MASCARO
Certified Practising
Accountants& CO
END OF FINANCIAL YEAR
30TH JUNE, 2015
ABN 95 047 575 326
www.mascaro.com.au
INCOME TAX RETURN CHECKLIST
Please complete details and circle applicable responses - either YES or NO.
Where the reply to any question is "YES" – PROVIDE APPROPRIATE DETAILS.
Tax File No: ________________________
ABN: _______________________
Name: _______________________________
Date of Birth: ________________
Current Address: ____________________________________________________________________________
Home Telephone No: ______________________
Mobile Phone No: _____________________________
Work Telephone No: ______________________
Email address: ________________________________
Please indicate your preference for an appointment, or, whether you prefer to have your completed return forwarded to
you by mail/email?
Appointment

Returned by Mail

Email

During the financial year ended 30th June 2015, did you change your Marital Status? : NO / YES
Date: ____________
INCOME:
IN 2015 WHAT WAS YOUR MAIN OCCUPATION?
_______________________________________________
FOR 2015, DID YOU RECEIVE ANY OF THE FOLLOWING?
1-3/
Salary and Wages (PAYG Summaries)
NO / YES How many PAYG Summaries do you have? ___________
4/
Eligible Termination Payments
NO / YES
______________________________________________
5/
Newstart, Sickness or other Allowances
NO / YES
______________________________________________
6/
Aust Govt pension & other allowances
NO / YES
________________________________ Veteran Code 
7/
Other Aust Super Pensions or Annuities
NO / YES
______________________________________________
8/
Australian Super Lump sum Payments
NO / YES
______________________________________________
9/
Attributed Personal Services Income
NO / YES_________________________________________________
10/
Interest:
NO / YES Please provide a Summary Statement of all your banks
for all accounts
Complete T2 or T3 and IT3
Bank
BSB
Account No.
TFN amt withheld
Interest Earned
ATO
Ref: Document1
Page 1 of 4
11/
Dividends:
NO / YES
[Provide all relevant statements]
12/
Employee share schemes:
______________________________________________
INT/DIV Supplementary Schedule]
NO / YES
______________________________________________
[Provide all relevant statements]
13/
Income from Partnerships and/or Trusts
NO / YES _______________________________________________
[Including Managed Funds][Provide annual tax statement]
[MANG.TRUSTS Supplementary Schedule]
14/
Personal Services Income (PSI)
NO / YES
______________________________________________
15/
Net Income/Loss from Business
NO / YES
______________________________________________
16/
Deferred non-commercial Business Losses
NO / YES
______________________________________________
18/
Net Capital Gains
NO / YES
______________________________________________
19/
Interests in Foreign Entities, Funds, Trusts
NO / YES
______________________________________________
20/
Foreign source income (incl foreign pensions)
& Foreign assets or property (IT4)
NO / YES
______________________________________________
21/
Rent Received
______________________________________________
22/
Bonuses from Life Assurance or Friendly
Society Policy
NO / YES
______________________________________________
23/
Forestry Managed Investment Scheme
NO / YES
______________________________________________
24/
OTHER INCOME: (including)
NO / YES
______________________________________________
Cents per Km method (up to max 5000kms)
NO / YES
______________________________________________
Log book Method
NO / YES
______________________________________________
[P9 Supplementary Schedule]
[CGT Supplementary Schedule]
NO / YES
[RENTAL Supplementary Schedule]
Lump Sum Pension Arrears
Sale/Disposal of Depreciable Assets
Proceeds from Income Protection Policy
ATO assessable interest
EMPLOYEE WORK RELATED DEDUCTIONS:
D1/
Motor Vehicle expenses
[M/V Supplementary Schedule]
[M/V Supplementary Schedule]
D2/
Other Work Related Travel Expenses
Domestic travel with reasonable allowance
NO / YES
______________________________________________
Overseas travel with reasonable allowance
- diary & all receipts required
NO / YES
______________________________________________
Claiming actual expenses
- travel for 6 or more nights in a row
- do you have a travel diary?
NO / YES
______________________________________________
[WRE Supplementary Schedule]
D3/
Uniform/Protective Clothing Expenses
Work Related Uniform/Protective Clothing
expenses
NO / YES
_____________________________________________
Laundry expenses
NO / YES
_____________________________________________
Dry Cleaning
NO / YES
_____________________________________________
Other claims - mending/polishing, etc.
NO / YES
_____________________________________________
Ref: Document1
Page 2 of 4
D4/
Self-education Expenses
NO / YES
_____________________________________________
[SELF -EDUCATION Schedule]
Please provide a summary of all receipts Incl. Course Fees, Books, Stationery, Travel.
D5/
Other Work Related Expenses
Home Office expenses
NO / YES
_______________________________________
Home/Mobile Phone [with Log Book/itemised]
NO / YES
_______________________________________
Computer & Software [with Log Book]
NO / YES
_______________________________________
Tools & Equipment
NO / YES
_______________________________________
Subscriptions & Union Fees
NO / YES
_______________________________________
Journals/Periodicals
NO / YES
_______________________________________
Expenses in relation to allowances
NO / YES
_______________________________________
Sun Protection Costs
NO / YES
_______________________________________
Other work deductions
NO / YES
_______________________________________
NO / YES
_______________________________________
(Incl Seminars not held at an educational institution)
OTHER DEDUCTIONS:
D7/
Interest deductions (incl. investment advice fee
paid to financial planner)
D8/
Dividend deductions (incl. margin loan interest)
NO / YES
_______________________________________
D9/
Donations/Gifts -$2 or more to eligible charities
NO / YES
_______________________________________
D10/
Tax Agents Fees for previous year [GIC]
NO / YES
_______________________________________
D11/
Undeducted Purchase Price of Foreign Annuity
NO / YES
_______________________________________
D12/
Personal super contributions (self-employed only)
NO / YES
_______________________________________
Fund name: ________________________________
Account number: _________________________
Fund ABN: ________________________________
Fund TFN:
_________________________
D14/
Forestry Managed Investment Scheme deduction
NO / YES
_______________________________________
D15/
Other Deductions
(Incl. income protection, post business cessation exp’s)
NO / YES
_______________________________________
HECS / HELP / SFSS (debts owed)
NO / YES
$ ______________________________________
Do you plan to claim Super Co-contribution?
NO / YES
Your after tax contribution:
OTHER INFORMATION:
A3/
$ ____________
(<$34,488 - $49,488)
M2/
Private Health Insurance Paid:
NO / YES
Provider Code:
________
- Provide Private Health Insurance Statement
Membership No: ____________________
If NO: Spouse DOB: ______________________
Policy Type: Hospital Ancillary
Both
Spouse Taxable Income: $_____________
Dependant Children's Full Names
Ref: Document1
Date of Birth
Page 3 of 4
Carried Forward Losses from prior years
L1/
NO / YES
Non-Primary:
$ _______________________
Capital:
$ _______________________
P.A.Y.G. Instalment Credits paid during 2015
NO / YES
$ ______________________________________
Did you Pay Child Support during 2015? (IT7)
NO / YES
$ ______________________Total for 2014/2015
Were you registered for Family Tax Benefits A &/or B or did your children receive Austudy during 2015?
TAX OFFSETS (REBATES):
SEPARATE NET INCOME OF DEPENDANT:
T1/
Spouse (without dependent child/student)
NO / YES
T2/
Seniors and pensioners Tax offset
NO / YES
T3/
Superannuation/Annuity Tax offset
NO / YES
T4/
Spouse Superannuation
NO / YES
T5/
Zone or Remote Area
NO / YES
T6/
Medical Expenses
(only if claimed in both 2013 and 2014)
NO / YES
$ _______________________
[TAX OFF-SET Schedule]
$ _______________________ [TAX OFF-SET Schedule]
NO / YES
To Claim a Medical Tax Offset your income must be less than $90,000 (family - $180,000) and your out-of-pocket expenses must be greater
than $2,218.00. If your income is higher than these thresholds, your out-of-pocket expense must be greater than $5,233.00. If you claimed
Medical Tax Offset in 2013 and 2014, these rules apply and there is no change to the types of medical expenses you can claim. If not, the
income test is the same but you can only claim a Medical Tax Offset for disability aids, attendant care and aged care costs. If you qualify,
please provide a summary of your OUT OF POCKET expenses after reimbursements from Medicare, and your Private Health Fund.
T7/
Dependent (Invalid and Carer)
NO / YES
$ _______________________ [TAX OFF-SET Schedule]
T11/
Other refundable Tax offset
NO / YES
$ __________________________
(primary producers & special disability trusts)
In order to facilitate the automatic credit of your net refund (where applicable) kindly complete the following authority.
I authorise the ATO to automatically credit my account, as follows:
BSB number:
Account name:
___________________
Account number: ___________________________________
_________________________________________________________________________
SIGNATURE OF TAXPAYER: .........................……………………........................................ DATE: ...................................................
Ref: Document1
Page 4 of 4