Tax Preparation Checklist - Form 1040

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Tax Preparation Checklist - Form 1040 Note: This organizer will help us to better serve you as a client by providing the information we will need in order to prepare your return. I. Personal Information Soc Sec # DOB Occupation Your Name Spouse Home Address Home Phone City, State, Zip Work Phone County Filing Status Single School District Married, filing Joint Separate Widowed - Date of spouse's death: II. Dependents (include children and other dependents) Full-time Dependent's Name Relationship Date of Birth Soc Sec # Disabled? student? gross income III. Income Items Keep in mind that some or many of the following items may not pertain to your individual situation. Complete only the sections that are applicable. A. EMPLOYMENT INCOME (include W-2 statements) B. INTEREST INCOME (include 1099-INT statements) List all places of employment for yourself and your spouse: List all payers and amounts of interest: Employer Payer

C. DIVIDEND INCOME (include 1099-DIV statements) D. PARTNERSHIP INCOME (include K-1 schedules) List all payers and amounts of dividends and capital gains: This would apply if you received income from partnerships, estates, trusts, or S-Corps. Payer Ordinary Capital Gains Payer E. RENTAL INCOME Description of property Location (city, state, zip) Income received F. SALES OF INVESTMENTS (include 1099-B and statements for any investments sold during the year) Includes stocks, bonds, mutual funds, and commodities. Invesment Date Acquired/Sold Cost Sale Price G. SALES OF PROPERTY (include 1099-S statements for any property sold) Property Personal Residence Vacation Home Land Date Acquired/Sold Cost + improvements Sale Price H. WITHDRAWALS FROM PENSION, ANNUITIES, IRA (include 1099-R) If you received withdrawals from your pension, IRA, and/or annuity that you may have, please document the plan trustee or payee, and the reason for withdrawal. Payee/Plan trustee Reason for withdrawal Reinvested? (select) Yes No Yes No I. OTHER INCOME Indicate the amount of all income received from the following sources: Workers' Compensation Disability Tips (not reported to employer) Gambling (net of expenses) State income tax refund Veterans' pension Alimony Child Support Prizes & awards Jury duty Scholarships

III. Expense Items Similar to the income section, some or many of the following items may not apply. A. MEDICAL AND DENTAL EXPENSES B. CHARITABLE CONTRIBUTIONS (include receipts or copies of checks written) Enter the amounts paid for each of the following that were not List the amounts contributed to any charitable causes or paid for or reimbursed by your employer: institutions during the year. Medical prescriptions (including insulin) Insurance premiums Medical equipment and supplies Glasses/contacts Hearing aids Braces Therapy Hospital visit costs Dental costs Nursing care Mileage (enter # of miles driven) Schools Churches Foundations Non-cash (value of donated items) Mileage (enter # of miles driven) C. TAXES PAID (include copies of bills) D. INTEREST EXPENSE (include Form 1098) Enter the amount of property taxes paid: Enter the amount of mortgage interest paid: E. OTHER EXPENSES (complete only for the questions for which you answer yes) (1) Did you have any job-related moving expenses during the past year? Date of move Moving costs (includes lodging during the move) Travel to new residence (# of miles) (2) Did you have any employment-related expenses for which you were not reimbursed? Books, subscriptions, supplies Tools, equipment Union and professional dues Tuition Licenses Gifts (3) Do you have an office in your home? Square feet of home Rent expense Insurance Square feet of office Utilities Maintenance (4) Did you have any child care expenses or were any provided as a benefit by your employer during the year? Name of provider Address Soc Sec or Employer ID paid

(5) Did you incur any travel expenses related to your job that were not reimbursed in the exact amount by your employer? Enter the amount paid for lodging, meals, car rental, airfare, taxis, etc. while on the road Enter the amount already reimbursed or received from your employer, if applicable (6) Do you own a vehicle that was used partially for business, not including commuting to and from work? Date of purchase Year, make and model Total miles driven Business miles driven Do you have written records supporting the amounts claimed? (select one) Yes No Did you sell or trade-in a car used partially for business? (select one) Yes No (7) Did you pay any alimony or child support during the year? Alimony Child Support Paid to Soc Sec # (8) Did you pay any educational expenses (i.e. tuition, fees, student loan interest, etc.)? Type of Expense Student's Name Name of School (9) Did you contribute to an IRA? Type (Traditional or Roth) (check one) You Spouse (10) Did you make any estimated tax payments during the year? Date Paid Federal State (11) Did you pay any of the following fees during the year? Tax preparation Investment advisory Safe deposit box rental

IV. Summarized Checklist of what to include W-2 forms Social security numbers for everyone All 1099 forms and K-1 schedules Charitable donation receipts Year-end investment statements Child care expenses and provider information Last year's tax return Real estate closing papers Property tax statements Record of self-employed income & expenses Moving expenses (if you moved AND changed jobs) Record of mortgage payments for the year Real estate closing papers (if bought, sold or refinced) Evidence of payments for rent & alimony Activity in IRA account(s) This checklist filled out V. Taxpayer Representation To the best of my knowledge the information provided is accurate and complete with regard to all income, expenses and other information applicable to the preparation of this year's income tax returns. Taxpayer Date Spouse, if married filing jointly Date