4. Income 5. I.R.A. (Individual Retirement Acct.) If you have any of the following income sources, Contributions made for this tax year: please mark and include forms. Amount Date Roth? # of each you Taxpayer: Form Name have W-2s (wage, salary income) Spouse: W-2G’s (unemployment) 1099-INT (interest statements) Withdrawals (Attach 1099-R or 5498): Brokerage Statements 1099-DIV (dividend statements) Amount Reason Rolled Over? 1099-C (cancellation of debt) Taxpayer: K-1 (partnership, S-Corp, Estate, or trust income) SSA-1099 (social security) Spouse: RRB-1099 (railroad retirement) 1099-R (pension/annuity income) Others: 6. Investments Sold (Attach Documentation (1099-B, etc.)) Stocks, Mutual Funds, Gold, Silver, and Partnership Interest Investment Date Acquired Cost Date Sold Price 7. Real Estate Sold (Attach 1099-S and Closing Statements) Was this your principal Property Date Acquired Cost Improvements Date Sold Price residence? 9. Charitable Contributions 8. Other Income You MUST keep the receipts, but we do not need to see them. Contributions greater than $250 Lawsuit settlements: must have goods or services were received” “no on the receipt in order to fully qualify. Describe: Church Scholarships (Grants) Alimony Received United Way Prizes, Bonuses, Awards Colleges, Universities Gambling, Lottery, Winnings Other Cash Contributions: - Gambling, Lottery ( ) Expenses Unreported Tips Director, Executor Fee Received Non-Cash Contributions: (Bring in Commissions details) Jury Duty Payment from Prior Installment State Income Tax Refund Volunteer Miles Driven: Jan.-Dec. 2016 miles Other:
4. Income If you have any of the following income sources, please mark and include forms. Form Name # of each you have W-2s (wage, salary income) W-2G’s (unemployment) 1099-INT (interest statements) Brokerage Statements 1099-DIV (dividend statements) 1099-C (cancellation of debt) K-1 (partnership, S-Corp, Estate, or trust income) SSA-1099 (social security) RRB-1099 (railroad retirement) 1099-R (pension/annuity income) Others: 5. I.R.A. (Individual Retirement Acct.) Contributions made for this tax year: Amount Date Roth? Taxpayer: Spouse: Withdrawals (Attach 1099-R or 5498): Amount Reason Rolled Over? Taxpayer: Spouse: 6. Investments Sold (Attach Documentation (1099-B, etc.)) Stocks, Mutual Funds, Gold, Silver, and Partnership Interest Investment Date Acquired Cost Date Sold Price 7. Real Estate Sold (Attach 1099-S and Closing Statements) Property Was this your principal residence? Date Acquired Cost Improvements Date Sold Price 8. Other Income Lawsuit settlements: Describe: Scholarships (Grants) Alimony Received Prizes, Bonuses, Awards Gambling, Lottery, Winnings - Gambling, Lottery Expenses ( ) Unreported Tips Director, Executor Fee Received Commissions Jury Duty Payment from Prior Installment State Income Tax Refund Other: 9. Charitable Contributions You MUST keep the receipts, but we do not need to see them. Contributions greater than $250 must have “no goods or services were received” on the receipt in order to fully qualify. Church United Way Colleges, Universities Other Cash Contributions: Non-Cash Contributions: (Bring in details) Volunteer Miles Driven: Jan.-Dec. 2016 miles
Client_Tax_Organizer_2016.docx