TAX ORGANIZER-2013
Email address:_________________________________
Phone #:_________________________________
Address:_________________________________
_________________________________
_________________________________________________________________________________________
Last Name
First Name
Initial
_________________________________________________________________________________________
Social Security #
D.O.B.
Occupation
_________________________________________________________________________________________
Spouse Last Name
First Name
Initial
_________________________________________________________________________________________
Social Security #
D.O.B.
Occupation
Did your name or address change last year?___________
Did your marital status change last year?_____________
Financial Institution for electronic deposit - refund: _______________________________________________
Is this a checking account
or savings account ________?
Account number:
Routing number: _______________________________
2. DEPENDENTS – You are claiming:
____________________________
Name (Last, First, MI)
_________________
SS#
_______________
D.O.B.
_________________
Childcare/Tuition Exp.
____________________________
Name (Last, First, MI)
_________________
SS#
_______________
D.O.B.
_________________
Childcare/Tuition Exp.
____________________________
Name (Last, First, MI)
_________________
SS#
_______________
D.O.B.
_________________
Childcare/TuitionExp.
3. ESTIMATED TAX PAYMENTS/REFUND-OTHER TAXES PAID
Did you receive a state refund last year? ___________How much was it?______________________________
Quarterly Estimated Tax Payments (Self Employed) - Please provide check copies.
Federal_______________
04/15/13
__________________
06/15/13
_________________
09/15/13
____________________
01/15/14
State_________________
04/15/13
__________________
06/15/13
_________________
09/15/13
____________________
01/15/14
Other Taxes:
_____________________________
Real Estate Tax-Primary Residence
_____________________
Other Personal R.E. Tax
_____________________________
Registration Owner Tax-Vehicles
4. OWN A FOREIGN COUNTRY BANK ACCOUNT? ________ (yes) _______ (no)
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5. INCOME SOURCES: PLEASE PROVIDE
W-2 INCOME-PLEASE PROVIDE ALL W-2 AND 1099 MISC. STATEMENTS
INTEREST INCOME-PLEASE PROVIDE ALL 1099-INT STATEMENTS
DIVIDEND INCOME-PLEASE PROVIDE ALL 1099-DIV STATEMENTS
CAPITAL GAIN INCOME-PLEASE PROVIDE ALL 1099-B AND 1099-S STATEMENTS
DEBT FORGIVENESS-PLEASE PROVIDE ALL 1099-A AND 1099-C STATEMENTS
BUSINESS INCOME-PLEASE PROVIDE ALL K-1 STATEMENTS
SSI-INCLUDE SOCIAL SECURITY STATEMENTS.
6. MEDICAL EXPENSES: Do not include any amounts reimbursed through FSA/HSA.
Premiums Paid Directly by You_________________________
Dental _____________________________
Co-Pays ______________________________________
Vision _____________________________
Long Term Care Premium (You)___________________
Labs, X-Rays ________________________
Long Term Care Premium (Spouse)_________________
Prescriptions _________________________
Medical Mileage ________________________________
Amount contributed by you to your HSA:
Family $ __________________ Single $ _______________
Amount contributed by your employer to your HSA:
$ __________________
a) Do you currently have health insurance? Y/N ____ Coverage was in place for how many months? ________
b) Is it employer sponsored?______
c) Individual coverage? ______ Family coverage? ______
d) Are you receiving a tax credit/subsidy for your health insurance? ______
7. INTEREST PAID BY YOU: (Provide 1098)
Did you refinance? ______ What did you use the money for? ________________________________________
__________________________________
Mortgage Int. on Primary Residence
_____________________________________
Interest on Other Non-Business Properties
__________________________________
2nd Mortgage/Heloc
_____________________________________
Points Paid to Refinance
8. CHARITABLE CONTRIBUTIONS
ALL CASH AND NON-CASH DONATIONS OF ANY SIZE MUST HAVE A SIGNED, DATED RECEIPT OR
CANCELLED CHECK. Attach a separate piece of paper for non-cash donations including dates of donation, who
items were donated to, the value at the time of donation, and how you determined value. For all cash donations over
$250, please provide the receipt letter from charity.
NON-CASH CONTRIBUTIONS:
1)____________________
Organization
_________
Amount
3)__________________
Organization
_______
Amount
2)___________________
Organization
_________
Amount
4)__________________
Organization
_______
Amount
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CASH CONTRIBUTIONS:
1)___________________
Organization
________
Amount
4)____________________
Organization
_______
Amount
2)___________________
Organization
________
Amount
5)____________________
Organization
_______
Amount
3)___________________
Organization
_______ _
Amount
6)____________________
Organization
_______
Amount
Total Volunteering Mileage______________
9. MISCELLANEOUS DEDUCTIONS & EMPLOYEE EXPENSES
________________
Tax Preparer Fees
__________________
Safe Deposit Fee
________________
Certain Legal Fees
____________________
Student Loan Interest
________________
Union Dues
__________________
Professional Dues/Fees
________________
Subscriptions
_____________________
Tools/Shoes
________________
Uniforms/Upkeep
__________________
Continuing Education
________________
Job Hunting Expenses
_____________________
Other
10. CHILD/DEPENDENT CARE EXPENSE
___________________
Provider Name
_________________
SS#/TIN
___________________________________
Address
___________
Amount
___________________
Provider Name
_________________
SS#/TIN
__________________________________
Address
___________
Amount
11. COLLEGE EXPENSES: (Provide 1098-T)
College expenses paid to a college/university: you, spouse, and dependents.
_________________________
Student’s Name
_________________________________
Name/State of Institution
_______________
Yr. In School
__________________________
Qualified Tuition/Fees
__________________________________
Room/Board
_______________
Supplies
__________________________
Student’s Name
__________________________________
Name/State of Institution
_______________
Yr. In School
__________________________
Qualified Tuition/Fees
__________________________________
Room/Board
_______________
Supplies
12. Total Contributions to the Colorado Scholars Choice 529 Plan: $________________
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13. IRA CONTRIBUTIONS
YOU
SPOUSE
Do you wish to make an
additional contribution for 2013?
Roth
_______________
__________________
____________________
Traditional
_______________
__________________
____________________
SEP
_______________
__________________
____________________
14. Do you or your spouse wish to designate $3 to the Presidential Campaign Fund?
You ______
Spouse ______
15. Qualified Educator Expenses: ________________
16. Early Withdrawal Penalties: ________________
17. ENERGY CREDITS: Qualifying windows, doors, roofing materials, and insulation. Solar, wind, or
geothermal
systems.
Property: _______________________________________________________________ (provide receipt(s)).
Amount of credit previously taken? __________________________________________
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17. SELF EMPLOYED INDIVIDUALS ONLY
_________________________________
1099 Misc. Self Employed Income
__________________________________________
Self Employed Income not reported on 1099
Vehicle Information:
___________
_________________
Yr/Make/Model Date Placed in Service
____________ ____________________ _____________
Total Miles/Yr. Total Business Miles/Yr. Commuting
Miles/Yr.
Do you have a written mileage record? __________ Was vehicle available for personal use?___________
Is another vehicle available for personal use? _________
Parking Fees/Tolls___________________ Property Tax on vehicle _____________________________
____________________
Legal/Professional Fees
_______________
Subscriptions
_______________
Gifts
_____________________
* Meals/Entertainment
____________________
Office Supplies
_______________
Commissions Pd.
_____________
Equip. Purchase
_____________________
Equip. Purchase Date(s)
_____________________
Prior Yrs. Depreciation
__________
Dues
_____________
Internet Service
_______________
Cell Phone/Pgr.
___________
______________
Liab. Ins.
Pd Wages/Contractors
___________
Advertising
_____________
Continuing Ed
_______________
Office Rent
___________
Utilities
___________
Airfare
_____________
Food-Travel
_______________
Hotel-Travel
____________________________
Transportation-Travel
___________
Tools
______________
Postage/Shipping
__________________
Repairs/Maintenance
____________________________
Supplies/Other
_____________________
Self Employed Health Ins.
_____________________
Bank Charges
______________
Phone
____________________________
Cost Of Goods Sold/Inventory
Office in the Home Expenses: Employees & Self Employed
__________________
Square Footage/Home
__________________
Square Footage/Office
______________
Cost of Home
_____________________
Cost of Land
__________________
Improvements
__________________
Utilities/year
______________
Repairs
_____________________
Mortgage Interest/Rent
_____________________________
Home Maintenance Expense
_____________________
Real Estate Taxes
_______________________
Home Owners Insurance
Would you like to use the optional method for home office deduction of $5/square foot of office space?
Yes _______ No _______ Whichever is best _______.
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Supplemental Income and Loss
18. Rental Real Estate & Royalties
Location Address:
A)_______________________________________
_________________________________________
B)________________________________________
__________________________________________
C)________________________________________
__________________________________________
Rent Income:
Rents received
Property A
____________
Property B
____________
Property C
____________
Expenses:
Advertising
____________
____________
____________
Auto/Travel
____________
____________
____________
Cleaning/Maintenance
____________
____________
____________
Commissions
____________
____________
____________
Insurance
____________
____________
____________
Legal/Professional Fees
____________
____________
____________
Management Fees
____________
____________
____________
Mortgage Interest paid
____________
____________
____________
Other Interest
____________
____________
____________
Repairs
____________
____________
____________
Supplies
____________
____________
____________
Taxes
____________
____________
____________
Utilities
____________
____________
____________
Other (list)
_______________
____________
____________
____________
_______________
____________
____________
____________
_______________
____________
____________
____________
*Purchase Date:
____________
____________
____________
*Total Cost on date
placed in service
____________
____________
____________
*Provide if new property/or new to us.
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