TAX YEAR 2017

CLIENT TAX ORGANIZER

INSTRUCTIONS

Dear Tax Client: Do not send your tax information until you have completed this organizer and have all of your tax info. to send. We will not accept or store partial information.

Thank you for allowing us to prepare your tax returns for tax year 2017. Please read and follow these instructions carefully. Failure to do this will delay the completion of your tax return and result in an inaccurate result. If you are sending your child’s tax info., they must complete & sign their own organizer. WARNING: No signed organizer, No tax preparation!!!

1.  Fill in only the areas that apply to you. Fill in all personal information even if you are a previous client.

2.  Include all tax documents that you received for the tax year (W2s, 1099 Misc., 1099 Int., 1099 Div., etc.)

3.  For PA Clients Only - Include your local tax return forms that you receive in the mail. We have all federal and state forms in our office.

4.  If you moved during the year we need your moving date as well as your old and new addresses.

5.  Do not send all your receipts for expenses. Send us a list of your expenses and group them in categories. We need to know that you have receipts for your expenses and may ask to verify them; but we do not keep them on file in our offices.

6.  If you have a ministerial housing allowance did you spend it all? If not, how much did you have left over above your housing costs?

7.  For auto expenses be sure to include a description of the auto, business miles, commuting miles, personal miles, and purchase date of each vehicle for which you are claiming mileage. Please separate your mileage for each vehicle. Do not send us just one mileage figure for all vehicles!

8.  If you have honoraria or other self-employed income, list it separately. List your expenses incurred due to this self-employment income separately from other employee expenses.

9.  List your federal, state, and local estimated tax payments that you made for the tax year along with the dates that you made the payments.

10.  Please sign the organizer (both husband & wife) at the signature lines to certify that the information that you are providing us is accurate and that you have receipts or other documentary evidence to support your income and expense

11.  You must complete the Healthcare Worksheet page as completely as possible or your taxes will be delayed. We will not prepare your taxes without this info. required on that page.

12.  You must include a copy of your driver’s license or photo page of passport (both husband and wife) along with the signed organizer.

2017 CLIENT TAX ORGANIZER

Please complete this Organizer before mailing us your information or arriving for your appointment.

1.  Personal Information
Name / Soc. Sec. No. / Birth Date / Occupation / Work Phone
Taxpayer
Spouse
Street Address / City / State / Zip / Home Phone
County / Boro or Township / School District / Municipality
Email Address

Taxpayer Spouse Martial Status

Blind □ Yes □ No □ Yes □ No □ Married Will file jointly □ Yes □ No

Disabled □ Yes □ No □ Yes □ No □ Single

Pres. Campaign Fund □ Yes □ No □ Yes □ No □ Widow(er), Date of Spouse’s Death ______

2.  Dependents (Children & Others)
Name (First, Last) / Relation-ship / Birth Date / Soc. Sec. No / Months Lived With You / Disabled / Full Time Student / Dependent’s Gross Income

Please provide for your appointment

-  Last Year’s tax return (new clients only) - All statements (W-2s, 1098s, 1099s, etc)

-  Name and address label (from government booklet or card)

Please answer the following questions to determine maximum deductions:

1. Are you self-employed or do you receive hobby income?

2. Did you receive income from raising animals or crops?

3. Did you receive rent from real estate or other property?

4. Did you receive income from gravel, timber, minerals, oil, gas, copyrights, or patents?

5. Did you withdraw or write checks from a mutual fund?

6. Do you have a foreign bank account, trust, or business?

7. Do you provide a home for or help support anyone not listed in Section 2 above?

8. Did you receive any correspondence from the IRS or State Dept. of Taxation?

9. Were there any births, deaths, marriages, divorces or adoptions in your immediate family?

□ Yes □ No

□ Yes □ No

□ Yes □ No

□ Yes □ No

□ Yes □ No

□ Yes □ No

□ Yes □ No

□ Yes □ No

□ Yes □ No

10. Did you give a gift of more than $14,000 to 1 or more people?

11. Did you have any debts cancelled, forgiven, or refinanced?

12. Did you go through bankruptcy proceedings?

13. If you rented, how much did you pay?

Was heat included?

14. Did you pay interest on a student loan for yourself, spouse, or dependent during the year?

15. Did you pay expenses for yourself, spouse, or dependent to attend classes beyond high school?

16. Did you have any children under age 19 or 19 to 23 year old students with unearned income of more than $1,050?

17. Did you purchase a new alternative technology vehicle or electric vehicle?

18. Did you own $50.000 or more in foreign financial assets?

□ Yes □ No

□ Yes □ No

□ Yes □ No

______

□ Yes □ No

□ Yes □ No

□ Yes □ No

□ Yes □ No

□ Yes □ No

□ Yes □ No

3.  Wage, Salary Income

ATTACH W-2s:

Employer Taxpayer Spouse

______□ □

______□ □

______□ □

______□ □

______□ □

______□ □

4. Interest Income

ATTACH 1099-INT, Form 1097-BTC & Broker Statements

Payer Amount

5. Dividend Income

From Mutual Funds & Stocks – ATTACH 1099-DIV

Capital Non-

Payer Ordinary Gains Taxable

6. Partnership, Trust, Estate Income

List payers of partnership, limited partnership, S-corporation, trust, or estate income. ATTACH K-1

______

______

7. Property Sold

ATTACH 1099-S and closing statements

Property / Date Acquired / Cost & Imp.
Personal Residence*
Vacation Home
Land
Other

*Provide information on improvements, prior sales of home, and cost of a new residence. Also see Section 17 (Job-Related Moving).

8. I.R.A. (Individual Retirement Acct.)

Contributions for tax year income

√ for

Amount Date Roth

Taxpayer
Spouse

Amounts withdrawn. ATTACH 1099-R & 5498

Reason for

Plan Trustee Withdrawal Reinvested?

□ Yes □ No

□ Yes □ No

□ Yes □ No

□ Yes □ No

9. Pension, Annuity Income

ATTACH 1099-R

Reason for

Payer Withdrawal Reinvested?

□ Yes □ No

□ Yes □ No

□ Yes □ No

□ Yes □ No

Provide statements from employer or insurance company with information on cost of or contributions to plan.

Did you receive: Taxpayer Spouse

Social Security Benefits □ Yes □ No □ Yes □ No

Railroad Retirement □ Yes □ No □ Yes □ No

ATTACH SSA 1099, RRB 1099

______

______

10. Investments Sold

Stocks, Bonds, Mutual Funds, Gold, Silver, Partnership interest – ATTACH 1099-B & confirmation slips

Investment / Date Acquired/Sold / Cost / Sale Price
/
/
/
/
11.  Other Income
14.  Taxes Paid

List All Other Income (including non-taxable)

Alimony Received ______Child Support ______

Scholarship (Grants) ______

Unemployment Compensation (repaid) ______

Prizes, Bonuses, Awards ______

Gambling, Lottery /expenses ______

Unreported Tips ______

Director/ Executor’s Fees ______

Real Property Tax (attach bills) ______

Personal Property Tax ______

Other______

15.  Casualty/ Theft Loss

For property damaged by storm, water, fire, accident, or stolen.

Location of Property______

______

Commissions ______

Jury Duty ______

Description of Property ______

Worker’s Compensation ______Veteran’s Pension ______

Other Federally Declared

Disaster Losses

Disability Income ______

Amount of Damage ______

Payment from Prior Installation Sale ______

State Income Tax Refund ______

Clergy Honoraria ______

Other______

Insurance Reimbursement ______Repair Costs ______

Federal Grants Received ______

16.  Charitable Contributions
12.  Medical / Dental Expenses

Medical Insurance Premiums

(Paid by you) ______

Prescription Drugs ______

Insulin ______

Eye Glasses, Contacts ______

Hearing Aids, Batteries ______

Braces ______

Medical Equipment, Supplies ______

Nursing Care ______

Medical Therapy ______

Hospital and Nursing Home ______

Doctor/Dental/Healthcare Professional ______

Lodging ______

Mileage (no. of miles) ______

Church Amount

______

______

______

______

______

______

______

______

Other

______

______

Non Cash

______

Volunteer (no. of miles) ______@ .14 ______

*Provide detail if over $5000.00 is paid to any organization.

13.  Interest Expense

Mortgage Interest Paid (ATTACH 1098) ______

Interest paid to individual for your home

(include amortization schedule) ______

Paid to :

Name ______

Address ______

______

Social Security No. ______

Investment Interest ______

Premiums paid or accrued for qualified mortgage insurance ______

17. Moving Information

Did you move in 2017?______Date of move ______

If yes:

Previous address______

County/School District/ Municipality ______

Current address______

County/School District/ Municipality ______

18. Child & Other Dependent Care Expenses
Name of Care Provider / Address / Soc. Sec No. or Employer No. / Amount Paid

Also complete this section if you receive dependent care benefits from your employer.

**COMPLETE either Actual or Standard Deduction.

19. Job-Related Moving Expenses

Date of move ______

Move Household Goods ______

Lodging during Move ______

Miles from old home to old workplace ______

Miles from old home to new workplace ______

______

23. Business Mileage/Actual Cost Meth.

Do you have written records? □ Yes □ No

Did you sell or trade in a car used for business? □ Yes □ No

If yes, attach copy of purchase agreement.

Make/ Year Vehicle ______

Date purchased ______

20. Employment Related Expenses That You Paid (Not self-employed)

Dues – Union, Professional ______

Books, Subscriptions, Supplies ______

Licenses ______

Tools, Equipment, Safety Equipment ______

Uniforms (including cleaning) ______

Sales Expense, Gifts ______

Tuition, Books (work related) ______

Entertainment ______

Office in home:

a) Total Home ______

Square Ft b) Office ______

c) Storage ______

Rent ______

Total Miles (personal & business) ______

Business miles (not to and from work) ______

From first to second job ______

Education (one way, work to school) ______

Job Seeking ______

Other Business ______

Round Trip commuting distance ______

Gas, Oil, Lubrication ______

Batteries, Tires, etc. ______

Repairs ______

Wash ______

Insurance ______

Interest ______

Lease Payments ______

Garage Rent ______

Insurance ______

Utilities ______

Other ______

* Please label “T” for taxpayer, “S” for spouse on each item.

24. Auto Mileage Record/Standard Deduction Method
VEHICLE 1
Description: / VEHICLE 2
Description:
Date placed in service: / Date placed in service:
Total mileage
Business mileage
Commuting mileage
Personal Mileage
21. Investment-Related Expenses

Tax Preparation Fee ______

Safe Deposit Box Rental ______

Mutual Fund Fee ______

Investment Counselor ______

Other ______

22. Business Travel

If you are reimbursed for exact amount, give total expenses.

Airfare, Train, etc. ______

Lodging ______

Meals (no. of days ______) ______

Taxi, Car Rental ______

Other ______

Reimbursement Received ______

25. Estimated Tax Paid/not W2 amounts

Date Paid Federal State Local

26. Education Expenses

Student’s Name Type of Expense Amount

______

______

______

______

______

______

28. For Ministers Only

Designated Housing Allowance $______

Amount of Housing Allowance Actually Spent $______

If you lived in a Parsonage – Fair Rental Value (FRV) of the Church

Parsonage $______

Unreimbursed Professional Expenses (DO NOT SEND RECEIPTS/

Just give category totals)

Professional Dues ______

Travel ______

Books ______

Subscriptions ______

Gifts ($25/personal/year limit) ______

Supplies ______

Religious Materials ______

Entertainment ______

Education ______

Other ______

27. Other Deductions

Alimony Paid to ______

Social Security No. ______

Student Interest Paid $______

Health Savings Account Contributions $______

Archer Medical Savings Acct. Contributions $______

29. Healthcare Insurance Coverage

Enter the name, SSN/DOB and health insurance status for each person claimed on your return in the table below regarding the health insurance reporting requirements which began in 2014.

Name of covered Individual(s) / SSN/DOB / Covered All 12 Months / Exchange Policy / Exemption Received / Jan / Feb / Mar / Apr / May / Jun / Jul / Aug / Sep / Oct / Nov / Dec

Use this worksheet to list the names of individuals listed on the income tax return and their health care insurance coverage status. It will help you tax preparer determine who has health insurance coverage, who may have an exemption, and who may be subject to the individual shared responsibility payment.

Beginning in 2014, most individuals are required to have:

§  Minimum Essential Coverage (MEC*), or

§  An Exemption from the responsibility to have minimum essential coverage, or

§  Make a Shared Responsibility Payment.

Minimum Essential Coverage includes employer-sponsored coverage, health insurance purchased through the Health Insurance marketplace (Exchange), Medicare, Medicaid, certain VA coverage, Tricare, Etc.

If you purchased a health insurance policy from an exchange (or market place), check the Exchange Policy box above. You will receive Form 1095-A from the exchange that issued your policy. Please provide us with this form.

Also if you received a 1095 B or C form, please include it with this organizer.

WE CANNOT BEGIN TO PROCESS YOUR TAXES WITHOUT THIS NECESSARY

HEALTHCARE INFORMATION, INCLUDING YOUR 1095 A, B, OR C.

** Beginning January 1, 2011 we must efile all tax returns unless you opt out.

□ Yes □ No Do you wish to opt out of efiling? If yes, you must complete and ATTACH OPT OUT form.

30. Direct Deposit of Refund / or Savings Bond Purchase

Would you like to have your refund (s) directly deposited into your account? □ Yes □ No

(The IRS will allow you to deposit your federal tax refund into up to three different accounts. Please provide the following information.)

BANK ACCOUNT:

Owner of Account □ Taxpayer □ Spouse □ Joint

Type of Account □ Checking □ Traditional Savings □ Traditional IRA □ Roth IRA

Name of financial Institution ______

Financial Institution Routing Transit Number (if known) ______

Your Account Number ______