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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: ________________________________

 

2. 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)

3. 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.

4. Employee Information

• Forms W-2

5. 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

6. 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.

7. Rental Property Income

• Records of income and expenses
• Rental asset information (cost, date placed in service, etc.) for depreciation

8. Retirement Income

• Pension/IRA/annuity income (1099-R)
• Social security/RRB income (1099-SSA, RRB-1099)

9. 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)

10. 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

11. 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)

12. 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

13. IRA Information

• Form 5498 showing IRA contributions
• Traditional IRA basis

14. 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 __________________________

_____________________________________________________

 

Answers Additional Space

Please write the number of the question and the additional information