KENNEY & MacDONALD, INC.
ACCOUNTING & TAXES
18 EAST CHESTNUT STREET
SHARON, MASSACHUSETTS 02067
TEL. NO. (781) 784-5756
FAX. NO. (781) 784-8276
www.kenney-macdonald.com
PAUL KENNEY EMAIL ADDRESS:
paul.kenney@kenney-macdonald.com
KEITH HERMAN EMAIL ADDRESS:
keith.herman@kenney-macdonald.com
CRAIG MACDONALD EMAIL ADDRESS:
craig.macdonald@kenney-macdonald.com
2015
TAX QUESTIONNAIRE
DIRECTIONS TO OFFICE
FROM BOSTON & POINTS NORTH: Route 128 To Route 95 South To Exit 10, Coney Street. At Top Of Ramp, Go Left And
Follow This Road For Approximately 3 Miles Into Sharon Center. At The Traffic Light, Take A Right. Proceed To The Next Light And
Take A Left On To East Chestnut Street. We Are The Second Building On Your Left.
FROM RHODE ISLAND AND POINTS SOUTH: Route 95 North To Exit 8, Sharon--Foxboro. At End Of Ramp Go Right Onto
S. Main Street And Follow For 3 Miles. At Set Of Lights At Fire Station, Take A Right On To East Chestnut Street. We Are The
Second Building On Your Left. 18 EAST CHESTNUT STREET.
Office Hours Are Extended During Tax Season From 9 A.M. To 8 P.M., Monday Thru Thursday, And, 9 A.M. To 4 P.M.,
Friday & Saturday. Sorry, No Sunday Appointments! Feel Free To Call For An Appointment During Those Times. If
You Have A Particular Date In Mind For Your Appointment, Call Now And It Will Be Reserved For You.
IN LIEU OF AN APPOINTMENT, YOU MAY WANT TO CONSIDER DROPPING OFF YOUR TAX MATERIAL.
YOU MAY FAX (781)-784-8276 OR EMAIL KMTAXINFO@KENNEY-MACDONALD.COM YOUR DOCUMENTS.
BE SURE TO CONFIRM OR UPDATE YOUR CONTACT INFO IF NEEDED.
1
KENNEY & MacDONALD, INC.
ACCOUNTING & TAXES
18 EAST CHESTNUT STREET
SHARON, MASSACHUSETTS 02067
TELEPHONE (781) 784-5756
FAX (781) 784-8276
HAPPY NEW YEAR!
We hope this letter finds all of you in good health and looking forward to the challenges 2016 will
present. Being a Leap Year, we’ll have an extra day to face these challenges; an extra day to procrastinate as
the tax filing deadline approaches; and, an extra day to listen to the political rhetoric that will surely enable our
decision making process come November. No matter your political inclinations, we suggest you follow the
lead of the three monkeys who “see no evil, hear no evil, speak no evil”. Folks seem pretty opinionated this
election year given the issues that lie ahead and the stances that the candidates have taken to address our
country’s concerns such as terrorism, immigration, gun control and health care, to name a few. The front
runners at this time appear to be Donald Trump and Hillary Clinton; but neither should take it for granted that
they will be their party’s standard bearer. There is a long road to hoe, for them and for us. The cast of
“Saturday Night Live” could not have asked for a bigger ratings booster given the cast of characters vying for
the Oval Office. Mr. Trump and his wall that will be built and paid for by Mexico, and Hillary Clinton and you
know who, “Oh No, Mr. Bill”, should provide ample fodder for all the pundits. Enough said. Farewell Mr.
Obama and be sure to count all your strokes!
On the local level, we had to endure all the calls from our “snow bird” friends digressing about it not
being a beach day while we were shoveling out from over 9 feet of snow! Many of us spent the spring and
summer entangled in insurance red tape trying to collect on claims to repair the damages caused from ice
dams and the like of last winter’s onslaught. The only bright spot last winter was the Patriots winning the
Super Bowl. Of course we had to listen to the endless blabber about TB12 and “deflategate” that is still on the
NFL’s back burner. Another hot topic was the State’s foray into the gambling world as a means to generate
millions into the State coffers. In light of what is transpiring at the local slots parlor in Plainville, we may have
another “Big Dig” on our hands. Projected revenues have been adjusted down by $100 million so someone,
you know who, is going to pay. On the bright side, gas is below $2 a gallon in many places and still falling.
Minimum wage being raised to $10 per hour is a welcomed boost to many in Massachusetts.
So on to the business at hand. Again, our congressional leaders waited until the last possible moment
to pass the “tax extenders” which basically makes your 2015 tax returns similar to 2014. A few tweaks here
and there but largely unchanged from the prior year. The following questionnaire will serve as a guide for you
to assist us in the preparation of your returns. Please review and provide the applicable information to our
office. It is of the utmost importance that we receive all source documents such as W-2's, 1099’s, etc. If you
are uncertain as to what we need, please call the office. Furthermore, to those of you with foreign income
and/or assets, held either as an owner, beneficiary or having indirect ownership, the penalties for failing to file
the requisite information returns are severe. The feds are actively searching for these offshore accounts for
non-compliance. The penalties may be both civil and criminal! Better to be ahead of the curve on this issue.
Unfortunately, at least from our perspective, the actual filing deadline for this year has been extended due to
the Emancipation Day holiday in Washington D.C. on Friday, April 15th. For Maine and Massachusetts’
residents, the deadline is April 19th, for all others, it is April 18th. This does not mean you can book
appointments for April 16th.
As always, we wish to extend our sincerest thanks for your continued patronage and numerous referrals
for our services. Remember always that we are here to help you. Please try to arrange for an appointment well
in advance of the deadlines. Waiting until a week prior to the due date will not guarantee that your return will
be completed in time. What it may mean is an extension! Best to all and we look forward to seeing you in the
coming weeks.
2
2015 TAX QUESTIONNAIRE
PERSONAL DATA:
YOUR NAME:
SPOUSE’S NAME:
STREET ADDRESS:
CITY OR TOWN:
YOUR OCCUPATION:
YOUR SSN:
YOUR AGE & D.O.B.
HOME TELEPHONE #
EMAIL ADDRESS:
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
____________________________STATE ____________________ZIP CODE _______________
____________________________SPOUSE’S OCCUPATION: ___________________________
____________________________SPOUSE’S SSN: _____________________________________
AGE____D.O.B.______________SPOUSE’S AGE & D.O.B.
AGE___D.O.B. ____________
____________________________WORK TELEPHONE #_______________________________
________________________________________________________________________________
DEPENDENT DATA:.
1. FULL NAME _____________________________
DATE OF BIRTH _________________________
SOC. SEC. NO. ___________________________
RELATIONSHIP __________________________
MONTHS LIVED WITH YOU IN ‘15 ________
3. FULL NAME _____________________________
DATE OF BIRTH _________________________
SOC. SEC. NO. ___________________________
RELATIONSHIP __________________________
MONTHS LIVED WITH YOU IN ‘15 _________
2. FULL NAME _____________________________________
DATE OF BIRTH _________________________________
SOC. SEC. NO. ___________________________________
RELATIONSHIP _________________________________
MONTHS LIVED WITH YOU IN ‘15 ________________
4. FULL NAME _____________________________________
DATE OF BIRTH _________________________________
SOC. SEC. NO. ___________________________________
RELATIONSHIP _________________________________
MONTHS LIVED WITH YOU IN ‘15 ________________
IMPORTANT NOTE: If you have children that are your dependents and have worked in 2015, it is important to inform
them that they cannot claim themselves if they are filing their own returns. If they file on their own and claim themselves it
results in problems with your returns and any applicable credits that you may be entitled to. Please check with us before
letting them file!
PLEASE REVIEW THE FOLLOWING QUESTIONS AND INDICATE YES/NO WHERE APPLICABLE:
GENERAL QUESTIONS
YES NO
Any Births, Adoptions, Marriages, Divorces Or Deaths In Your Immediate Family During 2015?
Can You Be Claimed As A Dependent On Another Person’s Tax Return?
Do You Or Your Spouse Qualify For The Blindness Exemption?
Did You Or Your Spouse Contribute To Any IRA Plans? Amounts $_____________Type Of IRA___________
Did You Or Your Spouse Contribute To A Keough/SEP Plan For The Current Year? Amounts $____________
Did You Rollover Any Existing IRA’s To A Roth IRA? Please Provide Details.
Did You Incur Expenses For College Tuition For Either Yourself Or Any Of Your Children? If So, See Page 5.
Do You Have Children Age 23 Or Under That Have Interest/Dividend Income In Excess Of $2,100?
Did You Incur Any Moving Expenses During The Year Associated With A Change Of Employment?
Did You Incur Any Costs For Dependent Care Expenses? Please Complete Daycare Schedule, Page 5.
Did You Make Estimated Tax Payments To IRS Or Your Home State For 2015? See Page 4.
For New Clients, Did You File Federal/State Tax Returns For The Prior Year? Please Provide Us With Copies.
Did You Receive Or Pay Any Alimony During 2015? Provide Details In Appropriate Sections.
Did You Incur Any Expenses In Connection With An Adoption? If So, Please Provide Details.
Did You Use Your Vehicle, Other Than Commuting, For Work Purposes? If So, See Auto Schedule, Page 6.
Are You Or Your Spouse Self-Employed? If So, Please Complete Business Schedule, Page 7.
Any Income From Farming Activities? If So, Please Complete Business Schedule, Page 7.
Did You Engage In Any Bartering Activities? If So, Please Provide Details.
Do You Own Any Rental Property? If So, Please Complete Rental Schedule, Page 6.
From Pensions Or Annuities? See Other Income Section, Page 4, And Provide Source Document(s).
Did You Receive Any Income From Unemployment Insurance? See Page 4 And Provide Source Document(s).
Income From S Corp., Partnerships, LLC’s, Estates Or Trusts? Source Document(s) Required. Also Refer To Page
Did You Or Your Spouse Receive Social Security Benefits? See Other Income Schedule, Page 4.
Did You Receive Any State Tax Refunds? Please Provide Source Document(s) And List On Page 4.
Any Lottery Or Gambling Winnings? Please List On Page 4, Other Income.
3
INCOME INFORMATION 2015
It is imperative that we have all source documents which accurately reflect the sources of income you have
received during 2015. This is not a guessing game so please be sure we receive the W-2’s, 1099’s or other
source documents. Failure to provide the records may result in future greetings from IRS! Specific types of
income are as follows:
SALARIES & WAGES: Please attach all W-2’s. Your return cannot be prepared based upon your last pay stub!
Most returns are filed electronically and key data appears on your W-2 that must match IRS files. You will need
to contact any former employers you had during the year if you have not received your W-2’s.
PENSION/RETIREMENT PLAN DISTRIBUTIONS: If you received a pension or retirement plan distribution
during 2015, we need Form 1099-R reflecting the transaction. Vital information appears on your 1099-R that
has a direct impact upon how the distribution is taxed and if the distribution is subject to penalty. Were you or
your spouse required to take a minimum distribution during 2015? Penalties are severe if you haven’t done
so…50% of the RMD!
INTEREST & DIVIDEND INCOME: 1099-INT’s and 1099-DIV’s are necessary to properly reflect your interest and
dividend income received during 2015. Dividend income is taxed at different rates and the 1099-DIV form
reflects this treatment. 1099-INT’s will also reflect interest from U.S. obligations which may not be taxed at the
state level. If you cashed savings bonds during the year, you need the 1099-INT form from the bank where you
cashed them. They may have given you a form at the time you cashed them and will not send you one in
January. Please check your records.
CAPITAL GAINS & LOSSES: We do not know what your basis is in any security sales that transpired in 2015.
We rely primarily on the reports from your brokerage accounts that reflect the necessary information such as
date sold, date purchased, cost of purchase and gross sales amounts. If you trade independent of any
brokerage account it is your responsibility to provide us with the required information. You may receive only a
1099-B that reflects the gross sale but we need the back-up info regarding when you purchased and for what
amount. The tax structure of these transactions has changed and for those of you in the higher tax brackets,
this may be a painful experience!
OTHER ITEMS OF INCOME: Other sources of income received during 2015 may be reported to you on the
following type of forms:
DESCRIPTION
FORM #
AMOUNT
State Tax Refunds
1099-G
$______________
Unemployment Income(yours)
1099-G
$______________
Unemployment Income(spouse)
1099-G
$______________
Social Security Income(yours)
1099-SSA
$______________
Social Security Income(spouse)
1099-SSA
$______________
Payments From Qualified Education Programs
1099-Q
$______________
Cancellation Of Debt
1099-A Or C
$______________
Health Or Medical Savings Account Withdrawals
1099-SA
$______________
Lottery/Gambling Winnings
W-2G
$______________
Partnership/LLC Income
1065 K-1
$______________
Sub S Income
1120S K-1
$______________
Trust Income
1041 K-1
$______________
Miscellaneous Income
1099-MISC
$______________
Alimony Income: Amounts Claimed Should Match Ex-Spouse’s Deduction $______________
Rental Income:
Please complete Rental Schedule on Page 6
Self-Employed Business Income:
Please Complete Business Schedule on Page 7
If You Have Other Items Of Income Not Listed Above, Please Bring It To Our Attention So We May Properly
Account For The Item On Your Return.
4
2015
DEDUCTIONS/CREDITS
MEDICAL & DENTAL EXPENSES:
Prescription Medicine & Drugs
Medical Insurance Premiums Paid
Long Term Care Premiums Paid
Long Term Care Expenses
Insurance Reimbursements
Medical Travel Miles
Medical Lodging
Doctors, Dentists, Etc.
Hospitals
Lab Fees
Eyeglasses/Contacts
Medical Parking/Tolls
All Other Medical
TUITION TAX CREDITS INFO:
$__________
$__________
$__________
$__________
$_________
______Miles
$__________
$__________
$__________
$__________
$__________
$__________
$__________
Student Name_______________________
College/Univ.________________________
Year In School 1____2____3____4____
Amounts Paid 2015 $______________
EDUCATOR’S EXPENSES:
Teaching Materials/Supplies $__________
ENERGY EFFICIENT EXPENDITURES:
Solar, Wind, Fuel Cells & Geothermal Heat
Qualified Energy Star Home Improvements
Amount Paid in 2015 $__________________
STUDENT LOAN INTEREST PAID:
Interest Paid In 2015
$__________
TAXES PAID:
State & Local Income Taxes
Real Estate Taxes-Primary Home
Real Estate Taxes-Secondary Home
Personal Property Taxes
Auto/Excise Taxes
All Other Taxes
$__________
$__________
$__________
$__________
$__________
$__________
INTEREST PAID: FORMS 1098-MTG MUST BE ATTACHED!
Mortgage Interest Paid
Mortgage Interest Paid Equity
Mortgage Insurance Premiums
Mortgage Points Paid
Investment Interest Expense
$__________
$__________
$__________
$__________
$__________
CHARITABLE CONTRIBUTIONS: SUBSTANTIATION REQUIRED
Receipted Donations By Cash/Check
Donated Items-Less Than $500
Donated Items-More Than $500
Charity Mileage
$__________
$__________
$__________
_______Miles
MISCELLANEOUS DEDUCTIONS:
Union/Professional Dues
Tax Return Preparation Fees
Safe Deposit Box Rental Fees
Uniforms, Shoes, Etc.
Job Related Tools/Equipment
Job Related Travel-Not Reimbursed
Job Related Expenses-Not Reimbursed
Investment Expenses
Casualty/Theft Losses
$__________
$__________
$__________
$__________
$__________
$__________
$__________
$__________
$__________
DEPENDENT CARE EXPENSES: CHILDREN UNDER AGE 13!
Number Of Children Cared For In 2015
________
Amounts Paid In 2015
$__________
Daycare Provider’s Name
________________________
Provider’s Address
_______________________________
Provider’s SSN# Or Fed. ID# ________________________
Did You Receive Dependent Care Benefits? YES___NO___
5
ALIMONY PAID:
Name Of Recipient
__________________
SSN Of Recipient
_______-____-______
Amount Paid In 2015
$___________
LOTTERY/GAMBLING LOSSES:
Winnings
$___________
Losses
$___________
NO WINNINGS…NO LOSSES!
MASS. RESIDENTS-OTHER DEDUCTIONS:
RENT PAID 2015
$___________
HEALTH INSURANCE POLICY # __________
HEALTH INSURANCE CO. NAME__________
TITLE V EXP. & CERTIFICATE YES___NO___
LEAD PAINT REMOVAL EXP. $___________
ESTIMATED TAX PAYMENTS FOR 2015:
FEDERAL IRS PAYMENTS
DUE DATE
AMOUNT
DATE PAID
4/15/2015
$________
____________
6/16/2015
$________
____________
9/15/2015
$________
____________
1/15/2016
$________
____________
STATE ESTIMATED PAYMENTS
DUE DATE
AMOUNT
DATE PAID
4/15/2015
$_________
____________
6/16/2015
$_________
____________
9/15/2015
$_________
____________
1/15/2016
$_________
____________
PLEASE CHECK RECORDS FOR ACCURACY
ELECTRONIC FUNDS TRANSFERS:
REFUNDS DIRECT DEPOSIT? YES___NO___
BALANCE DUE RETURNS?
YES___NO___
A VOIDED CHECK IS NEEDED TO SET UP
THE AUTHORIZATION FOR REFUNDS OR
BALANCE DUE TRANSACTION
2015 RENTAL PROPERTY SCHEDULES
GENERAL INFORMATION:
OWNERS’ NAMES
PROPERTY ADDRESS
ANY PERSONAL USE?
IF YES, WHAT %
DATE PURCHASED
PURCHASE PRICE
PROPERTY A
PROPERTY B
PROPERTY C
____________
____________
YES___NO__
___________%
____________
$___________
____________
____________
YES___NO__
___________%
____________
$___________
____________
____________
YES___NO__
___________%
____________
$___________
IF YOU PURCHASED A PROPERTY DURING 2015, WE NEED A COPY OF THE HUD SETTLEMENT SHEET. IF
YOU ARE A NEW CLIENT AND THE PROPERTY WAS PURCHASED PRIOR TO 2015, WE NEED COPIES
OF YOUR PRIOR YEARS TAX RETURNS THAT CONTAIN DEPRECIATION SCHEDULES.
RENTAL INCOME:
GROSS RENTAL INCOME
$___________
$___________
$____________
RENTAL EXPENSES:
ADVERTISING
AUTO/TRAVEL EXPENSES
CLEANING & MAINTENANCE
COMMISSIONS
INSURANCE
ACCOUNTING/LEGAL FEES
MANAGEMENT FEES
MORTGAGE INTEREST PAID
OTHER INTEREST
REPAIRS
SUPPLIES
TAXES-REAL ESTATE
TAXES-PERSONAL PROPERTY
UTILITIES
TELEPHONE
OFFICE EXPENSES
WATER & SEWER
GARDENING/LANDSCAPING
CONDO FEES
FUEL OIL/GAS HEAT
OTHER EXPENSES
$___________
$___________
$___________
$___________
$___________
$___________
$___________
$___________
$___________
$___________
$___________
$___________
$___________
$___________
$___________
$___________
$___________
$___________
$___________
$___________
$___________
$___________
$___________
$___________
$___________
$___________
$___________
$___________
$___________
$___________
$___________
$___________
$___________
$___________
$___________
$___________
$___________
$___________
$___________
$___________
$___________
$___________
$____________
$____________
$____________
$____________
$____________
$____________
$____________
$____________
$____________
$____________
$____________
$____________
$____________
$____________
$____________
$____________
$____________
$____________
$____________
$____________
$____________
CAPITAL IMPROVEMENTS MADE IN 2015:
COST OF IMPROVEMENT
$___________
DATE OF IMPROVEMENT
____________
NATURE OF IMPROVEMENT
____________
COST OF IMPROVEMENT
$___________
DATE OF IMPROVEMENT
____________
NATURE OF IMPROVEMENT
____________
COST OF IMPROVEMENT
$___________
DATE OF IMPROVEMENT
____________
NATURE OF IMPROVEMENT
____________
$___________
____________
____________
$___________
____________
____________
$___________
____________
____________
$____________
_____________
_____________
$____________
_____________
_____________
$____________
_____________
_____________
If You Have Other Information Pertinent To Any Rental Property, Please Bring The Information With
You For Your Scheduled Appointment. Also, Please Indicate How Much Of Your Time Is Spent In The
Management/Upkeep Of Your Rental Properties.
6
2015 BUSINESS OWNER’S SCHEDULE
GENERAL INFORMATION:
NAME OF BUSINESS OWNER(S)
__________________________________________________
BUSINESS NAME
__________________________________________________
BUSINESS ACTIVITY
__________________________________________________
BUSINESS STREET ADDRESS
__________________________________________________
BUSINESS CITY, STATE & ZIP CODE
__________________________________________________
FEDERAL I.D. # IF APPLICABLE
__________________________________________________
TYPE OF ENTITY: ____SOLE PROPRIETOR; ____LLC/PARTNERSHIP; ____TRUST; ____CORPORATION
INCOME & INVENTORY INFORMATION:
GROSS INCOME SALES/SERVICES
BONUSES/COMMISSIONS
OTHER INCOME
TOTAL GROSS INCOME
AMOUNT
$__________________
$__________________
$__________________
$__________________
BEGINNING INVENTORY @ 1/1/2015
MERCHANDISE/GOODS PURCHASED FOR RESALE IN 2015
RETURNS & ALLOWANCES
COST OF ITEMS WITHDRAWN FOR PERSONAL USE
ENDING INVENTORY @ 12/31/2015
$__________________
$__________________
$(_________________)
$(_________________)
$__________________
BUSINESS EXPENSE INFORMATION:
ACCOUNTING, LEGAL & OTHER PROFESSIONAL FEES
ADVERTISING, PROMOTIONS
AUTO EXPENSE-PLEASE COMPLETE SCHEDULE ON PAGE 8
BANK CHARGES & RELATED FEES
COMMISSIONS/SUBCONTRACTORS
DUES & PUBLICATIONS
ENTERTAINMENT- MEALS & RELATED CHARGES
HOME OFFICE EXPENSE-SEE SCHEDULE ON PAGE 8
INSURANCE-WORKER’S COMP/LIABILITY
INSURANCE-HEALTH INSURANCE PAID FOR OWNER
INSURANCE-HEALTH INSURANCE PAID FOR EMPLOYEES
INTEREST PAID ON BUSINESS DEBT
OFFICE EXPENSES
RENT/LEASE EXPENSES
REPAIRS & MAINTENANCE
SUPPLIES
TAXES-EMPLOYMENT
TAXES-ALL OTHER
TRAVEL EXPENSES-AIRFARE & ACCOMMODATIONS
TELEPHONE, FAX & RELATED CHARGES
UTILITIES-GAS, ELECTRIC, OIL, ETC.
WAGES/SALARIES
OTHER EXPENSES – PLEASE CLARIFY
$__________________
$__________________
$__________________
$__________________
$__________________
$__________________
$__________________
$__________________
$__________________
$__________________
$__________________
$__________________
$__________________
$__________________
$__________________
$__________________
$__________________
$__________________
$__________________
$__________________
$__________________
$__________________
$__________________
CAPITAL EXPENDITURES FOR 2015:
DID YOU PURCHASE BUSINESS EQUIPMENT, PROPERTY OR VEHICLES DURING 2015? IF SO, PLEASE
PROVIDE THE FOLLOWING INFORMATION FOR ALL SUCH ACQUISITIONS:
DESCRIPTION OF PURCHASE
___________________
COST OF EQUIPMENT/PROPERTY ACQUIRED
$__________________
DATE PURCHASED
___________________
IMPORTANT NOTE: We Need Copies Of Any And All 1099’s That Your Business May Have Received Or That You May
Have Issued. If You Have Employees, We Need The Year End Reports With The W-2’s And The W-3. Additionally, If You
Received A Form 1099-K, Third Party Transactions, We Will Need That As Well.
7
2015 AUTO/VEHICLE SCHEDULE
PLEASE COMPLETE THIS SCHEDULE IF YOU USED YOUR VEHICLES FOR BUSINESS PURPOSES DURING 2015. THE
DEDUCTION MAY BE BASED UPON AN ACTUAL METHOD OR A STANDARD MILEAGE RATE, WHICHEVER IS MOST
ADVANTAGEOUS. THE IRS MILEAGE FACTOR WAS 57.5 CENTS/MILE FOR THE WHOLE YEAR. YOUR TRAVEL LOGS
ARE ESSENTIAL!! IF YOU DON’T HAVE ONE, YOU SHOULD PREPARE ONE NOW AND KEEP IN YOUR RECORDS.
GENERAL INFORMATION:
VEHICLE #1
VEHICLE #2
VEHICLE MAKE & MODEL
DATE PURCHASED/LEASED
PURCHASE PRICE-GROSS
LESS: TRADE-IN
TOTAL MILEAGE 2015
BUSINESS MILEAGE 2015
ODOMETER READING @ 1/1/2015
ODOMETER READING @ 12/31/15
VEHICLE WEIGHT
_____________
_____________
_____________
(____________)
_____________
_____________
_____________
_____________
_____________
_____________
_____________
_____________
(____________)
_____________
_____________
_____________
_____________
_____________
_____________
_____________
_____________
_____________
_____________
_____________
_____________
_____________
_____________
_____________
_____________
_____________
_____________
_____________
_____________
_____________
_____________
_____________
_____________
_____________
EXPENSE INFORMATION:
GASOLINE & OIL
REPAIRS & MAINTENANCE
INSURANCE
TIRES
WASH & WAX
INTEREST EXPENSE
LEASE PAYMENTS
LICENSES & FEES
EXCISE/AUTO TAXES
OTHER EXPENSES
PLEASE PROVIDE US WITH ANY LOAN DOCUMENTATION REGARDING YOUR VEHICLES.
WERE YOU REIMBURSED FOR MILEAGE ?
YES__________
NO__________
IF SO, WERE REIMBURSEMENTS INCLUDED ON YOUR W-2? IF NOT ON W-2, AT WHAT RATE WERE YOU REIMBURSED?
YOU SHOULD HAVE A COPY OF THE COMPANY POLICY REGARD THEIR REIMBURSEMENTS.
2015 HOME OFFICE SCHEDULE
IF YOU OPERATE A BUSINESS FROM YOUR HOME, OR IF YOUR EMPLOYER ALLOWS YOU TO WORK FROM HOME, YOU
MAY BE ELIGIBLE TO DEDUCT A PORTION OF YOUR HOME FOR TAX PURPOSES, SUBJECT TO RESTRICTIONS. IF
APPLICABLE, PLEASE PROVIDE THE FOLLOWING INFORMATION. ALL EXPENSE INFORMATION IS THE TOTAL PAID
FOR THE YEAR.
GENERAL INFORMATION:
TOTAL NUMBER OF ROOMS IN HOME
NUMBER OF ROOMS USED FOR BUSINESS
OR: TOTAL SQUARE FOOTAGE OF HOME
SQUARE FOOTAGE OF BUSINESS AREA
EXPENSE INFORMATION:
HEAT OR FUEL OIL
ELECTRICITY
CONDO FEES/ASSESSMENTS
INSURANCE
RENT EXPENSE
REPAIRS & MAINTENANCE
WATER/SEWER; OTHER EXPENSES
______________
______________
______________
______________
______________
______________
______________
______________
______________
______________
______________
8