Neil I. Sidi, C.P.A.
450 Seventh Avenue-Suite 2304
New York, New York 10123-2304
Phone (212) 244-1040
Fax (212) 244-1044
Email:
TAX QUESTIONS FOR 2017FORM 1040:
LAST NAME: ______FIRST NAME______MIDDLE INITIAL___
SOCIAL SECURITY NUMBER: ___-__-____ DATE OF BIRTH__/__/__
FILING STATUS: CIRCLE ONE:SINGLEMARRIED
OCCUPATION: ______
IF MARRIED: SPOUSE'S NAME______
IS SPOUSE A U.S.A. CITIZEN? ___YES___NO
SPOUSE’S SOCIAL SECURITY NUMBER: ___-__-____.
SPOUSE’S DATE OF BIRTH ___/___/___
SPOUSE’S OCCUPATION: ______
LIST ANY CHILDREN AND THEIR SOCIAL SECURITY #’S & DATE OF BIRTH:
______
______
1-PERMANENT RESIDENCE ADDRESS: ______
______
______
______
2- TELEPHONE NUMBER (WORK): ______SPOUSE-WORK: ______
HOME NUMBER: ______
CELL NUMBER: ______SPOUSE-CELL: ______
FAX NUMBER: ______
WORK EMAIL ADDRESS: ______
PERSONAL EMAIL ADDRESS: ______
SPOUSE EMAIL ADDRESS: ______
3-TAX REFUND DIRECT DEPOSIT INFORMATION: (IF JOINT RETURN MUST HAVE EACH TAXPAYER’S NAME ON THE ACCOUNT)
BANK NAME______
ABA NUMBER (MUST BE 9 DIGITS) ______
ACCOUNT #______
TYPE OF ACCOUNT (“X” ONE) CHECKING: ____ SAVINGS: ____
Please confirm you and the members of your household were covered by a health insurance plan during each month of 2017. YES______No____
Please attach a PDF copy of your 2016 federal and state income tax returns if my office did not prepare your income tax returns.
4- MISCELLANEOUS BUSINESS EXPENSES (ONLY THOSE PAID DURING 2017):
>Business Publications:______
>Tax return preparation fees:______
>Business use of telephone:______Blackberry/data charges: ______
>Professional association dues: ______
>Professional licenses and registration fees: ______
Professionaleducation if notrequired to qualify you for employment: ______
>Professional seminars/Conferences: ______
>Jobhunting expenses: ______
>Computerrelatedequipment purchased: ______
>Internet access fees for business purposes: ______
5> Total Cash/checkcontributions to U.S. charities: ______
6>Personal property contributions to U.S. charities: ______
(IF OVER $500 OF PROPERTY CONTRIBUTIONS PLEASE INCLUDE RECEIPTS)
7>Real estate taxes paid onprimary (and secondary) residence you own:______
(IF CO-OP PLEASE PROVIDE COPY OF THE ACCOUNTANT’S LETTER)
In case you prepaid 2018 real estate taxes in 2017 in excess of your mortgage bank escrow account and it is not reflected on your Form 1098, please provide this additional amount of real estate taxes paid):______
8>Mortgage interest or pointspaid on primary (and secondary) residence you own. (PLEASE PROVIDE COPIES OF FORM 1098):______
9- PLEASE ATTACH COPY OF SALARIED INCOME FROM WORK W-2 WAGE & TAX STATEMENT, 1099-R FORMS FOR ANY PERSION OR IRA DISTRIBUTIONS RECEIVED, AND 1099-SSA FORMS FOR ANY SOCIAL SECURITY PAYMENTS RECEIVED.
10- PLEASE ATTACH COPY OF BANK INTEREST 1099-INT, STOCK DIVIDENDS 1099-DIV, MUTUAL FUNDS FORM 1099-DIV STATEMENTS (COST BASIS FOR ANY SALES OF STOCK/MUTUAL FUNDS). ALSO LIST ANY MARGIN INTEREST PAID OR INVESTMENT ADVICE OR MANAGEMENT CHARGES PAID FOR.
11- AT ANY TIME DURING 2017, DID YOU HAVE A FINANCIAL INTEREST IN OR MAINTAIN A SIGNATURE AUTHORITY OVER A FOREIGN BANK OR SECURITIES ACCOUNT OR OTHER FOREIGN FINANCIAL ACCOUNT? YES _____ NO _____ LIST THE COUNTRIES: ______
IF YES, WAS THE VALUE OVER US$10,000 AT ANY TIME DURING 2017? YES _____ NO ____
IF YES, WAS THE VALUE OVER US$100,000 AT ANY TIME DURING 2017 or over US$50,000 at December 31, 2017? YES _____ NO ____
12- List the amount of moving expenses incurred in 2017only if you moved more than 50 miles from your old home to your new workplace due to a job change:
- Date of the move: ______
- Transportation expenses for the move: ______
- Storage of household goods: ______
- Travel expenses for the move: ______
- Lodging expenses for the move: ______
13- If you lived in New York City or in New Jersey during 2017, how much was the total annual rent which you paid? $______
14- Did you have any child care expenses for any dependent children under the age of 13 (NANNY, DAY CARE, NURSERY SCHOOL OR DAY CAMP)Yes:______No:______
LIST NAME, ADDRESS AND TAX ID NUMBER OF PROVIDER AND AMOUNT PAID DURING 2017:
PROVIDER NAME: ______
ADDRESS: ______
TAX ID NUMBER: ______
AMOUNT PAID: ______NAME OF CHILD/CHILDREN PROVIDED FOR:______
(continued)
PROVIDER NAME: ______
ADDRESS: ______
TAX ID NUMBER: ______
AMOUNT PAID: ______NAME OF CHILD/CHILDREN PROVIDED FOR:______
15- NOTE: IF YOU BELIEVE YOUR UNREIMBURSED MEDICAL EXPENSES WILL EXCEED 7.5% (OR 2% FOR NJ RESIDENTS) OF YOUR INCOME THEN PROVIDE YOUR AGGREGATE 2017
UNREIMBURSED MEDICAL EXPENSES HERE: ______
OTHERWISE, DON’T SPEND THE TIME TO CALCULATE IT.
16- IF YOU WERE SELF EMPLOYED, AND NOT A W-2 EMPLOYEE, PLEASE LIST THE AMOUNT OF HEALTH INSURANCE ______
17- Did you contribute to a NY 529 College Savings Planin 2017? YES___ NO___
Ifyes, how much did you contribute? $______
18- (For Connecticut residents only): Did you contribute to a CHET College Savings Plan in 2017? YES___ NO___ If yes, list the account number: ______and how much did you contribute during 2017? $______
19- Did you purchase a primary or secondary residenceduring 2017?YES___ NO___
Ifyes, please attach a copy of the closing statement.
20- Did you pay college or post-secondary school tuitionfor either yourself or any dependentsduring 2017? If so, please include a copy of any form 1098-T received from the college or university.
21- Did you withdraw money from a 529 College Savings Plan in 2017? YES___ NO___
If so, please include a copy of any form 1098-Q received from the 529 plan.
22- Did you withdraw money from an HSA Plan in 2017? YES___ NO___.
Did you contribute any money into an HSA Plan in 2017? YES___ NO___.
If so, please include a copy of any form 1099-SA or 5498-SA.
22- Did you make any energy efficientimprovements to your primary home or purchase any solar energy efficient property for any home during 2017or replaceexterior windows, doors or heating or A/C units? IF YES, ATTACH DETAILS (DATE & AMOUNT) BY CATEGORY.
24- DID YOU MAKE ANY ESTIMATED TAX PAYMENTS FOR 2017? YES ___ NO______
IF YES, PLEASE LIST ANY ESTIMATED INCOME TAX PAYMENTS MADE FOR THE 2017 TAX YEAR TO THE US TREASURY OR STATE TAX AUTHORITIES BY AMOUNT AND BY DATE OR ATTACH COPIES OF CHECKS SENT:
TO US TREASURY:______
TO STATE: (LIST NAME OF STATE): ______
25- Did you contributeor intend to contribute by April 17, 2018to a traditional or Roth IRA for 2017? YES____ NO____. If yes, please list the amount, the type of IRA and whether it is for the taxpayer or the spouse:
NOTE THIS DOES NOT REFER TO A 401K OR 403B PLAN THROUGH YOUR EMPLOYMENT.
26- Did you roll over atraditional IRA into a ROTH IRA during 2017?YES____ NO____. IF YES PLEASE PROVIDE A COPY OF THE 1099-R.
27-If applicable, please attach a copy of any correspondence you received during 2017regarding your prior year federal and state income tax returns if the tax authorities made any changes to your returns as filed.
28- If you received an IRS Identity Protection Personal Identification Number on form Notice CP01A dated January 1, 2018 please provide a copy of the notice or list the six digit PIN number and specify for which taxpayer it applies to.
______
Note that each year the IRS reissues new IRS Identity Protection Personal Identification Numbers if you are eligible, so last year’s number would no longer be valid.
HERE IS A HELPFUL CHECKLIST OF TYPICAL SOURCE DOCUMENTS TO INCLUDE FOR PREPARATION:
W-2 FORMS
1099-R FORMS
1099-SSA FORMS
1099-G FORMS
1099-INT FORMS
1099-DIV FORMS
1099-B FORMS
REALIZED GAIN-LOSS SCHEDULE FOR SECURITY SALES
1099-MISC FORMS
1098 MORTGAGE INTEREST FORMS
1098-E STUDENT LOAN INTEREST PAID
1098-T TUITION PAID FOR YOURSELF AS WELL AS DEPENDENTS
1099-Q FOR 529 PLAN DISTRIBUTIONS FOR YOURSELF AS WELL AS DEPENDENTS
HUD-1 CLOSING STATEMENTS ON SALE/PURCHASE OF REAL PROPERTY
K-1 FORMS FROM PARTNERSHIPS AND S-CORPS
5498 FORMS FOR IRA’S OR HSA’S
1099-SA FOR HSA DISTRIBUTIONS
The IRS and state revenue agencies are now requiring that your driver's license information be included in the electronic filing for each taxpayer and spouse as a security checking measure. Therefore we ask that you please provide us with the following information for both you and your spouse, as applicable:
TAXPAYER SPOUSE
Driver's license issuing stateDriver's license number
Driver's license issue date
Driver's license expiration date
NY document number (first 3 alphanumeric characters)*
* The NY document number is the 8 or 10 alphanumeric characters at the bottom of the NY license or on the back if it was issued after January 28, 2014.
Alternatively, you can scan your driver's license(s) and send us a copy.
Failure to provide this information may result in a IRS letter 5071C generated by the IRS requesting verification of your identity in order to process your tax return which may delay the processing of your overpayment credit or refund.
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