ITEMIZED DEDUCTIONS
MEDICAL EXPENSES
CONTRIBUTIONS
Receipts from the
(Must exceed 10% of Adjusted Gross Income if
charity are required.
Net amount paid by
under age 65 and 7.5% if 65 or older.)
A. Cash Contributions for which you have receipts, canceled
you -- NOT PRETAX
Medical Insurance Premiums: Payroll Deduction
checks, payroll deductions, etc.
Paid directly by you
Medicare B/D deducted from Social Security
Dental Insurance
Long Term Care Insurance
Mileage
Alcohol or Drug Addiction Therapy
TOTAL:
Ambulance
B. Non-cash items:
Fair market value or garage sale price
Anesthesiology
on clothing, furniture, appliances, etc. Give organization,
Child Birth Class
item and value (if over $500, bring detailed information
Doctors, Dentists, Chiropractors, etc.
and receipts.) Autos, boats, airplanes bring 1098-C.
Eye Glasses, Contact Lenses, Exams
Hearing Aid, Batteries, Repairs
C. Transportation / Travel for Volunteer Work
Hospitals
Mileage
Insulin
Parking
Laser eye surgery
Out-of-pocket expenses (receipted)
Lodging (limited to $50/day per person)
Parking
CASUALTY & THEFT LOSSES
Prescribed Medical Attire
(support hose, shoes, etc.)
(Must exceed 10% or Adjusted Gross Income)
Prescribed Medical Equip: Cost/Rental
Date of Casualty _____________
Date Acquired ____________
Prescribed weight loss program
Kind of Property ____________
How Destroyed ____________
Prescriptions (not over-the-counter)
FMV Before _____________
FMV After _____________
Required nursing home care
Cost plus improvements
Special Schooling for Mentally or
Insurance reimbursements
Physically Handicapped
Federally declared disaster area? Yes__ No__
Ponzi-style Scheme Loss
Other
MISCELLANEOUS DEDUCTIONS
JOB EXPENSES: Job Supplies
TAXES
Job Hunting: Mileage / Travel (see pg. 4)
XXXXXXXXXXXXX
Real Estate: Home
Employment Agency Fees
Phone / Résumé / Postage / etc.
2nd Home
Other
Job-related Education: Tuition / Fees
Personal Property
Books / Supplies
Auto / Truck Tabs
Workshops / Seminars
Sales Tax on New Vehicle
Mileage / Food / Lodging (see pg. 4)
XXXXXXXXXXXXX
Other Sales Tax Paid (from receipts)
Malpractice Insurance
Phone: Additional extension only, plus
enhancements, long dist., fax, pager
INTEREST
Professional Dues / Licenses
Home Mortgage (paid to financial institution)
Professional Journals / Trade Journals
Bring in Form(s) 1098
Safety Equipment
Home Mortgage (paid to individual)
Tools - Small
List Name, Social Security Number & Address
Tools & Equipment - Depreciable
Uniforms - Cost / Cleaning
2nd Home Mortgage (paid to financial institution)
Union Dues / Initiation Fees
2nd Home Mortgage (paid to individual)
INVESTMENT EXPENSE: Save Deposit Box
List Name, Social Security Number & Address
Journals / Subscriptions
Phone / Postage / Mileage
Home Equity Loan: Bring in Form(s) 1098
Tax Preparation Fees / Tax Consultations
Points (bring closing papers if purchased this yr.)
IRA or Keogh Fees (paid separately)
Credit / Debit Card Fees for Tax Payments
Have you refinanced above properties this year?
OTHER:
If yes, bring closing papers.
Gambling Losses
Investment Interest (provide details)
Hobby Expenses