Tax Organizer Template - 2012
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Yes / No If yes, date of move: _________________
2012 Tax Year Organizer
Name_____________________________________ S.S.# _______________________ Occupation _______________________
Date of birth ____________________ Legally Blind? ______ Marital Status _______________________
Name____________________________________ S.S.# _______________________ Occupation ______________________
Date of birth ____________________ Legally Blind? ______
Home Phone __________________
Did your address change?
Cell Phone ____________________
Address ____________________________________________________________________
Cell Phone ____________________
E-mail Address_______________________________________________________________ Fax Number ___________________
E-mail Address_______________________________________________________________
Send me my e-file authorization forms via: ____E-mail ____Fax ____I'll pick-up
E-FILE INFORMATION:
Would you like Direct Deposit? Yes / No
Withdrawal? Yes / No
If Yes, Bank Routing Number
Bank Account Number
Bank Name _____________________________
Account type: _____ Checking _____ Savings
Would you like your tax refund applied to your 2013 taxes?
Yes / No
If yes, choose One:
___Entire Refund ___ 1st Qtr Est Pmt only
___ Other $________
DEPENDENTS:
F/T
Child Care
College Tuition /
S.S. #
Relationship
First & Last Name
(Paid 50% of support?)
Student?
Date of Birth
Expense
Books & Supplies
$
$
/
$
$
/
$
$
/
$
$
/
Note : Enter Child Care Provider information on bottom of page 2
INCOME: MUST PROVIDE ALL FORMS LISTED BELOW
(wages, interest, dividend, mutual funds, Soc. Sec., Pensions, etc. )
List payers only - no dollar amounts - we will take details from the forms you provide
W2s
1099 Misc / 1099-R
Interest- 1099INT
Dividends- 1099DIV
TAX FREE INTEREST/DIVIDEND: MUST PROVIDE BROKER STATEMENTS
OTHER INCOME:
Social Security - Taxpayer
Yes- Provide 1099SSA
Gambling
$
Provide W-2G
Social Security - Spouse
Yes- Provide 1099SSA
Gambling Losses
$ <
>
Unemployment- Taxpayer
Yes- Provide 1099G
Alimony Received
$
Unemployment- Spouse
Yes- Provide 1099G
$
Other Income (specify)
STOCK , BONDS & MUTUAL FUNDS CAPITAL GAIN TRANSACTIONS (1099-B):
MUST PROVIDE BROKER REALIZED GAIN/LOSS STATEMENTS, COST BASIS OR SIMILAR.
OTHER CAPITAL GAIN/LOSS TRANSACTIONS (LAND, COLLECTIBLES, ETC):
Cost Basis
(includes
Description
Date Purchased
Date Sold
Sales Proceeds
sale expenses)
$
$
$
$
IRA CONTRIBUTIONS: Taxpayer $_________________
Spouse $ ________________
Mark One: Roth / Traditional
Date__________
Mark One: Roth / Traditional
Date__________
SELF-EMPLOYED:
HSA CONTRIBUTIONS: HSA DISTRIBUTIONS:
(provide 1099-SA)
SEP/Pension/Simple Contribution
$______________
$__________________
$____________________
If more space is needed and you are attaching additional pages, please check here.
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2012
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