Tax Organizer

INDIVIDUAL TAX ORGANIZER LETTER

FORM 1040

The following tax organizer is primarily the work of the AICPA Tax Section of which I am an associate member. This income tax data organizer is provided to assist you in gathering information necessary to prepare your individual income tax returns.

The Internal Revenue Service matches information returns/forms with amounts reported on tax returns. A negligence penalty may be assessed when income is underreported or when deductions are overstated. Accordingly, all information returns reflecting amounts reported to the Internal Revenue Service are also mailed or delivered to the taxpayers in an envelope clearly marked “IMPORTANT TAX DOCUMENTS ENCLOSED” and should be submitted with this organizer. Forms such as:

W-2 (Wages)	Schedules K-1
1099-R (Retirement) 1099-INT(Interest)	(Forms 1065, 1120S, 1041)
1099-DIV (Dividends)	Annual Brokerage Statements
1099-B (Brokerage Sales)	1098 – Mortgage Interest
1099-MISC (Rents, etc)	Other tax information stmts
1099 (any other)	8886, Reportable transactions
1098-T (Education)	Form HUD-1 for Real Estate Sales/Purchases

To continue to be able to provide quality services on a timely basis, you are urged to collect your information as soon as possible. If information from “passthrough” entities such as partnerships, trusts and S corporations is the only data you are missing, please send the data you have assembled and forward the missing information as soon as it is available.

The filing deadline for your income tax return is April 15^th. If an extension of time is required, any tax due must be paid with that extension. Any taxes not paid by the filing deadline may be subject to late payment penalties and interest.

I look forward to providing services to you. Should you have questions regarding any items, please do not hesitate to contact me.

INDIVIDUAL TAX ORGANIZER (1040)

If we did not prepare your prior year returns, provide a copy of federal and state returns for the three previous years. Complete pages 1 through 4 and all applicable sections.

Taxpayer’s Name	SSN	Occupation

Spouse’s Name	SSN	Occupation
Home Address____________________________________________________________________________________

___________________________________	_____________________		______		____________		____________________
City, Town, or Post Office		County		State		Zip Code		School District

Telephone Number	Telephone Number (Taxpayer)	Telephone Number (Spouse)
Home	Office	Office
Email(T)	Fax	Fax
Email(S) ____________________	Cell	Cell
	Email________________________ ___________________________	Email_______________________

Taxpayer: Date of Birth	Blind? - Yes ____ No ____
Spouse: Date of Birth	Blind? - Yes ____ No ____

Dependent Children Who Lived With You:

Full Name	Social Security Number	Relationship	Birth Date
1.) _______________________________
2.) _______________________________
3.) _______________________________
4.) _______________________________
5.) _______________________________
6.) _______________________________
7.) _______________________________

Other Dependents:

Full Name	Social Security Number	Relationship	Birth Date	Number Months Resided in Your Home	% Support Furnished By You
8.) ______________________
9.) ______________________
10.) _____________________

Please answer the following questions and submit details for any question answered “Yes”:

				YES	NO
1.	Did any births, adoptions, marriages, divorces, or deaths occur in your family last year? If yes, provide details.			______	______
2.	Will the address on your current returns be different from that shown on your prior year returns? If yes, provide the new address and date moved.			______	______
3.	Were there any changes in dependents from the prior year? If yes, provide details.			______	______
4.	Are you entitled to a dependency exemption due to a divorce decree?			______	______
5.	Did any of your dependents have income of $1,000 or more? ($400 if self-employed)			______	______
6.	Did any of your children under age 19, age 24 if they are a full time student, have investment income over $2,000?			______	______
	If yes, do you want to include your child’s income on your return?			______	______
7.	Are any dependent children married and filing a joint return with their spouse?			______	______
8.	Did any dependent child 19-23 years of age attend school full-time for less than 5 months during the year?			______	______
9.	Did you receive income from any legal proceedings, cancellation of student loans or other indebtedness during the year? If yes, provide details.			______	______
10.	Did you make any gifts during the year directly or in trust exceeding $14,000 per person?			______	______
11.	Did you have any interest in, or signature, or other authority over a bank, securities, or other financial account in a foreign country?			______	______
12.	Were you the grantor, transferor or beneficiary of a foreign trust?			______	______
13.	Were you a resident of, or did you have income from, more than one state during the year?			______	______
14.	Do you wish to have $3 (or $6 on joint return) of your taxes applied to the Presidential Campaign Fund?			______	______
15.	Do you wish to contribute to any state fund(s)? If yes, indicate amount(s) and which fund(s): ______________________________________________________________________ ______________________________________________________________________			______	______
16.	Do you want any overpayment of taxes applied to next year’s estimated taxes?			______	______
17.	Do you want any federal or state refund deposited directly into your bank account? If yes, enclose a voided check.			______	______
	.1)	Do you want any balance due directly withdrawn from this same bank account on the due date?		______	______
	.2)	Do you want next year’s estimated taxes withdrawn from this same bank account on the due dates?		______	______
18.	Do either you or your spouse have any outstanding child or spousal support payments or federal debt?			______	______
19.	If you owe federal or state tax upon completion of your return, are you able to pay the balance due?			______	______
20.	Do you expect a large fluctuation in your income, deductions or withholding next year? If yes, provide details.			______		______
21.	Did you receive any distribution from an IRA or other qualified plan that was partially or totally rolled over into another IRA or qualified plan within 60 days of the distribution? (Form 1099R)		______			______
22.	If you received an IRA distribution, which you did not roll over, provide details. (Form 1099R)		______			______
23.	Did you “convert” IRA funds into a Roth IRA? If yes, provide details. (Form 1099R)		______			______
24.	Did you receive any disability payments this year?		______			______
25.	Did you receive tip income not reported to your employer?		______			______
26.	Did you sell or purchase a principal residence or other real estate? If yes, provide settlement sheet (HUD-1) and Form 1099-S.		______			______
27.	Did you collect on any installment contract during the year? Provide details.		______			______
28.	Did you receive tax-exempt interest or dividends not reported on Forms 1099-INT or 1099 -DIV?		______			______
29.	During this year, do you have any securities that became worthless or loans that became uncollectible?		______			______
30.	Did you receive unemployment compensation? If yes, provide Form 1099-G.		______			______
31.	Did you receive, or pay, any Alimony during the year? If yes, provide details.		______			______
32.	Did you have any casualty or theft losses during the year? If yes, provide details.		______			______
33.	Did you have foreign income, pay any foreign taxes, or file any foreign information reporting or tax return forms? Provide details.		______			______
34.	If there were dues paid to an association, was any portion not deductible due to political lobbying by the association or benefits received?		______			______
35.	Did you, or do you plan to contribute before April 15, 2014, to a traditional IRA, or Roth IRA for last calendar year? If yes, provide details.		______			______
36.	Did you, or do you plan to contribute before April 15, 2014 to a health savings account (HSA) for last calendar year? If yes, provide details.
37.	Did you receive any distributions from a health savings account (HSA)? If so, provide details.
38.	Has the IRS, or any state or local taxing agency, notified you of changes to a prior year’s tax return? If yes, provide copies of all notices or correspondence received.
39.	Are you aware of any changes to your income, deductions and credits reported on any prior years’ returns?		______			______
40.	Did you purchase gasoline, oil, or special fuels for non-highway use vehicles?		______			______
41.	Did you purchase an energy-efficient or other new vehicle? If yes, provide purchase invoice.		______			______
42.	If you, or your spouse, have self-employment income, did you pay any health insurance premiums or long-term care premiums?		______			______
43.	Were either you or your spouse eligible to participate in an employer’s health insurance or long-term care plan?		______			______
44.	If you, or your spouse, have self-employment income, do you want to make a retirement plan contribution?		______			______
45.	Did you acquire any “qualified small business stock”?		______			______
46.	Were you granted or did you exercise any stock options? If yes, provide details.		______			______
47.	Were you granted any restricted stock? If yes, provide details.		______			______
48.	Did you pay any household employee over age 18 wages of $1,800 or more?		______			______
	If yes, provide copy of Form W-2 issued to each household employee.
	If yes, did you pay total wages of $1,000 or more in any calendar quarter to all household employees?		______			______
49.	Did you surrender any U.S. savings bonds?		______			______
50.	Did you use the proceeds from Series EE U.S. savings bonds purchased after 1989 to pay for higher education expenses?		______			______
51.	Did you realize a gain on property which was taken from you by destruction, theft, seizure or condemnation?		______			______
52.	Did you start a business?		______			______
53.	Did you purchase rental property? If yes, provide settlement sheet (HUD-1).		______			______
54.	Did you acquire any interests in partnerships, LLCs, S corporations, estates or trusts this year? If yes, provide Schedule K-1 that the Organization has issued to you.		______			______
55.	Do you have records to support travel, entertainment, or gift expenses? The law requires that adequate records be maintained for travel, entertainment, and gift expenses. The documentation should include amount, time and place, date, business purpose, description of gift(s) (if any), and business relationship of recipient(s).		______			______
56.	Has your will or trust been updated within the last three years? If yes provide copies		______			______
57.	Did you incur expenses as an elementary or secondary educator? If so, how much?		______			______
58.	Did you make any energy-efficient improvements (remodel or new construction) to your home?		______			______
59.	Can the Internal Revenue Service and state tax authority discuss questions about this return with the preparer?		______			______
60.	Did you make any large purchases or home improvements?		______			______
61.	Did you pay real estate taxes on your principal residence? If so, how much?		______			______

ESTIMATED TAX PAYMENTS MADE

	FEDERAL		STATE (NAME):
	Date Paid	Amount Paid	Date Paid	Amount Paid
Prior year overpayment applied
1st Quarter
2nd Quarter
3rd Quarter
4th Quarter

WAGES, SALARIES, AND OTHER EMPLOYEE COMPENSATION

Enclose all Forms W-2.

PENSION, IRA, AND ANNUITY INCOME

Enclose all Forms 1099-R.
	YES	NO

1.	Did you receive a Lump Sum distribution from your employer?		______	______

2.	Did you “convert” a Lump Sum distribution into another plan or IRA account?		______	______

3.	Did you transfer IRA funds to a Roth IRA this year?		______	______

4.	Have you elected a Lump Sum treatment for any retirement distributions after 1986?	Taxpayer Spouse	______ ______	______ ______

SOCIAL SECURITY BENEFITS RECEIVED

Enclose all 1099 SSA Forms.

INTEREST INCOME - Enclose all Forms 1099-INT and statements of tax-exempt interest earned. If not available, complete the following:

TSJ*	Name of Payor	Banks, S&L, Etc.	U.S. Bonds, T-Bills	Tax-Exempt In-State Out-of-State













	Early Withdrawal Penalties

*T = Taxpayer S = Spouse J = Joint

INTEREST INCOME (Seller-Financed Mortgage)

Name of Payor

Social Security

Number

Address

Interest Received

DIVIDEND INCOME - Enclose all Forms 1099-DIV and statements of tax-exempt dividends earned. If not available, complete the following:

TSJ*	Name of Payor	Ordinary Dividends	Qualified Dividends	Capital Gain	Non Taxable	Federal Tax Withheld	Foreign Tax Withheld

*T = Taxpayer S = Spouse J = Joint

MISCELLANEOUS INCOME - List and enclose related Forms 1099 or other forms.

	Description	Amount
	State and local income tax refund(s)
	Alimony received
	Jury fees
	Finder’s fees
	Director’s fees
	Prizes
	Gambling winnings (W2-G)
	Other miscellaneous income

INCOME FROM BUSINESS OR PROFESSION – SCHEDULE C

Who owns this business? ¨ Taxpayer ¨ Spouse ¨ Joint

Principal business or profession

Business name

Business taxpayer identification number

Business address _________________________________________

_________________________________________

Method(s) used to value closing inventory:

____ Cost ____ Lower of cost or market ____ Other (describe) ______________ N/A _____

Accounting method:

____ Cash ____ Accrual ____ Other (describe) __________________________

		YES	NO
1.	Was there any change in determining quantities, costs or valuations between the opening and closing inventory? If yes, attach explanation.	______	______
2.	Did you deduct expenses for the business use of your home? If yes, complete office in home schedule provided in this organizer.	______	______
3.	Did you materially participate in the operation of the business during the year?	______	______
4.	Was all of your investment in this activity at risk?	______	______
5.	Were any assets sold, retired or converted to personal use during the year? If yes, list assets sold including date acquired, date sold, sales price, and original cost.	______	______
6.	Were any assets purchased during the year? If yes, list assets acquired, including date placed in service and purchase price, including trade-in. Include copies of purchase invoices.	______	______
7.	Was this business still in operation at the end of the year?	______	______
8.	List the states in which business was conducted and provide income and expense by state.	______	______
9.	Provide copies of certification for employees of target groups and associated wages qualifying for Work Opportunity Tax Credit.	______	______
10.	Did you make any payments during the year that would require you to file Form(s) 1099?	______	______
	If yes, did you file Form(s) 1099?	______	______

Attach a schedule of income and expenses of the business or complete the following worksheet. Complete a separate schedule for each business.

INCOME AND EXPENSES (Schedule C)

Description	Amount
Part I –Income
Gross receipts or sales
Returns and allowances
Other income (List type and amount.)

Part II - Cost of Goods Sold
Inventory at beginning of year
Purchases less cost of items withdrawn for personal use
Cost of labor (Do not include salary paid to yourself.)
Materials and supplies
Other costs (List type and amount.)
Inventory at end of year
Part III – Expenses
Advertising
Bad debts from sales or services
Car and truck expenses (Complete Auto Expense Schedule on Page 21)
Commissions and fees
Depletion
Depreciation and Section 179 expense deduction (provide depreciation schedules)
Employee health insurance and other benefit programs (excluding retirement plans and amounts for [sjr1] ownerowner owner))
Employee retirement contribution (other than owner)
Self employed owner:
a. Health insurance premiums
b. Retirement contribution
c. State income tax
Insurance (other than health)
Interest:
a. Mortgage (paid to banks, etc.)
b. Other
Legal and professional services
Office expense
Rent or lease:
a. Vehicles, machinery, and equipment
b. Real Estate or Other business property
Repairs and maintenance


Supplies
Taxes and licenses (Enclose copies of payroll tax returns.) Do not include state income tax.
Travel, meals, and entertainment:
a. Travel
b. Meals and entertainment
Utilities
Wages (Enclose copies of Forms W-3/W-2.)
Lobbying expenses
Club dues:
a. Civic club dues
b. Social or entertainment club dues
Other expenses (List type and amount.)

COMMENTS:

OFFICE IN HOME

To qualify for an office in home deduction, the area must be used exclusively for business purposes on a regular basis in connection with your employer’s business and for your employer’s convenience. If you are self-employed, it must be your principal place of business or you must be able to show that income is actually produced there. If business use of home relates to daycare, provide total hours of business operation for the year.

Business or activity for which you have an office

Total area of the house

(square feet)

Area of business

portion (square feet)

Business

Percentage

I. DEPRECIATION

	Date Placed in Service	Cost/Basis	Method	Life	Prior Depreciation
House
Land
Total Purchase Price
Improvements (Provide details)

II.	EXPENSES TO BE PRORATED:

	Mortgage interest		___________
	Real estate taxes		___________
	Utilities		___________
	Property insurance		___________
	Other expenses - itemize	_________________________	___________
		_________________________	___________
		_________________________	___________
		_________________________	___________

III.	EXPENSES THAT APPLY DIRECTLY TO HOME OFFICE:

	Telephone		___________
	Maintenance		___________
	Other expenses - itemize	_________________________	___________
		_________________________	___________
		_________________________	___________
		_________________________	___________

CAPITAL GAINS AND LOSSES - Enclose all Forms 1099-B (with supplemental year end brokerage statements) and 1099-S with HUD-1 closing statements). Complete the following schedule if no statements are available and provide all transaction slips for sales and purchases.

Description	Date Acquired	Date Sold	Sales Proceeds	Cost or Basis	Gain (Loss)

Enter any sales NOT reported on Forms 1099-B and 1099-S:

Description	Date Acquired	Date Sold	Sales Proceeds	Cost or Basis	Gain (Loss)

SALE/PURCHASE OF PERSONAL RESIDENCE

Provide closing statements (HUD-1) on purchase and sale of old residence and purchase of new residence.

	Description	Amount

For sale of personal residence, did you own and live in it for 2 of the 5 years prior to sale?

MOVING EXPENSES

Did you change your residence during this year due to a change in employment, transfer, or self-employment?

Yes _____

No _____

If yes, furnish the following information:

	Number of miles from your former residence to your new business location		_________ miles
	Number of miles from your former residence to your former business location		_________ miles
Did your employer reimburse or pay directly any of your moving expenses?		Yes _____		No _____

If yes, enclose the employer provided itemization form and note the amount of

reimbursement received.

$______________

Itemize below the total moving costs you paid without reduction for any reimbursement by your employer.

Expenses of moving from old to new home:
	Transportation expenses in moving household goods and family	$______________
	Cost of storing and insuring household goods	$______________

RESIDENCE CHANGE

If you changed residences during the year, provide period of residence in each location.

Residence #1 ________________________	From / /	To / /
Own_____ Rent____
Residence #2 ________________________	From / /	To / /
Own____ _ Rent_____

RENTAL AND ROYALTY INCOME – Complete a separate schedule for each property.

Description and location of property: _____________________________________________________________

__________________________________________________________________________________________

Type of property:

Residential rental ______

Commercial rental ______

Royalty ______

Self-rental ______

Other-Describe ___________

Personal use?

Yes _____

No _____

If personal use yes:

Number of days the property was occupied by you, a member of your

family, or any individual not paying rent at the fair market value.

__________

Number of days the property was not occupied.

If not occupied, was it available for rent during this time?

How many days was the property rented during the year?

__________

Yes____ No____

__________

Did you actively participate in the operation of the rental property during the year?

Yes _____

No _____

Were more than half of personal services that you or your spouse performed during the year performed in real property trades?

Yes _____

No _____

Did you or your spouse perform more than 750 hours of services during the year in real property trades or businesses?

Yes _____

No _____

Did you make any payments during the year that would require you to file Form(s) 1099?

If yes, did you file the Form(s) 1099?

Yes _____

No _____

Income:	Amount		Amount
Rents received		Royalties received
Expenses:
Mortgage interest		Legal and other professional fees
Other interest		Cleaning and maintenance
Insurance		Commissions
Repairs		Utilities
Auto and travel		Management fees
Advertising		Supplies
Taxes		Other (itemize)

If this is the first year we are preparing your return, provide depreciation records.

If this is a new property, provide the closing statement. (HUD-1)

List below any improvements or assets purchased during the year.

Description	Date placed in service	Cost

If the property was sold during the year, provide the closing statement. (HUD-1)

INCOME FROM PARTNERSHIPS, ESTATES, LLCS, TRUSTS, AND S CORPORATIONS

Enclose all Schedules K-1 received to date. Also list below all Schedules K-1 not yet received:

Name	Source Code*	Federal ID #

*Source Code: P = Partnership/LLC E = Estate/Trust S = S Corporation

CONTRIBUTIONS TO RETIREMENT PLANS

	TAXPAYER	SPOUSE
Are you covered by a qualified retirement plan? (Y/N)
Do you want to make the maximum deductible IRA contribution? (Y/N)
IRA payments made for this return	$	$
IRA payments made for this return for nonworking spouse	$	$
Do you want to make an IRA contribution even if part or all of it may not be deducted? (Y/N) If yes, provide copy of latest Form 8606 filed.
Have you made or do you want to make a Roth IRA contribution? (Y/N) If yes, provide Roth IRA payments made for this return.
	$	$
Do you want to make the maximum allowable Keogh/SEP/SIMPLE IRA contribution? (Y/N)
Keogh/SEP/SIMPLE IRA payments made for this return	$	$
Date Keogh/SIMPLE IRA Plan established

ALIMONY PAID

Name of Recipient(s)

Social Security Number(s) of Recipient(s)

Amount(s) Paid	$

If a divorce occurred this year, enclose a copy of the divorce decree and property settlement.

MEDICAL AND DENTAL EXPENSES (PLEASE NOTE THAT MEDICAL EXPENSES MUST EXCEED 7.5% OF ADJUSTED GROSS INCOME TO BE DEDUCTIBLE.) HEALTH INSURANCE PREMIUMS AND MEDICAL EXPENSES PAID WITH PRE-TAX DOLLARS (CAFETERIA PLANS, HEALTH SAVINGS ACCOUNTS, ETC.) ARE NOT DEDUCTIBLE.

Description	Amount
Premiums for health and accident insurance including Medicare
Long-term care premiums: Taxpayer $ Spouse $
Medicine and drugs (prescription only)
Doctors, dentists, nurses
Hospitals, clinics, laboratories
Eyeglasses / corrective surgery
Ambulance
Medical supplies / equipment
Hearing aids
Lodging and meals
Travel
Mileage (number of miles)
Long-term care expenses
Payments for in-home care (complete later section on home care expenses)
Other
Insurance reimbursements received	( )

Were any of the above expenses related to cosmetic surgery?

Yes_____

No _____

DEDUCTIBLE TAXES

Description	Amount
State and local income tax payments made this year for prior year(s).
Real estate taxes: Primary residence
Secondary residence
Other
Personal property or ad valorem taxes
Sales tax on major items (auto, boat, home improvements, etc.)
Other sales taxes paid (if applicable)
Intangible tax
Other taxes (itemize)
Foreign tax withheld (may be used as a credit)

INTEREST EXPENSE

Mortgage interest (Enclose Forms 1098.)

Payee*	Property**	Amount

*Include address and social security number if payee is an individual.

**Describe the property securing the related obligation, i.e., principal residence, motor home, boat, etc.

If any mortgage or equity loan was not used to buy, build, or improve your principal or second residence, please describe

how the proceeds were used. _____________________________________________________________________

Unamortized points on residence refinancing

Date of Refinance	Loan Term	Total Points

Student loan interest

Payee	Amount

Investment interest not reported on Schedules A, C, or E

Payee	Investment Purpose(stocks, land , etc)	Amount

Business interest not reported on Schedules C, or E

Payee	Business Purpose	Amount

CONTRIBUTIONS

Cash contributions, for which you have receipts, canceled checks, etc. NOTE: You need to have written acknowledgment from any charity to which you made individual donations of $250 or more during the year.

Donee	Amount	Donee	Amount

Expenses incurred in performing volunteer work for charitable organizations:

	Parking fees and tolls	$
	Supplies	$
	Meals & entertainment	$
	Other (itemize)	$
	Automobile mileage ______________________

Other than cash contributions (enclose receipt(s)):

Organization name and address
Description of property
Date acquired
How acquired
Cost or basis
Date contributed
Fair market value (FMV)
How FMV determined

For contributions over $5,000, include copy of appraisal and confirmation from charity.

CASUALTY OR THEFT LOSSES

Loss of property by theft or damage to property by fire, storm, car accident, shipwreck, flood or other “act of God”

	Property 1	Property 2	Property 3
Indicate type of property	¨ Business ¨ Personal	¨ Business ¨ Personal	¨ Business ¨ Personal
Description of property
Date acquired
Cost
Date of loss
Description of loss
Was property insured? (Y/N)
Was insurance claim made? (Y/N)
Insurance proceeds
Fair market value before loss
Fair market value after loss

Is the property in a Presidentially declared disaster area? Yes_____ No_____

MISCELLANEOUS DEDUCTIONS

Description	Amount
Union dues
Income tax preparation fees
Legal fees (provide details)
Safe deposit box rental (if used for storage of documents or items related to income-producing property)
Small tools
Uniforms which are not suitable for wear outside work
Safety equipment and clothing
Professional dues
Business publications
Unreimbursed cost of business supplies
Employment agency fees
Investment expenses
Trustee fees
Other miscellaneous deductions – itemize
Documented gambling losses

EMPLOYEE/SELF EMPLOYED BUSINESS EXPENSES – FORM 2106

Expenses incurred by: ¨ Taxpayer ¨ Spouse ¨ Occupation ______________________

(Complete a separate schedule for each business)

Description	Total Expense Incurred	Employer Reimbursement Reported on W-2	Employer Reimbursement Not on W-2
Travel expenses while away from home:
Transportation costs
Lodging
Meals and entertainment
Business use of home (see schedule)
Other employee business expenses – itemize

Automobile Expenses - Complete a separate schedule for each vehicle.

Vehicle description	___________	Total business miles	___________
Date placed in service	___________	Total commuting miles	___________
Cost/Fair market value	___________	Total other personal miles	___________
Lease term, if applicable	___________	Total miles this year	___________

		Average daily round trip commuting distance	___________

Actual expenses (*Omit if using mileage method)
Gas, oil*	___________	Taxes and tags	___________
Repairs*	___________	Interest	___________
Tires, supplies*	___________	Parking	___________
Insurance*	___________	Tolls	___________
Lease payments*	___________	Other	___________
Did you acquire, lease or dispose of a vehicle used for business during this year?				Yes _____	No _____
If yes, enclose purchase and sales contract or lease agreement.

Did you use the above vehicle in this business less than 12 months?				Yes _____	No _____
If yes, enter the number of months __________.

Do you have another vehicle available for personal purposes?				Yes _____	No _____

Do you have evidence to support your deduction?				Yes _____	No _____

Is the evidence written?				Yes _____	No _____

CHILD CARE EXPENSES/HOME CARE EXPENSES

Did you pay an individual or an organization to perform services for the care of a dependent under 13 years old in order to enable you to work or attend school on a full-time basis?		Yes _____	No _____
Did you pay an individual to perform in-home health care services for yourself, your spouse, or dependents?		Yes _____	No _____
If the response to either of the questions above is yes, complete the following information:
	Names(s) of dependent(s) for whom services were rendered. _______________________________________________________________________________
	List individuals or organizations to whom expenses were paid during the year. (Services of a relative may be deductible only if that relative is not a dependent and if the relative’s services are considered employment for social security purposes.)

Name and Address	ID#	Amount	If Under 18

If payments of $1,800 or more during the tax year were made to an individual, were the services performed in your home?

Yes _____

No _____

EDUCATIONAL EXPENSES

Did you or any other member of your family pay any post-secondary educational expenses this year?

Yes _____

No _____

If yes complete the following and provide Form 1098-T from school:

Student Name	Institution	Grade/Level	Amount Paid	Date Paid

Was any of the preceding tuition paid with funds withdrawn from an educational IRA or 529 Plan?

If yes, how much? $__________ Submit 1099-Q

Yes _____

No _____

Tax Organizer

YES

NO

YES

NO