Tax Organizer Template - 2015 Income Tax Return Page 3
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7Tax Questionnaire
Additional Instructions
Business Income
Yes
No
If yes, please contact for additional instructions.
Foreign Financial
Yes
No
If yes, please contact for additional instructions.
Accounts
Alimony received
Yes
No
If yes, provide amount.
Amount
$
Alimony paid
Yes
No
If yes, provide name, social security number, and amount.
Name
Social Security Number
Amount
$
IRA contribution
Yes
No
If yes, provide amount of contribution.
Amount
$
Student Loan Interest
Yes
No
If yes, provide 1098-E.
Medical and Dental
Yes
No
If yes, provide a list detailing the type of expense and amount paid.
Expense
$
Health Insurance Premiums*
$
Doctor and Clinic Fees
$
Dentist Fees
$
Lab and x-ray Fees
$
Medical Equipment and Supplies
$
Eyeglasses and Contact Lenses
$
Miles
$
Other
$
$
*Do not include amounts paid for or reimbursed by insurance or
health insurance premiums paid with pre-tax income.
Real Estate Property
Yes
No
If yes, provide form 1098, tax bill, or proof of payment.
Tax
Other Personal Property
Yes
No
If yes, provide tax bill or proof of payment.
Tax. (Not real estate tax)
Mortgage Interest
Yes
No
If yes, provide Forms(s) 1098
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