Web Site www.BobLindgren.com Bob Lindgren Tax Service Your Name: ______

200 W 98TH ST #101

BLOOMINGTON, MN 55420

952-881-7053 fax 952-884-0588

Dear Client:
Bring in a copy of your 2010 property tax statement if you owned your home in 2009 (which was mailed last March). You will need the
statement for a property tax refund. I am required to inform you that: Although Banks & Credit Card companies may sell your information
to others, which is not my policy. PLEASE NOTE THAT YOUR INFORMATION IS CONFIDENTIAL. (I may give your telephone #
out to your friend) DO NOT HAVE THIRD PARTIES CALL ME ABOUT YOUR TAX INFORMATION UNLESS YOU TALK TO
ME FIRST. As usual, I expect the tax season to be extremely hectic and busy. Call ahead with your questions. As many of you know, I
receive a number of telephone calls while prepare I your taxes. Sometimes it can be irritating, but it is the most effective way to serve you
best. List all employers, bonuses, and awards received on 1099s and w2gs on a separated piece of paper.
BOB LINDGREN

In order to claim day care expenses you must include the following:
Amount for each child. (Yes… we now need the amount of each child)

Name of daycare provider / Address/ Zip Code / Identification # / Amount Paid
1. / $______
2. / $______
3. / $______

DOES YOU EMPLOYER PROVIDE YOU WITH A DAY CARE BENEFIT PLAN? YES NO

RENTAL PROPERTY / HOUSE #1 / HOUSE #2 / BUSINESS EXPENSES FOR SALES/ SELF EMPLOYED
HUSBAND
BUSINESS #1 / WIFE
BUSINESS #2
RENT RECEIVED / $______/ $______/ REVENUE/SALES? / $______/ $______
Auto/Travel / $______/ $______/ Advertising / $______/ $______
Cleaning / Maintenance / $______/ $______/ Bank Charges / $______/ $______
Insurance / $______/ $______/ Commissions/ Paid out / $______/ $______
Legal / Professional / $______/ $______/ Dues / Publications / $______/ $______
Mortgage Interest / $______/ $______/ Entertainment / Meals / $______/ $______
Other Interest / $______/ $______/ Other Entertainment / $______/ $______
Repairs / $______/ $______/ Freight & UPS / $______/ $______
Supplies / $______/ $______/ Insurance / $______/ $______
Property Taxes / $______/ $______/ Interest / Business / $______/ $______
Utilities / $______/ $______/ Laundry / Cleaning / $______/ $______
Wages / $______/ $______/ Legal / Professional / $______/ $______
FHA MIP / $______/ $______/ Office Supplies / $______/ $______
Garbage / Sewer / $______/ $______/ Rent / $______/ $______
Improvement / $______/ $______/ Repairs / $______/ $______
Other (List) / $______/ $______/ Supplies / $______/ $______
AUTO EXPENSE
ONLY IF YOU USE CAR FOR BUSINESS / Travel out of town / $______/ $______
Utilities / Telephone / $______/ $______
Car #1 / Car #2 / Education / Seminars / $______/ $______
Make and Model / ______/ ______/ Health Insurance / $______/ $______
Date Purchased / ______/ ______/ Pay Phones / $______/ $______
Beg. Odometer 1/1/10 / ______/ ______/ Cell Phones / $______/ $______
End. Odometer 12/31/10 / ______/ ______/ Internet / Business / $______/ $______
Total Miles in 2010 / ______/ ______/ INVENTORY Beg/End / $______/ $______
Business Miles 2010 / ______/ ______/

OFFICE IN HOME

/ #1 / #2
Commuting Miles / Day / ______/ ______/ Total Square Footage / ______/ ______
License Tabs / $______/ $______/ Mortgage Interest / $______/ $______
Gas / Oil / Washes / $______/ $______/ Electricity / $______/ $______
Auto Club / $______/ $______/ Gas/Heat/Water / $______/ $______
Auto Insurance / $______/ $______/ FHA MIP / $______/ $______
Repairs / $______/ $______/ Real Estate Taxes / $______/ $______
Vehicle rent/ lease / $______/ $______/ Repairs / $______/ $______
Auto Interest / $______/ $______/ Insurance / $______/ $______
Parking / Meters / Tolls / $______/ $______/ Improvements / $______/ $______
Other / $______/ $______/ Other / $______/ $______
$______/ $______

Attn: Auto sales and finance people: List income and source of money received that is listed on a 1099. AND MENTION THE

AMOUNT TO THE TAX PREPARER AND VERBALLY CONFIRM THAT IS INCLUDED ON THE TAX RETURN. DOCUMENTATION

IS NEEDED FOR ALL EXPENSES BY THE GOVERNMENT.

TURN OVER PAPER

Name______/ Social Security #______/ Birth Date ______
Spouses Name______/ Social Security #______/ Birth Date______
Address______/ Home Telephone #______/ Work # ______


1. Are you or you spouse 65 or older? Yes No Disables? Yes No

2. Do you have any additional dependents/children for this tax year (2010)? Yes No

3. Lose any dependents in 2010? Yes No

4. ALL DEPENDENTS NEED A SOCIAL SECURITY NUMBER. List dependents name, Social Security #, Birth Date, & Age in 2004.

FULL NAME / SOCIAL SECURITY # / BIRTH DATE / AGE

1. ______

2. ______

3. ______

4. ______

Any children or relatives (NOT YOU DEPENDENTS) Live in your household? YES NO ______

INCOME THAT IS NOT TAXABLE BUT MAY HAVE TO BE REPORTED ON TAX RETURN

Tax Exempt Interest______( Do not include IRA interest) Workers Compensation______

IRA Received______Rolled Over?______

WAGES: ATTACH OR BRING IN W-2S AND 1099S
Interest Received / Husband / Wife / Social Security / H______/ W______
Bank Name / Unemployment
Comp. / H______/ W______
______/ H______/ W______/ Alimony / H______/ W______
______/ $______/ $______/ Pensions Received / H______/ W______
______/ $______/ $______/ $ Sale of stock/date / $______/ $______
Dividends Received / $______/ $______/ Stock Purchase Price / $______/ $______
______/ $______/ $______/ $______/ $______
______
MEDICAL
DEDUCTIONS / HUSBAND
or #1 / WIFE
or #2 / INTEREST & HOUSE
DEDUCTIONS / HUSBAND
or #1 / WIFE
or #2
Drugs and Medical / $______/ $______/ Points to buy House / $______/ $______
Medical Insurance / $______/ $______/ Real Estate Taxes / $______/ $______
Medical Car Miles / H______/ W______/ Mortgage Interest / $______/ $______
Other (LIST) / $______/ $______/ Contract/ Deed Interest / $______/ $______
Long Care Medical Ins. / $______/ $______/ Investment/Margin Int. / $______/ $______

CONTRIBUTIONS

/ $______/ $______/ List Other Deductions / $______/ $______
Church/Synagogue / $______/ $______/ Student Loan Interest / $______/ $______
Other / $______/ $______/ For you or dependents / $______/ $______
Non Cash (Clothes) / $______/ $______/ Seasonal real estate tax / $______/ $______
Contributions / $______/ $______/ Auto License tabs / $______/ $______
SALES TAX PAID ON CAR OR BOAT ______
Education/Seminars / $______/ $______/ Children school/Public / $______/ $______
College Expenses / $______/ $______/ Private expenses K-12 / $______/ $______
Investment Expenses / H______/ W______/ Uniforms / $______/ $______
IRA Custodial Fees / $______/ $______/ Uniform Cleaning / $______/ $______
Occupation License / $______/ $______/ Union Dues / $______/ $______

Professional Subscription

/ $______/ $______/ Work Tools / $______/ $______
Safety Deposit Box / $______/ $______/ Moving Expenses / $______/ $______

TAX PREP FEES

/ $______/ $______/ Motels / $______/ $______
Job Seeking Expenses / $______/ $______/ U-Haul: Truck / $______/ $______
Alimony Paid / $______/ $______/ Other (List) / $______/ $______
Entertainment / $______/ $______/ Forfeited Interest / $______/ $______
Did you convert to a Roth? / $______/ IRA DEDUCTIONS / $______/ $______
______
Date & Amount paid in 2010 Estimated Taxes. Bring in cancelled checks.
FEDERAL (IRS) 1.______2.______3.______4.______
MN & OTHER STATES 1.______2.______3.______4.______
Amount applied to 2010 estimated taxes from 2009 refund FEDERAL______MN______
Amount of State refund received last year. $______Paid $______
Property tax refund received last year. $______
Number of miles you drove to second job or seeking employment. ______Miles
DID YOU BUY A HOUSE LAST YEAR? YES/NO SELL A HOUSE? YES/NO BRING IN CLOSING PAPERS.
Bring in copy of 2010 property tax statement that you received last year.
BRING IN ANY DOCUMENTS OR PAPERS THAT MAY HELP TO COMPLETTE YOUR TAXES!
TURN OVER PAPER