phone #: Spouse s Phone #: Taxpayer email: Taxpayer Occupation: Spouse s email: Spouse s Occupation: What is your expected tax outcome? (circle one) Refund Balance Due Don t Know YES NO YES NO DEPENDENTS 1. Did your address change? If yes, please provide your new address. 2. Did you reside in more than one state last year? 3. Did your marital status change before the end of last year? 4. Have you or your spouse been a victim of identity theft and have you contacted the IRS? If yes, please furnish the 6-digit identity protection PIN(s) issued to you by the IRS. 5. Do you want to allocate $3 to the Presidential Election Campaign Fund? 6. Does your spouse want to allocate $3 to the Presidential Election Campaign Fund? 7. Do you want to contribute to the MN Election Campaign Fund? 8. Does your spouse want to contribute to the MN Election Campaign Fund? 9. Do you want to contribute to the MN Non-Game Wildlife Fund? Amount: 10. Does your spouse want to contribute to the MN Non-Game Wildlife Fund? Amount: 11. May the IRS discuss your tax return with your preparer? 12. Would you like to have your tax return electronically delivered to you for your signature and payment? 13. If you qualify for a refund, would you like it direct deposited to your bank account? 14. If you have a balance due, would you like it direct debited from your account? The withdrawal date is April 17, 2018. 15. Did you make any federal or state quarterly estimated payments? 16. If you have an overpayment of taxes, do you want the excess applied to 2018 estimated tax (instead of being refunded)? 17. Were there any additions or changes in dependents from the prior year? 18. How many children / dependents should be listed on your tax return? 19. Did you pay any child or dependent care expenses? (Please provide child care receipts). 20. Did you pay any wages to household employees? (Nanny, maid, etc...) (Please provide Schedule H)
DISCUSSION POINTS Please complete the questionnaire and return to ROR with your Tax Documents 21. Did you have any children under age 18 or full-time students ages 19-23 with unearned income of more than $1050. 22. Did you adopt a child or begin adoption proceedings in? 23. Are any of your dependents non-u.s. citizens or non-u.s. residents? YES NO HEALTH CARE COVERAGE YES NO INCOME 24. Did you and all your dependents have health care coverage for the full-year? (Provide 1095- A, 1095-B or 1095-C.) 25. If you or your spouse have Medicare/Medicaid insurance, did you have Supplemental Medical, Dental or Vision insurance? 26. Do you or your spouse have Long Term Care Insurance? 27. Did you or your spouse contribute to or receive distributions from a Health Savings Account? (Please provide Forms 5498-SA and 1099-SA) 28. Did you have any of the following types of Income? (Please check all that apply) Employment Income (W2) Social Security (1099-SSA) Pension Or Retirement (1099-R) Interest (1099-INT) Dividends (1099-DIV) Investment Income (1099-B) YES NO EDUCATION Unemployment, Disability Or Jury Duty (1099-G) Alimony Or Spousal Support Gambling, Prize Or Award Income (W2-G) Partnership, S-Corp Or Trust Income (Sched K1) 29. If you had Employment Income, how many W2 s did you have? 30. Did you pay alimony or spousal support in? Recipient Name / Amount: 31. Did you exercise any Employee Stock Options? 32. Did you sell any stocks or securities not reported on Form 1099-B? Miscellaneous Income (1099-MISC) Foreign Income / Interest 33. Do you have an interest in or signature authority over a financial account in a foreign country, such as a bank account, securities account, or other financial account? 34. Were you a grantor or transferor to a foreign trust? 35. Are you or your spouse making Student Loan payments? (Please provide form 1098-E) 36. Did you, your spouse, or a dependent incur any tuition expenses that are required to attend a college, university, or vocational school? (Please provide Form 1098-T)
DISCUSSION POINTS Please complete the questionnaire and return to ROR with your Tax Documents YES NO RETIREMENT 37. Did you receive a distribution from an Education Savings Account or a Qualified Tuition Program? (Please provide Form 1098-Q) 38. Did you contribute to one or more Qualified Education Programs (Section 529 Plan) in? 39. Did you convert part or all of your traditional, SEP, or SIMPLE IRA to a Roth IRA in (1099-R, 5498) 40. Did you make any contributions to an IRA account (Traditional IRA, ROTH, SEP) that is not through payroll and sponsored by your employer? YES NO ITEMIZED DEDUCTIONS 41. Did you have any of the following expenses? (Please check all that apply) Medical / Vision / Dental / Prescriptions Medical Mileage Mortgage Interest (1098) Real Estate / Property Tax Cash donations to charity Personal Property Tax (Vehicle License Tabs) Non-cash donations to charity 42. Did you pre-pay your 2018 Proposed Property Taxes? Amount: YES NO MISCELLANEOUS Gambling Losses Volunteer Expenses - Out of Pocket / Mileage 43. Did you have any of the following miscellaneous deductions? (Please check all that apply) Educator Classroom Expenses Uniforms & Work Clothes Moving Expenses Union Dues Unreimbursed Parking or Mileage Professional Dues or Subscriptions Professional Licenses Other Continuing Education (work related) Job Search Expenses None Safety Deposit Box Financial Planning Fees 44. Did you purchase and/or sell a home last year? Please provide a copy of your settlement statements (HUD) and or 1099-S. 45. Did you use any first time home buyer credits to purchase your home? 46. Did you refinance your home, or second home, or take a home equity loan during the year? 47. Do you have a home office that is exclusively used for work or business? 48. Did you have unreimbursed expenses for use of your vehicle for work other than commuting to the job?
DISCUSSION POINTS Please complete the questionnaire and return to ROR with your Tax Documents 49. Did you or your spouse make any gifts to an individual that total more than $14,000 or any gifts to a trust? YES NO PROPERTY TAX REFUND (Please provide Property Tax Statement or Certificate of Rent Paid) 50. Would you like us to file your MN Homestead Credit Refund or Renter Property Tax Refund if you qualify? 51. Were there any adults or non-dependent children with income, not already claimed on your tax return, living in your household in? YES NO RENTAL PROPERTY (Please provide a Profit & Loss Statement or complete Schedule E section of tax organizer for each rental property) 52. Do you own rental property or rent out any portion of your home? 53. How many rental properties do you own? 54. At any time during the year did you use your rental property for personal use? How many days? 55. Did you buy, sell or refinance any rental property last year? 56. Did you purchase any business assets or convert any personal assets to business use in (furniture, equipment, etc ) 57. Did you dispose of any business assets? 58. As a landlord did you use your personal vehicle for purposes related to your rental property? (collect rent, perform maintenance, check on property, etc ) YES NO BUSINESS INCOME (Please provide a Profit & Loss Statement or complete Schedule C section of tax organizer ) 59. Were you self-employed or did you own or start a business in? 60. Do you have a separate Employer ID Number (EIN) for your business? 61. Did you purchase any business assets or convert personal assets to business use in? 62. Did you dispose of any business assets? 63. Did you use your personal vehicle for business purposes other than commuting to and from work? 64. Do you have a home office where you regularly and exclusively conduct your work? 65. Do you work out-of-state any time during the year? 66. Did you make any payments that would require you to file a Form 1099?
Page 1 1040 US Client Information 1 ROR Tax Professionals 4500 Park Glen Rd Ste 100 Minneapolis, MN 55416 Telephone number: Fax number: E-mail address: 612-822-7177 612-822-2163 info@rortax.com Tax Return Appointment 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)................................................ 1=married filing separate and lived with spouse...................... Year spouse died, if qualifying widow(er) (2015 or 2016)............. First name and initial...... Last name................. Title/suffix................. Social security number..... Occupation................ Date of birth (m/d/y)....... Date of death (m/d/y)...... 1=blind.................... First name and initial...... Last name................. Title/suffix................. Social security number..... Occupation................ Date of birth (m/d/y)....... Date of death (m/d/y)...... 1=blind.................... In care of................. Street address............. Apartment number......... City....................... State..................... ZIP code.................. Region.................... Postal code............... Country................... Filing Status 1 = Single 2 = Married filing joint 3 = Married filing separate 4 = Head of household 5 = Qualifying widow(er) Series: 1 Client Information
Page 2 1040 US Client Information (continued) 1 p2 Please add, change or delete information for. CLIENT INFORMATION Home phone.............. Taxpayer Contact Information Spouse Contact Information Work phone............... Work extension............ Daytime phone (table)..... Mobile phone.............. Fax number............... E-mail address............ Home phone.............. Work phone............... Work extension............ Daytime phone (table)..... Mobile phone.............. Fax number............... E-mail address............ Driver's license no......... Daytime Phone 1 = Work 2 = Home 3 = Mobile Taxpayer Authentication Spouse Authentication Driver's license state....... Expiration date (m/d/y)..... Issue date (m/d/y)......... Theft protection PIN....... Driver's license no......... Driver's license state....... Expiration date (m/d/y)..... Issue date (m/d/y)......... Theft protection PIN....... 1 p2 Series: Client Information (continued)
Page 3 1040 US Dependents 2 Please add, change or delete information for. DEPENDENTS Dependent Dependent First name............................... Last name............................... Title/suffix............................... Date of birth (m/d/y)...................... Date of death............................ Date of adoption......................... Social security number................... Relationship............................. Type of Dependent 1 = Child living w/taxpayer 2 = Child not living w/taxpayer 3 = Dependent other than child 4 = Head of household only, not a dependent 5 = Earned income credit only, not a dependent Months lived at home..................... Type of dependent (see table)............ Earned income credit (see table).......... Earned Income Credit Claimed by: 1=taxpayer, 2=spouse........ First name............................... Last name............................... Title/suffix............................... Dependent Dependent 1 = When applicable (default) 2 = Student age 19 to 23 3 = Disabled 4 = Force 5 = Suppress Date of birth (m/d/y)...................... Date of death............................ Date of adoption......................... Social security number................... Relationship............................. NOTE: If you claim the earned income credit, please provide proof that your child is a resident of the U.S. This proof is typically in the form of: Months lived at home..................... Type of dependent (see table)............ Earned income credit (see table).......... Claimed by: 1=taxpayer, 2=spouse........ First name............................... Last name............................... Title/suffix............................... Date of birth (m/d/y)...................... Date of death............................ Dependent Dependent 1. School records or statement 2. Landlord or property management statement 3. Health care provider statement 4. Medical records 5. Child care provider records 6. Placement agency statement 7. Social service records or statement 8. Place of worship statement 9. Indian tribe office statement 10. Employer statement Date of adoption......................... Social security number................... Relationship............................. Months lived at home..................... Type of dependent (see table)............ Earned income credit (see table).......... Claimed by: 1=taxpayer, 2=spouse........ First name............................... Dependent Dependent NOTE: If your child is disabled, please provide one of the following forms of proof of disability: 1. Doctor statement 2. Other health care provider statement 3. Social services agency or program statement Last name............................... Title/suffix............................... Date of birth (m/d/y)...................... Date of death............................ Date of adoption......................... Social security number................... Relationship............................. Months lived at home..................... Type of dependent (see table)............ Earned income credit (see table).......... Claimed by: 1=taxpayer, 2=spouse........ 2 Series: Dependents
Page 4 1040 US Direct Deposit & Estimates (Form 1040 ES) 3, 6 Please enter all pertinent information. DIRECT DEPOSIT / ELECTRONIC PAYMENT (3) 1=direct deposit of federal tax refund into bank account.................. 1=electronic payment of balance due................................... 1=electronic payment of estimated tax.................................. BANK INFORMATION Percent to Deposit Name of Bank (xx.xx) Routing Number Account Number Type of Account (Table 1) Type of Invest. (Table 2) ESTIMATED TAX / 1040-ES (6) Federal Amount Paid Date Paid TS Overpayment applied from 2016........... 1st quarter payment...................... 2nd quarter payment...................... 3rd quarter payment...................... 4th quarter payment...................... Voucher Amount Additional Estimated Tax Payments Paid with extension....................... Former spouse SSN if joint estimates...... State Overpayment applied from 2016........... 1st quarter payment...................... 2nd quarter payment...................... 3rd quarter payment...................... 4th quarter payment...................... Amount Paid Date Paid TS Voucher Amount Additional Estimated Tax Payments Paid with extension....................... 1 Type of Account 2 Type of Investment 1 = Savings 2 = Checking 1 = Checking or savings (default) 2 = Taxpayer's IRA (next year limits) 3 = Spouse's IRA (next year limits) 4 = Health savings account (HSA) 5 = Archer MSA 6 = Coverdell savings account (ESA) 7 = Other 8 = Taxpayer's IRA (current year limits) 9 = Spouse's IRA (current year limits) Series: 5100, 5400 (t=taxpayer, s=spouse, blank=joint) 3, 6 Direct Deposit & Estimates (Form 1040 ES)
1040 US Direct Deposit & Estimates (Form 1040 ES) (cont.) Page 5 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?.. or applied to 2018 estimate?.... Other (please explain): 2018 ESTIMATED TAX INFORMATION Do you expect your 2018 taxable income to be different from?........................................... Yes No If "yes" explain any differences in income, deductions, dependents, etc.: Do you expect your 2018 withholding to be different from?............................................... If "yes" explain any differences: Yes No Series: 5400 (t=taxpayer, s=spouse, blank=joint) 7.1 Direct Deposit & Estimates (Form 1040 ES) (cont.)
Page 6 1040 US Wages, Pensions, Gambling Winnings 10, 13.1, 13.2 WAGES, SALARIES, TIPS (10) Name of Employer (Box c) Please enter all pertinent amounts & attach all W-2, W-2G and 1099-R forms. Last year's amounts are provided for your reference. 1=retirement plan (Box 13) 1=spouse Wages, Tips, Other Compensation (Box 1) Federal (Box 2) Social Security (Box 4) Tax Withheld Medicare (Box 6) State (Box 17) Local (Box 19) 2016 Wages PENSIONS, IRA DISTRIBUTIONS (13.1) Name of Payer Distribution code #2 Distribution code #1 1=IRA/SEP/SIMPLE Gross Distribution (Box 1) Taxable Amount (Box 2a) Tax Withheld Federal (Box 4) State (Box 12) Value of all IRAs at 12/31/17 2016 Distribution 1=spouse GAMBLING WINNINGS (W-2G) (13.2) Name of Payer 1=spouse Gross Winnings (Box 1) Tax Withheld Federal (Box 4) State (Box 15) Local (Box 17) 2016 Winnings GAMBLING LOSSES & WINNINGS (NON W-2G) (13.2) TS Total gambling losses...................................................... Winnings not reported on Form W-2G....................................... Amount 2016 Amount Series: 11, 14, 19 (T=taxpayer, S=spouse, Blank=joint) 10, 13.1, 13.2 Wages, Pensions, Gambling Winnings
Page 7 1040 US 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 1=taxpayer (also enter SSN & address for seller-financed mortgage) 2=spouse Banks, S&Ls, C/Us, etc. (Box 1) Interest Income Seller- Financed Mtg. (Box 1) U.S. Bonds, T-Bills (Box 3) Tax-Exempt Interest Total Municipal Bonds In-state Municipal Bonds Early Withdrawal Penalty (Box 2) 2016 Interest DIVIDEND INCOME (12) Name of Payer 1=tp 2=sp Total Ordinary Dividends (Box 1a) Dividend Income Qualified Dividends (Box 1b) Total Capital Gain Distrib. (Box 2a) U.S. Bonds (% or amt.) Tax-Exempt Interest Total Municipal Bonds In-state Muni-bonds (% or amt.) Foreign Tax Paid (Box 6) 2016 Dividends 11, 12 Series: 12, 13 Interest & Dividend Income
Page 8 1040 US Miscellaneous Income 14.1 Please enter all pertinent amounts and attach all 1099-MISC, SSA-1099, and RRB-1099 forms. Last year's amounts are provided for your reference. MISCELLANEOUS INCOME Amount 2016 Amount Taxpayer Spouse Taxpayer Spouse Social security benefits (SSA-1099, box 5)........ Medicare premiums paid (SSA-1099)............. 1=treat Medicare premiums paid as SE health ins.. Tier 1 RR retirement benefits (RRB-1099, box 5)... 1=lump-sum election for SS benefits.............. Alimony received................................ Taxable scholarships and fellowships............. Jury duty pay.................................... Household employee income not on W-2.......... Excess minister's allowance...................... Alaska permanent fund dividends................. Income from rental of personal property........... Income subject to S/E tax: Other income (1099-MISC, box 3, 8) TAX WITHHELD (not entered elsewhere) Federal income tax withheld...................... State income tax withheld........................ Local income tax withheld........................ 14.1 Series: 200 Miscellaneous Income
Page 9 1040 US State & Local Tax Refunds / Unemployment Compensation 14.2 Please add, change or delete information as appropriate. Be sure to attach all 1099-G forms. STATE AND LOCAL TAX REFUNDS / UNEMPLOYMENT COMPENSATION (Form 1099-G) 1099-G Amount Name of payer............................................... 1=spouse.................................................... Unemployment compensation: Total received (Box 1)................................... Overpayment repaid............................... State and local refunds: State and local income tax refund, credit or offsets (Box 2) 1=city or local income tax refund........................ Tax year for box 2 if not 2016 (Box 3).................... Federal income tax withheld (Box 4)........................... RTAA payments (Box 5)...................................... Taxable grants: Federal taxable amount (Box 6)......................... State taxable amount, if different........................ Farm amounts: Agriculture payments (Box 7)............................ 1=agriculture payments are from conservation reserve program......... Market gain (Box 9)..................................... Number of farm......................................... 1=box 2 is trade or business income (Box 8)................... State income tax withheld (Box 11)............................ Name of payer............................................... 1=spouse.................................................... Unemployment compensation: Total received (Box 1)................................... Overpayment repaid............................... State and local refunds: State and local income tax refund, credit or offsets (Box 2) 1=city or local income tax refund........................ Tax year for box 2 if not 2016 (Box 3).................... Federal income tax withheld (Box 4)........................... RTAA payments (Box 5)...................................... Taxable grants: Federal taxable amount (Box 6)......................... State taxable amount, if different........................ Farm amounts: Agriculture payments (Box 7)............................ 1=agriculture payments are from conservation reserve program......... Market gain (Box 9)..................................... Number of farm......................................... 1=box 2 is trade or business income (Box 8)................... State income tax withheld (Box 11)............................ 14.2 Series: 15, 16 State & Local Tax Refunds / Unemployment Compensation
Page 10 1040 US Education Distributions (ESA's and QTP's) 14.3 Please enter all pertinent amounts and attach all 1099-Q forms. Enter qualified education expenses below that are not entered elsewhere. Last year's amounts are provided for your reference. ESA'S AND QTP'S (Form 1099-Q) Amount 2016 Amount Name of payer............................................... 1=spouse.................................................... Qualified expenses: Higher education (net of nontaxable benefits)............. Elementary & secondary education (net of nontaxable benefits). Form 1099-Q: Gross distributions (Box 1).............................. Earnings (Box 2)....................................... Basis (Box 3)........................................... Rollover: 1=nontaxable, 2=taxable (Box 4)................ Distribution type: 1=private 529, 2=state 529, 3=Coverdell ESA (Box 5)... ESA's only: contributions to this ESA........................... Value of this account at 12/31/17 (plus outstanding rollovers)... Basis in this ESA as of 12/31/16......................... Name of payer............................................... 1=spouse.................................................... Qualified expenses: Higher education (net of nontaxable benefits)............. Elementary & secondary education (net of nontaxable benefits). Form 1099-Q: Gross distributions (Box 1).............................. Earnings (Box 2)....................................... Basis (Box 3)........................................... Rollover: 1=nontaxable, 2=taxable (Box 4)................ Distribution type: 1=private 529, 2=state 529, 3=Coverdell ESA (Box 5)... ESA's only: contributions to this ESA........................... Value of this account at 12/31/17 (plus outstanding rollovers)... Basis in this ESA as of 12/31/16......................... Name of payer............................................... 1=spouse.................................................... Qualified expenses: Higher education (net of nontaxable benefits)............. Elementary & secondary education (net of nontaxable benefits). Form 1099-Q: Gross distributions (Box 1).............................. Earnings (Box 2)....................................... Basis (Box 3)........................................... Rollover: 1=nontaxable, 2=taxable (Box 4)................ Distribution type: 1=private 529, 2=state 529, 3=Coverdell ESA (Box 5)... ESA's only: contributions to this ESA........................... Value of this account at 12/31/17 (plus outstanding rollovers)... Basis in this ESA as of 12/31/16......................... 14.3 Series: 15, 16 Education Distributions (ESA's and QTP's)
Page 11 1040 US Business Income (Schedule C) 16 Please enter all pertinent amounts. Last year's amounts are provided for your reference. GENERAL INFORMATION Principal business/profession................... Principal business code........................ Business name, if different from Form 1040..... Business address, if different from Form 1040... City, if different from Form 1040................ State, if different from Form 1040............... ZIP code, if different from Form 1040........... Foreign region................................. Foreign postal code............................ Foreign country................................ Employer identification number................. Other accounting method....................... Accounting method: 1=cash, 2=accrual................................... Inventory method: 1=cost, 2=lower cost/market, 3=other................... 1=change of inventory method............................................ 1=spouse, 2=joint........................................................ 1=first Schedule C filed for this business.................................. If required to file Form(s) 1099, did you or will you file all required Form(s) 1099: 1=yes, 2=no.. 1=not subject to self-employment tax..................................... 1=did not "materially participate".......................................... 1=personal services is not a material income producing factor.............. 1=investment............................................................ 1=minister's Schedule C.................................................. 1=single member limited liability company................................. 1=trader in financial instruments or commodities........................... INCOME Amount 2016 Amount Gross receipts or sales (Form 1099-MISC, box 7).......................... Returns and allowances.................................................. Other income: COST OF GOODS SOLD Inventory at beginning of the year......................................... Purchases............................................................... Cost of items for personal use............................................ Cost of labor............................................................ Materials and supplies................................................... Other costs: Inventory at end of the year.............................................. 16 Series: 51
Page 12 1040 US Business Income (Schedule C) (cont.) 16 p2 Please enter all pertinent amounts. Last year's amounts are provided for your reference. EXPENSES Amount 2016 Amount Accounting.............................................................. Advertising.............................................................. Answering service....................................................... Bad debts from sales or service.......................................... Bank charges............................................................ Car and truck expenses (not entered elsewhere)........................... Commissions............................................................ Contract labor........................................................... Delivery and freight...................................................... Dues and subscriptions................................................... Employee benefit programs.............................................. Insurance (other than health)............................................. Mortgage interest (paid to banks, etc.).................................... Other interest (not entered elsewhere).................................... Janitorial................................................................ Laundry and cleaning.................................................... Legal and professional................................................... Miscellaneous........................................................... Office expense.......................................................... Outside services......................................................... Parking and tolls......................................................... Pension and profit sharing plans - contributions............................ Pension and profit sharing plans - admin. and education costs.............. Postage................................................................. Printing................................................................. Rent - vehicles, machinery, & equipment (not entered elsewhere)........... Rent - other............................................................. Repairs................................................................. Security................................................................. Supplies................................................................ Taxes - real estate....................................................... Taxes - payroll.......................................................... Taxes - sales tax included in gross receipts............................... Taxes - other (not entered elsewhere)..................................... Telephone............................................................... Tools................................................................... Travel................................................................... Total meals and entertainment in full (50%)............................... Department of Transportation meals in full (80%).......................... Uniforms................................................................ Utilities.................................................................. Wages.................................................................. Other expenses: NOTE: If you purchased or disposed of any business assets, please complete Sheet 22. 16 p2 Series: 51 Business Income (Schedule C) (cont.)
Page 13 1040 US Capital Gains & Losses (Schedule D) 17 If you sold any stocks, bonds, or other investment property in, please list the pertinent information for each sale below or provide a spreadsheet file with this information. Be sure to attach all 1099-B forms and brokerage statements. Quantity Description of Property (Box 1a) Date Acquired (Box 1b) Date Sold (Box 1c) Sales Price (gross or net) (Box 1d) Cost or Basis (Box 1e) Blank=basis rep. to IRS, 1=nonrec. security (Box 3, 5) Expenses of Sale (if gross sales price entered) Federal Income Tax Withheld (Box 4) 17 Series: 52 Capital Gains & Losses (Schedule D)
Page 14 1040 US Sale of Home & Moving Expenses 17, 27 SALE OF HOME (17) If you sold your home or moved in, please complete the information below. For the sale of home, please provide Form 1099-S and closing statements from the purchase and sale of your home. Description of property (Box 3)........................................................................ Date acquired (m/d/y)................................................................................. Date sold (m/d/y) (Box 1)............................................................................. Sales price (Box 2)................................................................................... 1=sale of home....................................................................................... 1=owned and used property as main home for at least 2 of 5 years before sale........................... 1=first-time homebuyer credit was previously taken on this home........................................ 1=business use in year of sale........................................................................ Number of days after December 31, 2008 that home was not used as principal residence.................. Adjusted Basis Original cost......................................................................................... Improvements: Adjusted basis........................................................................................ Expenses of Sale (Commissions, advertising fees, legal fees, and loan charges paid by the seller) Total expenses of sale................................................................................ Reduced Exclusion Please complete the following information if due to a change in health, place of employment, or unforeseen circumstances you either: a) Did not meet the ownership and use tests *, or b) Excluded gain on the sale of another home after May 6, 1997. If excl. gain from another home after May 6, 1997 & within 2 yrs. of current sale, enter date of sale (m/d/y) 1=sale due to change in health, employment or unforeseen circumstances............................... Days used as main home - taxpayer................................................................... Days used as main home - spouse.................................................................... Days property owned - taxpayer....................................................................... Days property owned - spouse......................................................................... MOVING EXPENSES (27) (If you moved because of a change in the location of your job) 1=spouse, 2=joint..................................................................................... 1=armed forces move due to permanent change of station.............................................. Miles from old home to new work place................................................................ Miles from old home to old work place................................................................. Expenses for transportation and storage of household goods and personal effects........................ Lodging and travel (excluding meals): Lodging and travel (excluding automobile)........................................................ Parking fees and tolls........................................................................... Gas and oil..................................................................................... Miles driven to new home........................................................................ (* owned and used property as main home for at least 2 of 5 years before sale) 17, 27 Series: 52, 500 Sale of Home & Moving Expenses
Page 15 1040 US Rental & Royalty Income (Schedule E) 18 Please enter all pertinent amounts. Last year's amounts are provided for your reference. GENERAL INFORMATION Description of property......... Street address................. City........................... State......................... ZIP code...................... Type of property (see table).... Other type of property.......... Number of days rented................................................... Amount 2016 Amount Type of Property 1 = Single Family Residence 2 = Multi-Family Residence 3 = Vacation/Short-Term Rental 4 = Commercial 5 = Land 6 = Royalties 7 = Self-Rental Percentage of ownership if not 100% (.xxxx)................. Percentage of tenant occupancy if not 100% (.xxxx)................. 1=spouse, 2=joint.............. 1=qualified joint venture........ 1=nonpassive activity, 2=passive royalty.................. INCOME Rents or royalties received............................................... DIRECT EXPENSES Advertising.............................................................. Association dues........................................................ Auto and travel (not entered elsewhere)................................... Cleaning and maintenance............................................... Commissions............................................................ Gardening............................................................... Insurance............................................................... Legal and professional fees.............................................. Licenses and permits.................................................... Management fees........................................................ Miscellaneous........................................................... Mortgage interest (paid to banks, etc.).................................... 1=investment.................. 1=single member limited liability company.................. If required to file Form(s) 1099, did you or will you file all required Form(s) 1099: 1=yes, 2=no......... NOTE: Direct expenses are related only to the rental activity. These include rental agency fees, advertising, and office supplies. Qualified mortgage insurance premiums................................... Excess mortgage interest................................................ Other interest (not entered elsewhere).................................... Painting and decorating.................................................. Pest control............................................................. Plumbing and electrical.................................................. Repairs................................................................. Supplies................................................................ Taxes - real estate....................................................... Taxes - other (not entered elsewhere)..................................... Telephone............................................................... Utilities.................................................................. Wages and salaries...................................................... Other: 1=did not actively participate... 1=RE prof., activity is trade or business, 2=RE prof., not trade or business....... 1=rental other than real estate. Amount 2016 Amount Series: 53 NOTE: If you purchased or disposed of any business assets, please complete Sheet 22. 18 Rental & Royalty Income (Schedule E)
Page 16 1040 US Rental & Royalty Income (Sch. E) (cont.) 18 p2 Please enter all pertinent amounts. Last year's amounts are provided for your reference. The indirect expense column should only be used for vacation homes or less than 100% tenant occupied rentals. GENERAL INFORMATION Foreign region........................................................... Foreign postal code...................................................... Foreign country.......................................................... OIL AND GAS Amount 2016 Amount Production type (preparer use only)....................................... Cost depletion........................................................... Percentage depletion rate or amount...................................... State cost depletion, if different (-1 if none)............................... State % depletion rate or amount, if different (-1 if none)................... VACATION HOME Number of days personal use............................................. Number of days owned (if optional method elected)........................ INDIRECT EXPENSES NOTE:Indirect expenses are related to operating or maintaining the dwelling unit. These include repairs, insurance, and utilities. Advertising.............................................................. Association dues........................................................ Auto and travel (not entered elsewhere)................................... Cleaning and maintenance............................................... Commissions............................................................ Gardening............................................................... Insurance............................................................... Legal and professional fees.............................................. Licenses and permits.................................................... Management fees........................................................ Miscellaneous........................................................... Mortgage interest (paid to banks, etc.).................................... Qualified mortgage insurance premiums................................... Excess mortgage interest................................................ Other interest (not entered elsewhere).................................... Painting and decorating.................................................. Pest control............................................................. Plumbing and electrical.................................................. Repairs................................................................. Supplies................................................................ Taxes - real estate....................................................... Taxes - other (not entered elsewhere)..................................... Telephone............................................................... Utilities.................................................................. Wages and salaries...................................................... Other: 18 p2 Series: 53 Rental & Royalty Income (Sch. E) (cont.)
Page 17 1040 US Vehicle Expenses 22 p3 Please enter all pertinent amounts. Last year's amounts are provided for your reference. GENERAL INFORMATION Amount 2016 Amount Description of vehicle.................................................... 1=no evidence to support your deduction.................................. 1=no written evidence to support your deduction........................... 1=vehicle is available for off-duty personal use............................ 1=no other vehicle is available for personal use............................ 1=vehicle used primarily by more than 5% owner.......................... Number of months of business use if changed from 100% personal use..... AUTOMOBILE MILEAGE Total mileage (for the tax year)........................................... Business mileage........................................................ Commuting mileage (for the tax year)..................................... Average daily round-trip commute........................................ ACTUAL EXPENSES Parking fees and tolls (business portion only).............................. Gasoline, lube, oil....................................................... Repairs................................................................. Tires.................................................................... Insurance............................................................... Miscellaneous........................................................... Auto license (other than personal property taxes).......................... Personal property taxes (based on car's value)............................ Interest (car loan) (for Schedule C, E & F)................................. Vehicle rent or lease payments........................................... Inclusion amount (enter as positive)...................................... Value of employer-provided vehicle on Form W-2 (2106)................... 22 p3 Series: 61 Vehicle Expenses
Page 18 1040 US Adjustments to Income 24 Please enter all pertinent information. Last year's amounts are provided for your reference. TRADITIONAL IRA CONTRIBUTIONS Amount 2016 Amount Taxpayer Spouse Taxpayer Spouse IRA contributions you made or expect to make (1=maximum) ($5,500/$6,500 if 50 or older)....... Contributions made to date....................... 1=covered by plan, 2=not covered................ payments from 1/1/18 to 4/17/18............ ROTH IRA CONTRIBUTIONS Roth IRA contributions you made or expect to make (1=maximum) ($5,500/$6,500 if 50 or older). Contributions made to date....................... SEP, SIMPLE AND QUALIFIED PLANS (KEOGH) Profit-sharing (25%/1.25) contributions you made or expect to make (1=maximum)........... Money purchase (25%/1.25) contributions you made or expect to make (1=maximum)........... Defined benefit contributions you expect to make.. Self-employed SEP (25%/1.25) contributions you made or expect to make (1=maximum)........... Plan contribution rate if not.25 (.xxxx)............ Individual 401k: SE elective deferrals (except Roth) (1=max.)... Individual 401k: SE designated Roth contributions (1=max.).... SIMPLE contributions: Self-employed SIMPLE contributions you made or expect to make (1=maximum)........ Employer matching rate if not.03 (.xxxx)...... 1=nonelective contributions (2%)............. Contributions made to date....................... ADJUSTMENTS TO INCOME Self-employed health insurance: Total premiums (excluding long-term care).... Long-term care premiums.................... Student loan interest paid (1098-E, box 1)........ Educator expenses (kindergarten thru grade 12)... Jury duty pay given to employer.................. Expenses from rental of personal property........ Other adjustments to income: Alimony paid: Recipient's first name.... Recipient's last name.... Taxpayer Spouse Recipient's SSN......... Amount paid............. 2016 amt: 2016 amt: 24 Series: 300 Adjustments to Income
Page 19 1040 US 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 2016 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 - 1/17 payment on 2016 state estimate............. State income taxes - paid with 2016 state return extension............. State income taxes - paid with 2016 state return....................... State income taxes - paid for prior years and/or to other state.......... City/local income taxes - 1/17 payment on 2016 city/local estimate...... City/local income taxes - paid with 2016 city/local extension............ City/local income taxes - paid with 2016 city/local return................ SALES AND USE TAXES PAID State and local sales taxes (except autos and special items)........... Use taxes paid on purchases.................................... Use taxes paid with 2016 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