TODAY’S DATE
TAX YEAR
2015
INCOME TAX DATA ITEMIZER
NEW CLIENT
NEW ADDRESS
TAX PAYER’S NAME:
SPOUSE’S NAME:
TAX PAYER’S OCCUPATION:
SPOUSE’S OCCUPATION:
STREET ADDRESS:
COUNTY
HOME PHONE NUMBER:
SS #
SS #
BIRTH DATE:
BIRTH DATE:
CITY:
SCHOOL DISTRICT:
EMAIL ADDRESS:
DEPENDENTS:
1).
2).
3).
4).
STATE:
ZIP CODE:
Relationship:
SS#
SS#
SS#
SS#
BIRTH DATE:
BIRTH DATE:
BIRTH DATE:
BIRTH DATE:
FORMS & THINGS TO BRING
W-2: How Many?
K-1 How many?
Energy Tax Incentives
Are you a Volunteer Firefighter or Ambulance Worker?
1099R- Pension/ Annuity/ IRA/ 401k/ Distribution?
Total Online & Out of State Purchase
Social Security Forms- How many?
Monthly Rent Paid
College Savings Plans(Contribution/Distribution)
Alimony Paid or Received:
Last Year’s Tax Return (New Clients Please Provide)
Spouse SS#
Purchase New Home/Refinance Existing? (Include Closing Papers)
Early Withdrawal Penalty – How Much?
Health Savings Account (HSA)
Child Support Paid:
INTEREST & DIVIDEND INCOME
PAYER
INTEREST
INTEREST
INTEREST
$
PAYER
$
DIVIDENDS
DIVIDENDS
DIVIDENDS
OTHER INCOME
COLLEGE INFORMATION
Jury Duty
Who Attended Institution
Tuition Paid
Unemployment
Fed. Withholding Tax
State Withholding Tax
Other Income
2014 Tax Refund (State Only)
Gambling/Bingo/ Lottery Winnings
Student Loan Interest
Any Foreign Bank AccountsYES
NO
How Do You Want to Receive Your Refund? Pay Balance Due?
Check
Direct Deposit/Debit ROUTING #:
ACCOUNT #:
PAYMENTS TO RETIREMENT PLANS
ESTIMATED TAXES PAID
Carry Forward
ROTH:
IRA Traditional:
IRA Simple:
KEOGH:
Books/Supplies
APRIL 15
JUNE 15
2015
Fed.
State
2015
.
.
.
.
SEPT 15
JAN 15
2015
2016
.
.
.
.
SALE OF STOCK OF OTHER PROPERTY
DATE BOUGHT
DATE SOLD
DESCRIPTION
MEDICAL EXPENSES
COST PRICE
CONTRIBUTIONS
(DO NOT INCLUDE EXPENSES THAT WERE REIMBURSED OR PRE-TAX)
Self employed Health Insurance
Medical Insurance/Medicare
Please Bring to Tax Appt.
1095A
1095B
1095C
Long-term Care Insurance
Medical Equipment
Prescriptions (Include Co-Pay)
Eyeglasses/Contacts
Doctors (Include Co-Pay)
Dentist
Hospital and Ambulance
Smoking & Weight Loss Medical Expense
Nursing Home
Medical Auto Miles (
) @ .23 =
Other Medical Expenses
Church, Synagogue, Temple, Mosque
Charitable Mileage
(
)
x .14 =
Other Organizations
United Way
Heart & Lung Assoc.
Cancer & MS
Boy & Girl Scouts
Goodwill or VETS
Salvation Army
MISCELLANEOUS DEDUCTIONS
TAXES PAID
School
City
County
Property Tax Freeze Credit Rebate
NYS Income Taxes Paid With 2014 Return
Mortgage Tax
NYS Sales Tax- Large
SALE PRICE
Work Related -Internet Expenses
Work Related Cell Phone
Union Dues
Job Search Expenses
Work-related Tools
Professional Organization
Legal & Accounting
Professional Fees
Work Related Auto Miles (
) x .575 =
Work Related Parking & Tolls
Professional Journals & Books
Work Related Supplies
Work Related Education
Home Office-Work Related
Uniform Expenses
Upkeep of Uniforms
Safe Deposit Boxes
Moving Expenses
Investment Fees/IRA Custodial Fee
Gambling Losses
Casualty/Theft Losses
Amount of Employer Reimbursement
Property Taxes
_________________
INTEREST EXPENSES
# 1 Mortgage Interest 1098
# 2 Mortgage Interest 1098
# 3 Home Equity line Interest 1098
Personal Mortgage Insurance (PMI)
Private Mortgage Paid
Name & Address
SS#
Investment Interest
Mortgage Points
Boat/RV/Camper Interest
_________________
(________________)
CHILD CARE EXPENSES
CHILD’S NAME
NAME OF CARE GIVER
ADDRESS OF CARE GIVER
Do You Contribute To a Employer Provided Child Care Plan
Yes
No
SS# Or PROVIDER ID
AMOUNT PAID
TO CARE GIVER
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