Please fill out this form and hit "SUBMIT" at the bottom of this page to send a confidential e-mail to taxsolutionslady@yahoo.com.  If you prefer to "snail-mail" then DO NOT hit SUBMIT but rather print the file to be mailed.  [It is about 16 pages long if you print the file.] 

If you cannot complete this form in one setting, check appropriate box below before you submit. When you continue, begin with name of primary taxpayer (including SSN) and then continue where you left off.

complete (all information is being submitted)

INcomplete (I will resubmit additional information later)

PERSONAL DATA

First Name: Middle initial: Last Name:
SSN:
Spouse First Name: Middle initial: Last Name:
Spouse SSN: Spouse Maiden Name:
Address: City/State/Zip:
County: School District: Contribute to Presidential Election: Yes No
Birthday: Occupation:
Spouse Birthday: Spouse Occupation:
Home Phone: Work (you): Work (spouse):
Fax: Cellular: Other:
Pager: Voice Mail: E- Mail:

 

DEPENDENT CHILDREN & OTHER DEPENDENTS

First Name & MI: Last Name : SSN:
Birthday: Months home:

First Name & MI: Last Name : SSN:
Birthday: Months home:

First Name & MI: Last Name : SSN:
Birthday: Months home:

First Name & MI: Last Name : SSN:
Birthday: Months home:

First Name & MI: Last Name : SSN:
Birthday: Months home:

First Name & MI: Last Name : SSN:
Birthday: Months home:

INTEREST INCOME
(provide all Form 1099-INT, Interest Income Statement)

Payer: Amount: $
Payer: Amount: $
Payer: Amount: $
Payer: Amount: $
Payer: Amount: $

 

DIVIDEND/CAPITAL GAINS DISTRIBUTION
(provide all Form 1099-DIV, Interest Income Statement)

Payer: Amount: $
Payer: Amount: $
Payer: Amount: $
Payer: Amount: $
Payer: Amount: $

 

 

OTHER TAXABLE INCOME (Please provide all income statements for proof)
$ State income tax refund

$ Alimony received from ex-spouse

$ Social Security or Railroad retirement

 

 $ Unemployment compensation

$ Commission/Bonus not on W-2

$ Prize winnings/Gambling (Form W-2G)

 
ADJUSTMENTS TO INCOME  
$ Your IRA contribution for this year

$ Spouse IRA contribution for this year

$ Your SEP or Keogh contribution this year

$ Spouse SEP or Keogh contribution this year

 

 $ Penalty for earl withdrawal

$ Alimony paid to ex-spouse

Name:

Social Security Number:

 

PAYMENTS MADE OR CREDIT OF PAYMENT  

$ Estimated payments

 

$ Payment with Extension

 

$ Carryover of prior year

 
 
EMPLOYEE WAGES OR SALARIES
(please provide all Form W-2's) 		IRA, PENSION, OR ANNUITY DISTRIBUTION
(please provide all Form 1099-R's)
Payer: Amount: $

Payer: Amount: $

Payer: Amount: $

Payer: Amount: $

Payer: Amount: $

 

Payer: Amount: $

Payer: Amount: $

Payer: Amount: $

Payer: Amount: $

Payer: Amount: $

 

   
CHILDCARE EXPENSES (to receive credit you must have the name, address and ID number)
NAME: ADDRESS: ID NUMBER: AMOUNT: $
NAME: ADDRESS: ID NUMBER: AMOUNT: $
NAME: ADDRESS: ID NUMBER: AMOUNT: $
NAME: ADDRESS: ID NUMBER: AMOUNT: $
NAME: ADDRESS: ID NUMBER: AMOUNT: $
NAME: ADDRESS: ID NUMBER: AMOUNT: $
NAME: ADDRESS: ID NUMBER: AMOUNT: $
NAME: ADDRESS: ID NUMBER: AMOUNT: $
NAME: ADDRESS: ID NUMBER: AMOUNT: $

NAME:

 

ADDRESS:

 

ID NUMBER:

 

AMOUNT: $

 

MEDICAL EXPENSES PAID  
$ Hospital, medical & dental premiums $ Nursing home, private care
$ Prescription drugs $ Lab, MRI, & X-Ray
$ Hospital $ Long distance calls, taxis, bus fare, rental car
$ Medical miles ________ miles X $.10/mi) $ Travel Expenses (airfare, lodging, meals)

$ Glasses, contacts, hearing aides

 

$ Ambulance

 

TAXES PAID HOME MORTGAGE INTEREST
$ State income tax paid last year

$ City.County/local taxes paid last year

$ Home real estate taxes

$ Other real estate (lot/vacation homes)

$ Personal property tax on household goods

$ Tags for vehicles and motorcycles

$ Boat/ motor/ trailer/ tags

$ Tags for motor home/camper/snow mobile

 

 $ First mortgage interest

$ Second mortgage interest

$ Home equity loan interest

$ Home equity loan interest

$ Points

Individual's name:

Address:

SSN:

 

CHARITABLE CONTRIBUTIONS (Cash, checks, credit cards, CRITICAL! Get receipts for contribution deduction)
$ Church: $ Heart Fund, YMCA, YWCA
$ Church: $ Sunday School material, books, tapes
$ Ministry: $ Expenses as a Deacon, Deaconess, Usher
$ Ministry: $ Feeding, housing, clothing street people
$ School, Scouts, Educational TV, radio $ Chorus robes, sheet music, tapes, CD's
$ Arthritis Foundation, Easter Seals, DAV $ Children or Youth Ministry expenses
$ United Way, Red Cross, Christmas Seals $ Building & yard maintenance expenses
$ Long distance calls, parking, tolls, taxi $ Mission Trip (transp, visa, lodging, meals)
$ Charity miles at $/12/ mi $ Muscular Dystrophy, AMVET, Cancer

$ Carryover of unused charitable contributions from the previous year(s)

 
NONCASH CHARITABLE CONTRIBUTIONS (Use fair market value, not garage sale value. Detail your giving for larger contribution rather say, "Bags of clothes" Always get receipts!)
Name of organization: Items donated Date: Value:
Name of organization: Items donated Date: Value:
Name of organization: Items donated Date:

Value:

Name of organization:

 

Items donated

 

Date:

 

Value:

 

PERSONAL CASUALTY OR THEFT LOSS BUSINESS CASUALTY OR THEFT LOSS
Type of casualty or loss

What was loss:

Date of loss:

Place:

$ fair market value before loss

$ fair market value after loss

Loss covered by insurance: yes no

Amount reimbursed by insurance: $

Police or insurance report?: yes no

 

 Type of casualty or loss

What was loss:

Date of loss:

Place:

$ fair market value before loss

$ fair market value after loss

Loss covered by insurance: yes no

Amount reimbursed by insurance: $

Police or insurance report?: yes no

 
AS AN EMPLOYEE: UNREIMBURSED BUSINESS EXPENSES
$ Hand tools, equipment, supplies $ Office supplies
$ Dues: union & professional $ Publications, books, etc
$ Employment related education $ Long distance business calls
$ License, fees, credentials $ Business gifts, (limited to $25/person)
$ Travel (Airfare, lodging, meals) $ Travel or local business meals
$ Taxi, tolls, tips, parking, shuttle $ Uniforms, purchase & clean

$ Business insurance (malpractice, disability)

 

$ other:

 

MISCELLANEOUS DEDUCT ABLE EXPENSES  
$ Tax preparation $ Other:
$ Legal fees to obtain or protect income $ Investment publications, books, meetings
$ Adoption expenses $ Safety deposit box for investments
$ Investment expenses (broker fees, etc) $ Gambling losses

$ Job seeking expenses (resume, calls, airfare, lodging, rental, toll, meals, mileage, placement fees)

 
SALES OF STOCKS, MUTUAL FUNDS, REAL ESTATE, AND PERSONAL PROPERTIES
Description of item 1: Date acquired: Date sold: Selling price: Original cost: Improvements:
Description of item 2: Date acquired: Date sold: Selling price: Original cost: Improvements:
Description of item 3: Date acquired: Date sold: Selling price: Original cost: Improvements:
Description of item 4: Date acquired: Date sold: Selling price: Original cost: Improvements:
Description of item 5: Date acquired: Date sold: Selling price: Original cost: Improvements:
Description of item 6: Date acquired: Date sold: Selling price: Original cost: Improvements:
Description of item 7: Date acquired: Date sold: Selling price: Original cost: Improvements:
Description of item 8: Date acquired: Date sold: Selling price: Original cost: Improvements:

Description of item 9:

 

Date acquired:

 

Date sold:

 

Selling price:

 

Original cost:

 

Improvements:

 
MOVING EXPENSES: RELATED TO A CHANGE IN JOBS
Miles from old job: Miles from old home to new job: Difference in miles:
Cost to pack household goods and personal effects (boxes, blankets, dolly, tape, pads, string, rope, etc) $
Cost to ship & store household goods and personal effect (truck, trailer, van, labor, storage rent, etc.) $
Cost of travel (gas, airfare, bus, rental, etc.) and lodging going from old to new residence (no meals) $
Other costs, not mentioned above associated with moving:  $

Amount of money reimbursed by the employer for the move: $

 
BUSINESS EXPENSE INSTRUCTIONS  

Business expense deductions are based on RECEIPTS, logs, and planners. Your documentation should have the business purpose, date, and time, place and amount. To deduct business meals or entertainment, you should (1) discuss business during the meal or entertainment, or (2) have a substantial and bonafide business discussion or activity before or after the meal or entertainment, or (3) if alone, you should be out of town and overnight on a business trip. You must record the name and business relationship of each person entertained. IRS may not allow these expenses unless they are documented! GET RECEIPTS! This is very CRITICAL!

 

BUSINESS NAME:

 

DATE BUSINESS STARTED:

 

AREAS OF BUSINESS INCOMES
$ Total money received from your retail customers for products or services
$ Total money received from distributors or wholesale buyers, including cost of shipping and sales tax
$ Commissions or bonuses received for volume of sales made (Form 1099, non-employee compensation)
$ Bonuses, prizes, and awards (value of trips won, use of car, and other valuable items)
$ Other income (speaking fees, sale of marketing tickets, money received coordinating business trips)

$ TOTAL INCOME

 
AREAS OF BUSINESS EXPENSES  
$ Advertising (business cards, flyers, brochures, TV, radio, Yellow Pages, promotional materials, etc.)
$ Bad debts (business loans not collectible, bounced checks previously reported as income)
$ Commissions and fees paid out to others for services rendered
$ Employee benefits (health, dental, life, and legal insurance, company car, membership, discounts, etc.)
$ Insurance (Business: liability, renter's, bonding, malpractice, disability, NOT health, life, or vehicle)
$ Interest (mortgage, car and business loans, finance charges from credit cards used for business purposes)
$ Legal, tax prep, accounting, IRS representation, business and financial consulting fees
$ Office expenses (paper, pens, pencils, envelopes, staplers, calculators, folders, paper clips, postage)
$ Rental expenses of vehicles, machinery, and equipment (dental, chiropractic beds, copiers, computers)
$ Rental or lease of office space, warehouse, post office box, meeting rooms, storage, etc.)
$ Repairs and maintenance of office areas and business equipment, NOT cars, trucks, or vans)
$ Supplies (miscellaneous and petty cash expenses not sure where to record)
$ Taxes, licenses, permits (sales taxes paid, business licenses if required, construction permits and fees)
$ Travel airfare (cost of airline tickets and changes)
$ Travel lodging (cost of lodging, must have the receipts to be allowed the deductions says IRS)
$ Travel rental car (includes the cost of the rental car, insurance, and GAS paid)
$ Travel others (shuttle, taxi, bus, train, ship, parking, tolls, tips, travel equipment, etc.)
$ Travel business meals (actual out of pocket expenses for meals or the per them rate for each area)
$ Local business meals (cost of business meals in which you didn't stay out of town and overnight)
$ Utilities (electric, gas, and water paid for business facilities that is not a part of the personal residence
$ Wages or salaries (money paid to employees, including your children on staff)

$ Other business expenses ( ) not mentioned on any other pages of this TIP

 
COST OF GOODS SOLD  
$ Returns and allowances for products and services reimbursed
$ Beginning of the year inventory which should be the same as last year's end of the year inventory
$ Products purchased for resale purposes less items withdrawn for personal use
$ Labor cost directly associated with the selling of products and services (outside salesman & broker)
$ Materials and supplies used to sell or make products for sale (bags, boxes, lumber, steel, screws, nails)
$ Any other expenses related to the selling or manufacturing of products or services not included above

$ End of the year inventory (You should do a physical count of inventory available to be sold)

 
OTHER BUSINESS EXPENSES  
$ Bank charges (monthly service charge, cost of checks, NSF charges, ATM charges)
$ Business gifts (gifts for your customers, employees, suppliers, associates, not more than $25 ea.)
$ Business phone service (long distance calls, second line, call waiting and forwarding, conference calls)
$ Cellular phone & Pager (cost of the cellular phone & pager, activation fee, and monthly charges)
$ Dues and membership (annual renewal fee, credit card fee, Sam's Club, business associations, etc.)
$ Freight, shipping, and postage (UPS, Fed Ex, Airborne, Express Mail, bus, trucks, substantial postage)
$ Laundry and dry cleaning (cost of cleaning uniforms or clothing related to a overnight business trip)
$ Major conventions (cost of registration and included transportation, lodging, and meals)
$ Pubs and subscriptions (books, manuals, magazines, newspaper, cassettes, CD's)
$ Samples, demos, & displays (cost of items to sample, give as samples, demonstrate, or display for sale)
$ Seminars, rallies, & meetings (cost of registration and included transportation, lodging, and meals)
$ Tools (tapes, books, videos, white board, planner, etc. used to build your business)
$ Uniforms (buying and cleaning of uniforms, gowns, & tuxedos and business clothes laundered at home)

$ Voice mail, etc. (Answering service, 800 service, internet, E-mail, Web site, etc.)

 
DEPRECIABLE BUSINESS FURNITURE AND EQUIPMENT
If you need more room to record depreciable purchases, make additional copies of this depreciation worksheet.
Description of items used for business Date purchased or transferred Cost of FMV of the item Business use %

 

 

 

 
PER DIEM CHART FOR DETERMINING THE DAILY MEAL ALLOWANCE
If you need more room to record per diem, e-mail additional information as per this worksheet.
DATES # of Days Locations (state, city, county) # of people Purpose of trip
to
to
to

to

 

 

 

 

 

"BUSINESS USE OF HOME" EXPENSE
To qualify, the "business use of home" must be your primary work place (the place where you spend most of your time and/or make most of your money). You must use the business area exclusively unless it is your only business location and you have storage of inventory, have clients come on a regular basis, or regularly use it for presentations and training.
Square footage of business areas (multiply the length times the width of each area)
Total living square feet of your home (multiply the length times the width of the house)
$ Mortgage interest
$ Real estate taxes
$ Homeowner & hazard insurance
$ Repairs & maintenance (paint, plumbing, electric, IIVAC, carpet cleaning, lawn care, pest control, etc.)
$ Utilities (electric, gas, water, trash, propane)
$ Total rent paid for the year
$ Management or condo fees

$ Cost of your home including improvements

 
VEHICLE EXPENSES: MILEAGE RATE VERSUS ACTUAL EXPENSES
* You can keep track of your business miles in your planner, on a calendar, or in an official mileage log.
* You need the date, location, total miles (or beginning and ending odometer reading), and purpose of the business trip.
* You need the beginning and end of the year odometer reading of each vehicle that you will use for business purposes.
* Note: Commuting miles from your residence to your work place and back are not deductible.
* The bottom line: KEEP A BUSINESS MILEAGE LOG or the IRS will disallow your car and truck expenses.

* You need to keep track of all your receipts for vehicle expenses. GET THE RECEIPTS!!!

 
Descriptions Vehicle #1 Vehicle #2 Vehicle #3
Vehicle year, make, model

$

miles

miles

miles

miles

miles

miles

miles

miles

miles

miles

miles

days/week

months

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

miles

miles

miles

miles

miles

miles

miles

miles

miles

miles

miles

days/week

months

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

miles

miles

miles

miles

miles

miles

miles

miles

miles

miles

miles

days/week

months

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$
Date vehicle purchased or placed in service
Vehicle cost or FMV when place in service
End of the year odometer reading
Beginning of the year odometer reading
Total miles for the year
Miles to pick up & deliver products
Miles to meetings, rallies, & major seminars
Miles to prospect, recruit, counsel, or train
Miles to Job sites, pick up materials & supplies
Miles driven for sales appointments
Other (bank, post office, store, printers, etc.)
Other:
Round trip distance to work as an employee
Number of days/week you worked
Number of months worked this year
Gas
Oil changes
Tune-ups
Radiator repair
Tires
Batteries
Alternators
Washes
Waxes
Belts
Transmissions
Engine work
A/C
Wipers
Electrical repair
Tags
Title
Sound system
Body work
Brakes
Alignment
Insurance
Other vehicle expenses:
Interest paid on car loan(s)

Total lease payments made this year

NOTE: You will be allowed to use either the mileage rate or actual vehicle expenses, NOT BOTH!

 
SALE OF YOUR "OLD" RESIDENCE  
Date you bought the old residence  
Date you sold the old residence  
$ Cost or basis of old residence  
$ Closing costs at time of purchase  
$ Closing costs for any refinance or equity loan  
$ Improvements made through the years  
$ Selling price of the old residence  
$ Closing costs of old residence when sold  
$ Fixing up expenses to prepare for sale  
Was your old residence rented or used for business? No. Yes. If yes, what percentage? %
Was it your principal residence for 3 of last 5 years? No. Yes
Date you bought new residence:  
Cost of new residence: $  

If a new residence is not yet acquired, do you plan to purchase one within 2 years from date of sale? No. Yes.

 
RENTAL AND ROYALTY INCOME AND EXPENSES
If you have more than 4 rental properties, e-mail or snail mail extra copies of this rental income and expense worksheet.
Property Type of property Address
1
2
3