2000 Income Tax Data Organizer

2016 INCOME TAX DATA ORGANIZER

This Income Tax Data Organizerassists you to collect documents information needed to complete yourincome tax return.

PERSONAL INFORMATION

Name / Social Security # / Birthdate /

Occupation

Cell Phone #

Taxpayer

Spouse
Street Address/City /

Township

/ School District / County / State / ZIP / Home Phone
E-Mail Address / Taxpayer: / Spouse:

Do you have a will? _____Y _____N Do you feel you have sufficient life insurance? _____Y _____N

Direct Deposit (Provide a JOINT account if MFJ)

Bank Routing #______Account # ______Checking (Please include a copy of check.) Savings

TaxpayerSpouseMarital Status

Give $3 to Presidential Campaign? __YNYN_Single

Are you or your spouse blind?____Y____N____Y____N___Married

Dependent on another return?____Y____N____Y____N___Separated as of ______Date

___Divorced as of ______Date

DEPENDENT CHILDREN

(If dependent is a COLLEGE STUDENT, include tuition statement from bursar / finance office. See page 3.)

(If dependent ALREADY FILED A TAX RETURN, include a copy of dependent’s tax return.)

Name

/ Social Security# /

Birthdate

/ Relationship / Student (Y/N) / College Grade Levelas of 12/31/16(see page 3) / ChildcareCost
(see page 4 to list childcare information)
$
$
$
$

OTHER INDIVIDUALS RESIDING IN YOUR HOMEOROTHER DEPENDENTS

Name

/ Social Security # / Birthdate / Relationship / Dep’s own income / $ Support
by you / $ Support
by others / # Months
in home
$ / $ / $ / #

Include the following documents with your information.

All W2’s‘FINAL PAYSTUB’

 All 1099 INT, DIV, MISC, R, etc.

 All 1099 SSA, 1099 RRB

 All 1099 B - Sale of Stocks/Mutual Funds

 All 1098 Mortgage Interest, 1098-T, 1098-E

 All K-1’s (Partnerships, Corporations, Etc.)

HEALTH INSURANCE (Form 1095 A, B, C)

 Health Savings Account (HSA) Year End Statements

 529 Education Account Year End Statements

 Property & Personal Real Estate Tax Bills

Settlement Sheets –Purchase &/or Sale of Home, Rental

 Stocks/Mutual Funds Purchase Information

 Investment Year End Statements

 Student’s Itemized College Financial Statement

 Student &/or DependentTax Return if ‘self-prepared’

Home Energy Improvements Paperwork & Receipts

______

If you have a tax refund, do you want the refund applied to next year’s estimated taxes? ___Y ___N
Did you receive any tax adjustments or correspondence from IRS /or State? ___Y ___N (Include copy)
Do you have HEALTH INSURANCE? ___Y ___N(If yes, complete blue medicalform)
Did you give a gift of more than $14,000 to one or more people? ___Y ___N
Did you contribute to a 529 College Education Savings Account? ___Y ___N(Include Year-End Statements)
Did you make any home improvements that qualify for an energy credit? ___Y ___N (Include Paperwork)
Do you have a foreign bank account, foreign trust, or foreign business? ___Y ___N
Did you withdraw money or write checks from a mutual fund? ___Y ___N
Do you provide a home for or help support anyone not listed above? ___Y ___N
Do you have 1099 info FOR US TO COMPLETE?See our website for 1099 requirements. ___Y ___N (Separately give to us before 1/31)
Do you have:Self-employment or hobby income? ___Y ___N

Rental income from real estate or other property?___Y ___N (See page 3)

Farm income from animals, crops, or subsidies? _Y _N

Income from timber, minerals, oil, gas, copyrights, patents? ___Y ___N

Total Purchases /Services (internet, out of state, etc.) for which no PA Sales Tax was paid. $______

ThisIncome Tax Data Organizer assists the taxpayer & preparer to EXPEDITE your income tax return.

Page 2____

ESTIMATED TAX PAYMENTS

(Please Provide Check # AND Date of Check)

Prior Year Credit
(We will fill in.) / First Quarter
(due 4/15/16) / Second Quarter
(due 6/15/16) / Third Quarter
(due 9/15/16) / Fourth Quarter
(due 1/15/17) / TOTALS
$$ Amount

Check # / Date Paid

/ $$ Amount

Check # / Date Paid

/ $$ Amount

Check # / Date Paid

/ $$ Amount

Check # / Date Paid

Federal / $ / $ / $ / $
Ck# / Ck# / Ck# / Ck#
State / $ / $ / $ / $
Ck# / Ck# / Ck# / Ck#
Local / $ / $ / $ / $
Ck# / Ck# / Ck# / Ck#

INTEREST INCOME

(Include Form(s) 1099-INT)

Payer / Amount
$
$
$
$
$
SELLER FINANCED
Payer Name: / $
Address:
Social Security #:

DIVIDEND INCOME

(Include Form(s) 1099-DIV)

Payer / Ordinary Div / Cap Gn Div
$ / $
$ / $
$ / $
$ / $
$ / $
$ / $
TAX EXEMPT INCOME
$ / $
$ / $
$ / $

INVESTMENTS SOLD

(Include Form(s) 1099-B AND Year End Statements)

# of Shares / Investment / Date Acquired / Date Sold / Sales Price /

Cost

$ / $
$ / $
$ / $
$ / $

PENSION, SOCIAL SECURITY, IRA, ANNUITY

(Include Form(s) 1099-R, 1099-SSA, 5498, AND Year End IRA Statements)

T =Taxpayer or S =Spouse

Recipient
T or S / Payer / Amount / ROLLOVER TO / WAS IRA USED FOR
Traditional / Roth IRA / Education / First Home / Medical
$ / $ / $ / $ / $ / $
$
$
$
T / Social Security / $
S / Social Security / $
2016 IRA
(You Made ORWill Make by 4/15/17)
Contribution Max $5,500 / Age 50 & Older $6,500 / SALE OF PROPERTY
(Include Form(s) 1099-S Settlement Sheetsfor Original Purchase & Sale of Property)
Traditional / Roth / Land, Primary or Vacation Home / Date Acquired / Purchase Price
+ Improvements
Taxpayer / $ / $ / $
Spouse / $ / $ / $

______Page 3

RENTAL INCOME

Property #1 / Property #2 / Property #3 / Property #4 / K-1 INCOME
Description / (S-Corporations, Partnerships, Estates, Etc.)
Address /

OTHER INCOME

Income (Gross Rent)

/ Alimony Received
$______
*Did you pay $600+ to any person for services, rent, etc. during the year?
(IF YES, see Page 1, Q 10) / __Yes __No / __Yes __No / __Yes __No / __Yes __No / Commissions / Fees
$______
Advertising / Jury Duty Who Received?
Auto & Travel / $______T____ S____
Cleaning & Maintenance / Tax Refunds
CommissionsFees / State $______
Insurance / Local $______
Legal Fees / Accounting
Mortgage Interest / Unemployment (Include Form 1099G)
Other Interest / $______
Repairs
Supplies / Royalties
Taxes / $______
Utilities
Improvements / Lottery / Gambling Winnings
# Travel Miles for Rental / $______
Other______
What % of property did you occupy during 2016? / % / % / % / % /

ALIMONY PAID

If vacation home, # of days YOU occupied in 2016? / Days / Days / Days / Days / To ______
SS#______
Did you actively participate in the operation of rental? / __Yes __No / __Yes __No / __Yes __No / __Yes __No / Amount $______

EDUCATION EXPENSES PAID IN 2016 FOR COLLEGE, GRAD SCHOOL, ETC.

Student

/ Institution /

Tuition

Date Paid

Required Fees

(Enrollment &Books) / Scholarships Received
$ / $ / $
$ / $ / $

PLEASE INCLUDE tuition statement from bursar / finance office.

PLEASE INCLUDE student loan interest paid. $______(Include Form(s) 1098-E)

MEDICAL / DENTAL PAID BY YOU IN 2016 / TAXES PAID BY YOU IN 2016
Expense Type / Taxpayer / Spouse / Real Estate Taxes (MAIN HOME)
Medical Insurance / $ / $ / County / Township / $
Medicare Insurance / $ / $ / School / $
Long Term Care Insurance / $ / $ / Real Estate Taxes (2nd / OTHER HOME)
Prescriptions / $ / $ / County / Township / $
Doctor / Dentist / Orthodontist / Etc. / $ / $ / School / $
Eyeglasses / Medical Aids / Etc. / $ / $ / Personal Taxes
Hospitals / Ambulance / $ / $ / County / $
Nursing Home / Skilled Care / $ / $ / Township / $
LESS: Insurance Reimbursements / $ / $ / Other (OPT, LST, Etc.) / $
Total Miles To / From Medical Care / # / # / Sales Tax – Vehicle / Boat (include bill of sale) / $

Page 4

INTEREST EXPENSE

Paid to Bank(Attach Form(s) 1098)

Mortgage Interest$______

Home Equity Loan Interest$______

Interest Paid to Individual for home$______

Individual’s Name______

Address______

Social Security # ______

Refinance: Loan Date ______# of Years______

(Please include Refinance Settlement Documents)

UNREIMBURSED EXPENSES

YOU PAID AS A W-2 EMPLOYEE

Please list ALL expenses incurred AND any reimbursements

TaxpayerSpouse

Union Name______#______

Business Supplies______

Tools, Equipment, Safety Equipment______

Uniforms, (include cleaning)______

Other -______

Travel -# Days away from home______

Airfare, Train, etc.______Lodging______Taxi, Car Rental, etc. ______

Rental Car -Gas Expense______

Meals & Entertainment – Actual______

REIMBURSEMENT from Employer______

PERSONAL VEHICLE BUSINESS MILEAGE

Do you have written records? ______Yes _____No

Taxpayer Spouse

Vehicle Make/Year______

Date Vehicle Purchased______

Total Miles(personal + business)**______

Business Miles(should be less than total)______

Round Trip Commuting Miles______

Interest Paid on Vehicle Loan______

Lease Payments on Vehicle______

Parking & Tolls______

Gas/Oil/Repairs(actual records)______

Insurance Paid for Year______

REIMBURSEMENT from Employer______

** MILEAGE VERIFICATION (check all that apply to you)

-Maintenance/Repair Records ______Yes _____No

-Mileage Log______Yes _____No-Year End Odometer Reading______Yes _____No

CHARITABLE CONTRIBUTIONS

(List the name of each charity for cash contributions over $3,000

ANDnon-cash contributions over $500)

Church ______$______

Other Cash______$______

Non-Cash (under $500 – Fair Market Value)$______

Other Non-Cash______$______

Non-Cash (over $500) ______$______

Charitable Miles#______miles

HOME OFFICE EXPENSE

Total Square Feet of Home______sq. ft.

Square Feet Used for Business______sq. ft.

Insurance$______

Maintenance/Repairs$______

Rent$______

Utilities

Garbage$______Water/Sewer$______

Electric$______Other-______$______

Oil$______Other-______$______

Provide the following(IF you did not previously provide)

Purchase Price + Renovations$______

Date of Purchase ______

INVESTMENT EXPENSES

Tax Preparation Fee$______

Safe Deposit Box Rental$______

Mutual Fund Fees$______

IRA Maintenance Fee(out of pocket)$______

Investment Counselor$______

Penalty Fee(Early Withdraw - Savings)$______

CHILDCARE PROVIDER INFORMATION

Provider’s Name______

Address ______

Social Security #______or E.I.N.______

Child/Children cared for: ______

Amount Paid $______



Provider’s Name______

Address ______

Social Security #______or E.I.N.______

Child/Children cared for: ______

Amount Paid $______

REIMBURSEMENT from Employer $______

To the best of my knowledge, the enclosed information is correct and includes all income, deductions, and other information authorizing the preparationof this year’s tax return for which I have adequate records.

______Date______

Signature Required

______Date______

Signature Required

Thank you! We look forward to serving you!

2000 Income Tax Data Organizer

PERSONAL INFORMATION

Occupation

Cell Phone #

Taxpayer

Township

Give $3 to Presidential Campaign? ____Y____N____Y____N___Single

DEPENDENT CHILDREN

Name

Birthdate

Name

Farm income from animals, crops, or subsidies? ___Y ___N

Check # / Date Paid

Check # / Date Paid

Check # / Date Paid

Check # / Date Paid

Cost

OTHER INCOME

Income (Gross Rent)

ALIMONY PAID

Student

Tuition

Date Paid

Required Fees

CHARITABLE CONTRIBUTIONS

Give $3 to Presidential Campaign? __YNYN_Single

Farm income from animals, crops, or subsidies? _Y _N