2015 TAX DEDUCTION FINDER
Your Name__________________________________________________________________ Soc. Sec. No.__________________________
Spouse’s Name______________________________________________________________ Soc. Sec. No.__________________________
Your Occupation ____________________________Date of Birth _____________________ Home Phone __________________________
Spouse’s Occupation ________________________Date of Birth _____________________ Work Phone ___________________________
Address ____________________________________________________________________ e-mail ________________________________
THINGS TO BRING:
Last year’s return (if new client)
W-2 Forms
Purchase & sale info for all property sold
1099 Forms for: interest · dividends · soc. sec. · unemployment · self-employment · debt cancellation. · retirement
1098 Forms for: mortgage interest · tuition · noncash contributions · proof of health insurance
FEDERAL
STATE
DEPENDENTS
Name
Number of months lived in your home
Last year I received refunds of:
First, Initial & Last
Social Security #
Relationship
Birthdate
Grade
Last year I had to pay:
(required)
❏
I want my refunds directly deposited into my bank,
IRA …
(bring a voided check / account info)
INCOME
(other than income shown on W-2s)
SOURCE
T/S/J
AMOUNT
SOURCE
T/S/J
AMOUNT
INTEREST (Bring in 1099s or Statements)
DIVIDENDS (Bring in 1099s or Statements)
If Individual, list Name, Address & Soc. Sec. #
Include all tax exempt
Include all tax exempt and Municipal Bonds
Excludable Series EE Savings Bonds
OTHER INCOME NOT INCLUDED ABOVE OR ON W-2
UNEMPLOYMENT (Bring in 1099)
PERSONAL INJURY AWARDS
ALIMONY
DISABILITY/RETIREMENT
TIPS
IRA(Bring in 1099-R)
COMMISSIONS/BONUSES
SOCIAL SECURITY (Bring in SSA-1099)
PRIZES/AWARDS/GAMBLING/LOTTERY
SOCIAL SECURITY (Bring in SSA-1099)
JURY/ELECTION DUTY
RAILROAD RETIREMENT (Bring in RRB-1099)
BUSINESS/FARM/RENTAL (Bring details)
RAILROAD RETIREMENT (Bring in RRB-1099)
STOCK & PROPERTY SALES (Bring 1099,
DEBT CANCELLATION – BRING 1099-C or A
Cost, Dates)
PARTNER./CORP/ESTATE/TRUST (Bring K-1)
NON-TAXABLE INCOME
SCHOLARSHIPS/FELLOWSHIPS, if not on W-2
VETERANS PENSION/DISABILITY
STRIKE PAY
CHILD SUPPORT/ASSISTANCE
PENSIONS (Bring in 1099-R)
WORKER’S COMPENSATION
FOREIGN INCOME/ASSETS
OTHER (identify)
HOBBY INCOME
OTHER (identify)
ESTIMATE PAYMENTS PAID IN/FOR 2015
FEDERAL
STATE
Date Paid
Check #
Amount
Date Paid
Check #
Amount
4th Qtr. Prior Year
1st Qtr. This Year
2nd Qtr. This Year
3rd Qtr. This Year
4th Qtr This Year
RETIREMENT PLANS
If you or your spouse has an IRA, SEP, SIMPLE or Keogh Retirement Plan, list the amount you have contributed for 2015 and the date of contribution.
❏
❏
You $ ___________________
Date ____________________
Spouse $ ________________
Date _____________________
IRA:
Regular
Roth
SEP.........................................
You $ ___________________
Date ____________________
Spouse $ ________________
Date _____________________
Keogh ....................................
You $ ___________________
Date ____________________
Spouse $ ________________
Date _____________________
SIMPLE..................................
You $ ___________________
Date ____________________
Spouse $ ________________
Date _____________________
If amount listed is not the maximum, do you want to contribute the maximum deductible amount?
Yes __________
No __________
Did you convert any funds from a regular IRA to a Roth IRA? You $__________ Spouse $__________ .
MEDICAL SAVINGS ACCOUNTS (MSAs) / HEALTH SAVINGS ACCOUNTS (HSAs)
Amount Contributed: You _______________ Spouse _______________ Amount withdrawn for Qualified Expense _______________
Amount of Insurance Deductible _______________ Type of Plan: Single _______________ Family _______________
GEN-TDF-1