Individual Income Tax Questionnaire Page 4
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Taxes Paid
Auto Licenses : List separately
Real Estate Taxes :
Home…………………..…..….
(Describe) :
M-1PR Refund Received……
(
)
Second home/Cabin…………
Land………………….………..
Sales Tax - on these major purchases:
vehicle, boat, home building materials, etc.
Income Taxes :
Date Paid
Federal
State
Prior Years Refunds Received……………………….………...……………………..…….
Prior Years Additional Payments…….……..…..……..…..……...……………….….……
Estimated Tax Payments:
Prior Year 4th Installment Due January 15, 2012……………….………………….
1st Installment Due April 15, 2013……….……….......……………...………...……
2nd Installment Due June 15, 2013………….…...……...……………………...…..
3rd Installment Due Sept 15, 2013…….……….………...………..…………...……
4th Installment Due Jan 15, 2014…….…………………....……...…………..…….
Other Deductions
Alimony Paid…………...………...…..………
Tax Preparation Fee………..………………...…….
Name and Social Security # of Recipient
Safe Deposit Box…………….………..………...….
Investment Fees and Expenses………..….….…..
IRA Maintenance Fees…………………..…..….…
Work or Job Related Expenses :
Adoption Expenses………………….…..…..……..
Union and Professional Dues…..…….
Explain __________________________
Work Supplies…….……………..…….
Moving Expenses (over 50 miles)…….…..….……
Tools and Safety Equipment………..…
Explain __________________________
Required Uniforms and Laundry………
Mileage:
Trade Journals and Subscriptions……
________ miles @ $ .23
Your Continuing Education :
Job Hunting Expenses…………..……...……….…
Other Items
:
(Enter information for your dependents
(Describe)
education on the dependent questionnaire)
Tuition and Fees………...….…..….….
Books and Supplies.….……...……..…
Travel or Miles @ $ .555 ……..…...……
If you have expenses for business, work, or farm use of your personal automobile, fill in the required information
on the separate information questionnaires.
Please bring the following documents with your information:
W-2 Forms for wages and gambling winnings.
Credits:
1099 Forms for Interest, Dividends, Stock Transactions, Real Estate
Hybrid Vehicles:
Sales, and Miscellaneous Income.
Manufacturer certificate.
(limited by model)
1099 Forms for Pension and IRA Distributions.
Mortgage Interest Credit:
1099 Forms for Unemployment Compensation received.
Mortgage Interest Certificate.
K-1 Forms for Partnerships, S-Corporations, Estates and Trusts.
Child & Dependent Care Credit:
1098 Forms for Interest Paid on Mortgages.
Qualifying expenses
1098-E Forms for Interest Paid on Student Loans.
First Time Homebuyer Credit:
1098-T Forms for tuition payments.
Only available to certain military personnel
1099-C Forms for Cancellation of Debt.
Education Credits:
SSA - 1099 Forms for Social Security Benefits received.
Forms 1098 T and cost of books.
RRB - 1099 Forms for Railroad Retirement Benefits received.
Wind & Geothermal Energy:
Real Estate Sales / Purchases Closing Statements.
Receipts for qualified property.
Contract For Deed - Name, Address, and Social Security Number
Adoption Credit:
Information.
Receipts for qualified expenses.
Refinancing Loan Closing Statements.
Energy Credits:
Any Tax Notices from the Internal Revenue Service or Minnesota
Receipts for energy efficient costs.
Department of Revenue.
Payment for tax preparation is expected at the time your returns are filed. All unpaid balances are subject to a
1 1/2% per month (18% annual rate) service charge.
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