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  1. Personal Information
  • Your social security number or tax ID number

Your Name: __________________________________   SSN: ____________________

D.O.B.: _____________________________

  • Your spouse’s full name and social security number or tax ID number

Dependent 1’s Full Name: __________________________________ SSN: ____________________

D.O.B.: _____________________________

Dependent 2’s Full Name: __________________________________ SSN: ____________________

D.O.B.: _____________________________

Dependent 3’s Full Name: __________________________________ SSN: ____________________

D.O.B.: _____________________________

Dependent 4’s Full Name: __________________________________ SSN: ____________________

D.O.B.: _____________________________

Dependent 5’s Full Name: __________________________________ SSN: ____________________

D.O.B.: _____________________________

  • Amount of any alimony paid and ex-spouse’s full name and social security number

______________________________________________   SSN: _____________________________

E-MAIL: _____________________________________ PH: ________________________________

 

  1. Information About Other People Who May Belong on Your Return Please use the additional blank space at the end of this questioner)
  • Childcare records (including the provider’s tax ID number) if applicable
  • Income of other adults in your home
  • Form 8332 showing that the child’s custodial parent is releasing their right to claim a child to you, the noncustodial parent (if applicable)
  1. Education Payments
  • Forms 1098-T from educational institutions
  • Receipts that itemize qualified educational expenses
  • Records of any scholarships or fellowships you receivedForm1098-E if you paid student loan interest.
  1. Employee Information
  • Forms W-2
  1. Self-Employment Information
  • Forms 1099-MISC, Schedules K-1, income records to verify amounts not reported on 1099s
  • Records of all expenses — check registers or credit card statements, and receipts
  • Business-use asset information (cost, date placed in service, etc.) for depreciation
  • Office in home information, if applicable
  1. Business Use of Vehicle Information
  • Log showing total miles driven for the year (or beginning/ending odometer readings), total business miles driven for the year (other than commuting), and the business purpose of the mileage

          Total Mileages: ____________________  Business: ___________________

  • Amount of parking and tolls paid
  • If you want to claim actual expenses, receipts or totals for gas, oil, car washes, licenses, personal property tax, lease or interest expense, etc.
  1. Rental Property Income
  • Records of income and expenses
  • Rental asset information (cost, date placed in service, etc.) for depreciation
  1. Retirement Income
  • Pension/IRA/annuity income (1099-R)
  • Social security/RRB income (1099-SSA, RRB-1099)
  1. Savings and Investments
  • Interest, dividend income (1099-INT, 1099-OID, 1099-DIV)
  • Income from sales of stock or other property (1099-B, 1099-S)
  • Dates of acquisition and records of your cost or other basis in property you sold (if basis is not reported on 1099-B)
  1. Other Income
  • Unemployment, state tax refund (1099-G)
  • Gambling income (W-2G or records showing income, as well as expense records)
  • Amount of any alimony received
  • Health Savings Account and long-term care reimbursements (1099-SA or 1099-LTC)
  • Jury duty records
  • Hobby income and expenses
  • Prizes and awards
  • Other 1099
  1. Affordable Care Act
  • Form 1095-A if you enrolled in an insured plan through the Marketplace (Exchange)
  • Marketplace exemption certificate if you applied for and received an exemption from the Marketplace (Exchange)
  1. Other Deductions and Credits
  • Receipts for classroom expenses (for educators in grades K-12)
  • Form 5498-SA showing HSA contributions
  • Record of moving expenses not reimbursed by employer
  • Forms 1098 or other mortgage interest statements
  • Amount of state/local income tax paid (other than wage withholding), or amount of state and local sales tax paid
  • Real estate and personal property tax records
  • Invoice showing amount of vehicle sales tax paid
  • Cash amounts donated to houses of worship, schools, other charitable organizations
  • Records of non-cash charitable donations
  • Amounts paid for healthcare insurance and to doctors, dentists, hospitals
  • Amounts of miles driven for charitable or medical purposes
  • Expenses related to your investments
  • Amount paid for preparation of last year’s tax return
  • Job-hunting expenses
  • Receipts for energy-saving home improvements
  • Record of estimated tax payments made
  • Foreign Taxes paid
  1. IRA Information
  • Form 5498 showing IRA contributions
  • Traditional IRA basis
  1. If you were affected by a federally declared disaster
  • City/county you lived/worked/had property in
  • Records to support property losses (appraisal, clean-up costs, etc.)
  • Records of rebuilding/repair costs
  • Insurance reimbursements/claims to be paid
  • FEMA assistance information
  • Check FEMA site to see if my county has been declared a federal disaster area

15.   Tax Estimate Payments

  • Estimated Tax Payments Made with ES Vouchers
  • Last Year’s Tax Return Overpayment Applied to This Year
  • Off Highway Fuel Taxes

General Information

  • Your tax returns at least for the previous three years.
  • Prior Year Adjusted Gross Income (AGI) & Personal Identification Number (PIN)-how to find last year’s adjusted gross income (AGI)
  • Routing Transmit Number (RTN) (For direct deposit/debit purposes):

___________________________________________________

  • Bank Account Number (BAN) _____________________
  • Routing Number __________________________

_____________________________________________________

 

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