ࡱ> RTOPQ{ OHbjbjzz ;?}FF8 $6r(D"fff- v $ $6&6&6&6&6&6&6$8:|J6.$u- .$.$J6ff_6`)`)`).$^ff$6`).$$6`)`)`)f)$.`)6u606`)E;$bE;`)E;`) !`)M"|"e J6J6'D 6.$.$.$.$E; F f:  INDIVIDUAL INCOME TAX ORGANIZER FOR 2013 (as of 8 Mar 2013) Name: SS#DOB:Occupation/Retired/Disabled:Name: SS#DOB:Occupation/Retired/Disabled:Address:City:State:Zip: Home Phone:Work PhoneCell PhoneE-mail:  Dependants: Name: SS#DOB:Relationship:Name: SS#DOB:Relationship:Name: SS#DOB:Relationship: Filing Status:SingleMarried Filing JointQualifying Widow(er)Head of HouseMarried Filing Separate*If dependent had earned/investment income over $1,900, bring details *New clients, bring last three years tax returns *Did you refinance your home? Yes/no *Foreign Bank Account Report (FBAR) over $10K (Form TD F 90-221) or ownership of Foreign Assets over $50K (Form 8938) *Short Sale/Bankruptcy /Foreclosure from Primary Residence (extended thru 2013)? *Traditional IRA converted to ROTH IRA? Year of conversion____/amount$______ *Tax Shelter? (If yes file form ______ *529 Plan Deduction (state) return? (CO/VI) **Form 8332 Non-custodial Parent (Divorce degree after 2008 not sufficient) *Claimed First-Time Home Buyer Credit in 2008 and start making repayment in 2010 *Colorado Charitable Contributions, not claimed on Sch-A *Long-term Care Premiums Credit on Colorado return *Loss due to Ponzi Scams *Identify Theft VictimsIRS Issued Identity Protection Pin Number *Federal and Estate Planning, e.g., Living Will, Durable Power of Attorney, Medical Power of Attorney, and Trust (if appropriate) Year Round Service Agreement [ ] Yes [ ] No (hourly charge $85/hr) Estimated Tax Payments Federal $State $Date PaidFederal $State $Date Paid1st Quarter3rd Quarter2nd Quarter4th QuarterINCOME ___ Wages (W-2s) ___ Interest & Dividends/Municipal Bonds/Govt Interest (1099) ___ Commissions & Bonus/Prizes (not on W-2) ___ State Income Tax Refund from Prior Year (1099-G) ___ Sale of Stocks/Mutual funds (1099-B) (release date 15 Feb) ___ Unemployment Compensation (1099-G) ___ Unreported Tips & Gratuities ___ Business Income (use worksheet) ___ 1099-K (Merchant Card and Third Party Payments) ___ Sale of Personal Residence (Bring closing documents) (1099-S) ___ Veterans Pension/Disability (1099-R) or statement ___ Social Security Taxpayer (1099-SSA) ___ Social Security Spouse (1099-SSA) ___ IRA/Pensions/Annuities/Rollovers/SEP/Keogh (1099-R) ___ Railroad Retirement (1099-R) ___ Estates & Trust (furnish documents) ___ Farming (furnish documents) ___ Cancellation of Debt/Foreclosure (1099-A/1099-C) ___ Gambling/Lottery Winnings (W-2G)(losses limited to winnings ___ Hobby Income ___ Inheritance/Gifts (mandatory over $13K report on 709) 2013-$14K ___ Director/Executor Fees ___ Jury Duty or Election Board Fees ___ Legal Settlement (Bring Details) ___ Partnerships & S-Corporations/Trusts (Bring K-1) ___ Payments From Prior Installment Sale ___ Prizes & Awards ___ Rental Income (use worksheet) ___ Royalties (1099sINCOME CONTINUED: ___ Sale of Business (Bring details) ___ Sale of Capital Asset (Bring details) ___ Disability Income/Veterans Benefits ___ Workmans Compensation/SDI ___ Alimony Received (ss # ___________________) ___ Child Support ___ Scholarships, Fellowships or Grants (1098-T) ___ Education Savings Account or 529 Plan Withdrawals (1099-Q) ___ Bartering Income ___ Installment Sale ___ Other income (Explain) _________________________________________ _________________________________________ ADJUSTMENT TO INCOME: ___ Alimony Paid _______ Recipients Name/SS#__________ ___ Health Savings Account (HSA) Deduction amount $____ ___ Medical Savings Account (MSA) Deduction amount $____ ___ IRA/Keogh contributions deduction (Taxpayer) amount $____ ___ IRA/Keogh contributions deduction (Spouse) amount $____ ___ Self-Employed SEP, Simple, & Qualified Plans amount $____ ___ Moving Expenses (see worksheet) ___ Penalty on early withdrawal of savings account ___ One-half Self-employment tax (rpt on Sch-C only for 2010) ___ Self-Employed Health Insurance Premiums100% ___ Educator Expense (Extended 08/09/10/11/2012 to 2013) ___ Business Expense of Reservists (travel over 100 miles) ___ Student Loan interest deduction (1098-E)(no limit to first 60 mths) ___ Tuition & fees deduction (1098-T) (Extended 08/09/10/11/12 to 13) ___ Domestic production activities deduction DEDUCTIONS AND CREDITS Medical (*7.5% floor increases to 10% starting 2013) ___ Ambulance ___ Artificial Teeth ___ Doctors and Dentists ___ Eyeglasses/Contacts ___ Health Insurance Premiums (Paid By You)*(new 2011 under age 27) ___ Hearing Aid and Supplies ___ Hospitals and Clinics ___ Lodging (Away from home) ___ Long Term Care Expense ___ Medical Aid Rental ___ Medical Travel (Air, Cab, etc.) ___ Medical Miles Driven (.24 cents)_______ ___ Nurses ___ Nursing Home Medical Care ___ Prescription Medicine & Insulin ___ Spouse Long Term Health Insurance ___ Wheel Chair or Special Equipment ___ X-Ray/Lab Fees ___ Your Long Term Health Insurance ___ Amount above reimbursed by insurance ___ Other Medical _______________________________________ _______________________________________ _______________________________________ Interest ___ First Home Mortgage Interest (1098) ___ Second Mortgage Interest ___ Points paid to Refinance ___ Home Equity/Improvement/Line of credit Loan Interest ___ Loan Points (closing statement, not shown on 1098) ___ Points Amortization (closing statement, not shown on 1098) ___ Mortgage Insurance Premiums Paid on Polices after 2006 (extended thru 2013)(Yr End fiscal cliff 12, might not be listed on 1098) ___ Home Mortgage Paid to Individual Name, Address, SS# _________________________ ______________________________________________ ______________________________________________ ___ Investments Interests(Land, deductible to net invest income) Taxes ___ Additional state Tax Paid w/last years return ___ Land Tax ___ Other/Personal Property Taxes (ownership tax on vehicles) ___ Real Estate Tax *Regardless if not itemizing, only for 08/09) ___ State & Local Sales Tax (new car/boat purchase 2010/11 thru 2013) Contributions/Tithes (MUST HAVE RECEIPTS) ___ Cancer, Heart, Boy or Girl Scout, etc. ___ Church Name ___ Disaster Victims ___ United Campaign, Veterans Organization, etc. ___ YMCA/YWCA ___ Other Cash Contributions (Furnish Receipts) ____________________________________________ ____________________________________________ Non-Cash Contributions (*Use Good or Better Condition) ___ Value of Donated Items (Receipts Required) ___ Appreciated Property (Furnish Details) ___ Transportation or Mileage for Charitable Work (Mileage at .14 cents) ___ Out-of-pocket expenses for volunteering ___ Other (Explain) ______________________________________ Miscellaneous ___ Business Bad Debt (Furnish Details) ___ Casualty Loss (Furnish Details) ___ Estate Taxes ___ Financial Planning Fees ___ Gambling Loss limited to total Winnings (Furnish Details) ___ Hobby Expenses ___ Investment Expenses ___ IRA/Retirement Fund Fees ___ Job Search Expenses ___ Legal Fees-Tax Related ___ Office in Home (Use Worksheet Attached) ___ Passport for Business Travel ___ Professional/Organizational/Union Dues ___ Safe Deposit Box ___ Safety/Protection Equipment/Clothing ___ Business use of car (see worksheet) ___ Subscriptions and Trade Journals ___ Tax Counsel and Preparation Fees ___ Tools and Equipment (Work Related) ___ Uniforms (Cost and Cleaning) ___ Education required to maintain your job Credits ___ Alternative Hybrid Vehicle Credit (FUEL CELL) ___ First Time Homebuyer Credit **new 2008 (form 5405) (purchased new home after 8 Apr 08 and before 1 Jul 09) *Use IRS Look-up to verify repayment ___ Long-Time Resident Credit (2009 only) ___ Foreign tax Credit ___ Education--Life Time Learning Credit (1098-T) Yr _____ ___ EducationAmerican Opportunity Credit 2009/2010/2011/ 2012 extend to 2017 (replaces Hope Credit (1098-T) Yr _____ ___ Retirement Savings Contribution Credit (Savers Credit) ___ Child Tax Credit (extended thru 2013 $1,000)and thru 2017? ___ Adoption Credit (furnish documents) (non-refundable 2012) ___ Elderly or Disabled Credit ___ Residential Energy Efficient Property Credit (see worksheet) *(reinstated for 2009 & 2010-30% (was avail in 06&07) For 2011-10% (storm doors/windows/AC/furnace/water heater/sky light/SOLAR PANELS) (cumulative of $500 for 2012 and 2013) Child and Disabled Dependent Care Expense Name, Address, phone, SSN or EIN# of Provider ____________________________________ ____________________________________ Child ____________________ Amount Paid ______ Child ____________________ Amount Paid ______ Child ____________________ Amount Paid ______ Other Taxes ___ Household Employment Taxes EMPLOYEE BUSINESS EXPENSES The purpose of this worksheet is to help you organize your tax deductible business expenses. In order for an expense to be deductible, it must be considered an ordinary and necessary expense. You may include other applicable expenses. Do not include expenses for which you have been reimbursed, expect to be reimbursed, or are reimbursable. MISCELLANEOUSTELEPHONEPROFESSIONALBusiness CardsAnswering Service Continuing Ed ClericalBeeper/Pager DuesComputer SuppliesCellular E & O InsuranceGifts/Promotional ItemsFaxesLegal & ProfessionalOffice SuppliesLong DistanceLicensesPostagePay PhoneMembershipsPhotocopying2nd Line PublicationsPrintingOtherSeminarsRepairsResumesShippingOtherStationeryTotalTotalTotalEQUIPMENT TRAVEL & ENTERTAINMENT EXPENSEVEHICLE EXPENSE Attach CaseAirfare, trainDescription of VehicleCalculatorCar rental & gasDate placed in serviceCameraParking, tollsOdometer Reading Beginning of YearDeskTaxi, bus, shuttlesOdometer Reading End of YearChairLodgingTotal MilesFiling CabinetMealsBusiness Mileage 2012 (.555cents) Business Mileage 2013 (.565 cents)Cell PhoneEntertainmentGas, lube, oilSoftwareTipsRepairs & MaintenanceTape RecorderTelephoneTiresTelephoneDry cleaningTowingOtherNumber of days out of townInsuranceAuto License/ Reg.Personal Property TaxLease PaymentsInterestAuto ClubWarrantyIs Car Leased? Yes NoIs Car owned (or Financed)? Yes No Was this vehicle depreciated in a prior year? Yes No TotalTotalTotal OTHER INFORMATION BUSINESS INCOME AND EXPENSES How many months was your business in operation in 2012? ______ Name of Business ___ Principal Business Activity: ______________ Full Address _______________________________________ Type of Entity: (Sole Proprietor (Schedule-C), LLC, Partnership, C-Corp, S-Corp): ________ Federal ID# __________________ Date of In Corporation: __________ Copy of Articles of Incorporation/Organization: YES / NO Copy of IRS Entity Acknowledge Letter: _________ INCOME ___ Gross Receipts or Sales ___ Returns and Allowances ___ Inventory at Beginning of Year/Period ___ Purchases for resale ___ Cost of Items for Personal Use ___ Cost of Labor ___ Material and Supplies ___ Other Costs ___ Inventory at End of Year/Period EXPENSES ___ Accounting ___ Advertising ___ Amortization ___ Answering Service ___ Bad Debts from Sales/ Services ___ Car & Truck Expenses (see worksheet) ___ Casualty Loss ___ Cleaning & Maintenance ___ Commissions ___ Depreciation & Section 179 ($500K thru 2013) ___ Dues and Publications ___ Employee Benefits ___ Employee Health Insurance Premiums (Only for 2010, self- employed health insurance deductible on Sch-C vs. front 1040 ___ Freight ___ Insurance other than Health ___ Interest (Mortgage) ___ Interest (Other) ___ Internet Access ___ Legal & Professional Fees ___ Meals & Entertainment ___ Office Supplies and Postage ___ Pension/Profit Sharing ___ Practice Development ___ Professional Development ___ Rent (Machinery/Equipment) ___ Rent (Other) ___ Repairs ___ Security ___ SuppliesEXPENSES CONTINUED ___ Taxes Paid ___ Telephone (second line) ___ Cell phone ___ Auto Travel (2012-.555 cents/2013-.565 cents) ___ Hotel ___ Airfare/parking fee/tolls/taxi/rental car ___ Meals ___ Utilities ___ Wages ___ Other ________________________________________ ________________________________________ ________________________________________ DEPRECIABLE PROPERTY PURCHASED IN 2011 (Description)(Acquire Date)(Cost/Adj)(Sold Date)(Sales Price) _________________________________________________ _________________________________________________ _________________________________________________ _________________________________________________ _________________________________________________ BUSINESS IN THE HOME ___ Simplified Option*New 2013* (New Option deduction, capped at $1,500/yr based on $5 a sq ft for up to 200 sq ft. You do not depreciate the portion of home used in a trade or business, and claim allowable mortgage interest, real estate taxes, etc., as usual on Schedule A. Under Regular method, these deductions had to be allocated between personal and business.) ___ Hours worked in the Home ___ Total Sq Foot of Home ___ Sq. Ft. Exclusively for Business ___ Date converted to Business Use ___ Cost of Home ___ Cost of Improvements ___ Insurance ___ Interest (furnish 1098) ___ Utilities ___ Repairs & Maintenance to Office ___ Taxes ___ Other Expenses __________________________________________________ __________________________________________________  RENTAL INCOMEType of Property &Full AddressTotal Amount of Rent ReceivedDeposits ReceivedTotal Days For Personal UseRental Unit ARental Unit BRental Unit CRental Unit D RENTAL EXPENSE DEDUCTIONSRental Unit ARental Unit BRental Unit CRental Unit DAdvertisingAssociation DuesAuto  HYPERLINK "mailto:Miles: Jan-Jun @ .51" Miles 2012 - .555 cents  HYPERLINK "mailto:Jul-Dec@.555" 2013 - .565 cents (Travel Exp see worksheet)Cleaning/MaintenanceCommissionsEquipmentGardening/LandscapingHeating & Air ConditioningInsuranceInterest-MortgageInterest-OtherLawn workLegal Professional FeeManagement FeePainting/DecoratingPest ControlPlumbingRepairs-ElectricalRepairs-CarpentryRepairs-PlumbingRepairs-RoofingContract Labor/WagesTaxesTelephone/Long DistanceTrash RemovalUpkeep/CleaningUtilitiesPostage/FreightAppliances/Furniture (date of purchase & cost)Casualty LossOtherOther MOVING EXPENSESOUT OF POCKET TRAVEL COSTS TO NEW RESIDENCETRAVEL COSTS REIMBURSED BY EMPLOYERDate Moved(Depart)/(Arrive): Location:Air Fare:Amount:Distance from previous residence to new place of work (great than 50 miles):Auto Expense:Distance from previous residence to previous place of work:Lodging:Cost of moving household items: Other expense: Moving Miles Driven: 2012 (.235 cents) 2013 (.24 cents)  Education Expenses (Form 1098-E & 1098-TStudents NameEducation PurposeName of InstitutionExpense Type (tuition, student loan interest)Amount PaidPaid by Whom?First four year of college? Yes or No Residence Energy Efficient Property CreditDid you make any improvement to your principal residence during the year to increase energy efficiency such as solar electric property, fuel cells, solar water heating, geothermal heat pump or small wind energy property?Description of Improvement/ExpenditureDate Placed in ServiceAmount New for 2011 as of 27 Oct 2011: If clients have been identity theft victims and if they have reported this to IRS. If so, youll want to ask them to provide their IP PIN so you can file their return electronically (and so it will not be held up for manual review). The electronic return will be rejected (in one of two error codes: ERC 0603 or F1040-178), and the return must be filed on paper, where it will undergo significant manual scrutiny.     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