2015 Carteret Financial Returning Client Organizer
265 Washington Avenue, Carteret NJ 07008
732 541-6550 phone 732 541-9410 fax
(website to download forms)
(email address to send documents)
GENERAL INFORMATION
Client Name______Spouse______Phone______
1. Did you marital status change during the year?...... YES NO
If yes, explain ______
2. Did your address change? ...... YES NO
New address ______Date of change______
3. Please provide your current email addresses for us even if we have one on file.
Taxpayer EMAIL ______Spouse EMAIL______
4. Would you like your refund direct deposited?...... YES NO
____ Use bank account information on file for fill in new information below.
Bank Acct number______Routing number ______
Name of Bank ______Savings ______or Checking ______
5. Have you or your spouse been a victim of identity theft? ...... YES NO
If yes, provide the six digit identity pin provided by IRS. Taxpayer ______Spouse______
6. Did you rent in the state of NJ in 2015? YES NO
Amount of rent paid actually paid______If you shared rent, name of the person you share with______
CHILDREN AND DEPENDENTS
If you claim someone as a dependent, they CANNOT claim themselves on their own tax return.
1. Are you claiming any new dependants this year? ...... YES NO
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2. Were any dependent children over age 18 full time students for a semester?...... YES NO
If yes, must include form 1098T or 1098Q from college and fill in info on pg 2. (Do not include room and board)
Student Name______Tuition Paid ______Books and Supplies Required for courses ______
Student Name______Tuition Paid ______Books and Supplies Required for courses ______
3. Did any dependent child over age 18 have an income of less than $4000.00?...... YES NO
4. Did any dependent child age 18 or under have investment income more than $1050?...... YES NO
5. Are you claiming a dependent child that did not live with you for at least 1/2 the year?...... YES NO
If yes, include form 8332 if someone else is the custodial parent.
6.Did you pay over 50% support for adult living with youearning less than $4000?...... YES NO
If yes,list information above in dependent information QUESTION 1.
7. Did you pay childcare/eldercare expense for your custodial child or dependent adult?...... YES NO
If yes, provide information below.
1.Circle one Custodial child/Dependent Adult Name ______Amount Paid ______
Provider Name if not on file______Provider Address ______
Federal ID or SS # of provider if not on file______
2.Circle one Custodial child/Dependent Adult Name ______Amount Paid ______
Provider Name if not on file ______Provider Address ______
Federal ID or SS # of provider if not on file______
INCOMEINFORMATION
1. WAGES-Did you or your spouse any? If yes, include all W-2 forms...... YES NO
2. NON-EMPLOYEE COMPENSATION- Did you or your spouse have any? ...... YES NO
If yes, include all 1099-MISC forms and refer to our website for a schedule C worksheet to help you. We need to
know what business expenses you incurred to offset your income
3. DISABILITY INCOME- Did you or spouse have nay disability income, other than state disability?....YES NO
If yes, include 1099 or W-2 form. This information may be included on your W2.
4.GAMBLING INCOME-Did you or spouse have any gambling income?If yes, include W-2G ...... YES NO
*Write off your losses up to the amount of your winnings, please give documentation such as profit/loss statement from casinos.
5. INTEREST INCOME- Did you or spouse have any?If yes, provide 1099-INT statements...... YES NO
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6. DIVIDEND INTEREST- Did you or spouse have any? If yes, provide 1099-DIV statement...... YES NO
7. SOCIAL SECURITY OR RAILROAD RETIREMENT BENEFITS - Did you or your spouse have any?...... YES NO
If yes, provide SSA-1099 pr RRB-1099.
8. UNEMPLOYMENT -Did you or your spouse collect unemployment?...... YES NO
If yes, provide 1099-G. (download from state website if you live in NJ
9. CANCELLATION OF DEBT- Did you or your spouse have any cancellation of debt?...... YES NO
If yes, provide from 1099-C ......
10. HSA DISTRIBUTIONS If yes, obtain form from your employer...... YES NO
11. EDUCATION SAVINGS ACCOUNTS OR QUALIFIED TUITION PROGRAM DISTRIBUTION?...... YES NO
If yes, provide form 1099-Q
12. LONG TERM CARE PAYMENTS? If yes, include form LTC...... YES NO
13. ALIMONY-Were any paid or received? (Child support is not taxable)...... YES NO
If yes, provide alimony amount received ______Alimony paid ______
Person receiving alimony ______Social Security number of person receiving alimony______
14. STOCKS, BONDS, OR INVESTMENT PROPERTY NOT IN A RETIREMENT ACCOUNT-Any sold? YES NO
If yes, we need the brokerage house's 1099-B. You need to make sure the 1099-B form lists the following:
Original cost of the investment. Date investment was purchased, Sale date, and the Sales proceeds for the investment.
Please contact your broker if any of the information is missing.
15. REFINANCE OR SELL (circle one) your principal home or second home in 2015? ...... YES NO
If yes, and a REFINANCE, include the settlement statement from the refinance of the home. (HUD statement)
If yes, and a SALE, we need the HUD statement from the sale and original purchase amount of the home and cost of improvements. Keep a list of the improvements in case of an audit.
Please answer questions below.
1. If yes and a SALE was this your main home? YES OR NO
2. If yes and a SALE did you ever rent out this property or use it as a business related home office? YES OR NO
3. If yes, and a SALE did you live in the house for two of the last five years? YES OR NO
4. If yes, and a SALE have you been widowed in the last two years?
5. If yes, and a SALE did you receive this house as part of a Like-Kind Exchange in the last 5 years? YES OR NO
16. TIP INCOME- Did you collect more than $20.00 in any given month? ...... YES NO
If yes, we need a log of tip income.
17.Did you receive interest in a Partnership, LLC, S Corporation, Estate, Trust of REMIC? ...... YES NO
If yes, please include K1 Statement
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18. IRA or Pension-Did you have any distributions? If yes, we need 1099-R form...... YES NO
19. FOREIGN INCOME-Did you or your spouse receive any? If yes, answer questions below...... YES NO
1. Did you have a foreign bank account with a balance in excess of $10,000 USD? (No extensions allowed)...... YES NO
2. Did you own any financial assets (including partnership interests, hedge funds and private equity funds) with a FMV in excess of $50,000 by 12/31/15 or in excess of $75,000 at any time during 2015? (Foreign stock held in US based brokerage account is excluded. However, foreign stock not maintained in a financial account is included)...... YES NO
ESTIMATED TAXES PREPAID IN ADVANCE
1. Did you prepay any estimated taxes? If yes, please list below ...... YES NO
PERSONAL DEDUCTIONS AND CREDITS
1. PROPERTY TAXES PAID OUT (must obtain for primary or rental property) ...... YES NO
This information can be found on your property tax bill or your mortgage statement.
Primary home property taxes ______address ______
Secondary home property taxes______address ______
Rental property taxes amount ______address ______
2. MORTGAGE INTEREST PAID -to a bank or a private party on a primary or secondary home...... YES NO
If yes, please provide form 1098 from your lender.
First Mortgage Name of Lender ______Amount of mortgage interest paid ______
Home Equity Name of Lender ______Amount of mortgage interest paid ______
Second Mortgage Other/Please specify______Amount of mortgage interest paid ______
3. MORTGAGE INSURANCE PAID (not the same as homeowners insurance)...... YES NO
If yes, tell us the amount if not on form 1098.
Amount of mortgage insurance ______
4. Did you purchase a new vehicle, boat, or aircraft?...... YES NO
If yes, enter the amount of sales tax paid ______
5.NON-CASH DONATIONS PAID- example- Goodwill, Lupus etc...... YES NO
If yes, we are required to get proof of all non-cash donations over $250.00. Please give us your forms that you received from
any charities stating the amount you donated in non-cash donations. Also, keep an itemized list of items donated.
6.CASH DONATIONS PAID...... YES NO
If yes, you must have written proof of every cash donation you made. Please give us an itemized list.
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7. EDUCATOR SUPPLIES PURCHASED ...... YES NO
If yes, how much? ______please keep documentation
8. STUDENT LOAN INTEREST PAID ...... YES NO
If you do not have form 1098-E, please download the information from lender website and provide the following.
Name of person with loan______Name of lender ______
Amount of student loan interest ______
9. ENERGY CREDIT- Did you purchase any doors, windows, furnaces, etc.?...... YES NO If yes, please include all invoices showing all purchases. If you incurred home improvement costs during 2015 you may be eligible for a tax credit. The improvements must be energy efficient related improvements including Solar, HVAC, insulation, roofing, siding, biomass stoves, water heater, windows, doors, skylights, geothermal heat pump, solar energy, wind energy, fuel cells. If you received an energy tax credit in 2013 or 2014 you may not qualify for 2015.
10.MEDICAL EXPENSES- any out of pocket? Use the chart below to help you calculate total...... YES NO*DO NOT INCLUDE MEDICARE PREMIUMS OR MEDICAL EXPENSES CALCULATED ON YOUR W2
Total Medical Expenses ______Please keep all documentation for backup.
Quick Tip- You do not need to keep each individual RX receipt, just obtain a printout from your pharmacy.
MISCELLANEOUS DEDUCTIONS
1.Did you pay out any of the following miscellaneous deductions?...... YES NO
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GIFT TAX RETURNS
1. Did you or your spouse give a gift of more than $14,000 to any one person?...... YES NO
If yes, you will be required to fill out a gift ta
AUTOMOBILE USE IN 2015
1. Did you use your automobile for business purposes?...... YES NO
BUSINESS INCOME AND EXPENSES
1. Do you have a business or have you started a new business?...... YES NO
You may download a schedule C worksheet from our website at to help you report income
and business expenses.
This QUESTIONNAIRE and ENCLOSED WORKSHEETS have been filled out accurately to the best of my (our) knowledge.
Taxpayer Signature:______Date:______
Spouse Signature:______Date:______