Tax Organizer Form - North Dakota
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4TAX ORGANIZER
TAX PROS, Inc.
th
4520 19
Ave S, Suite 3
Fargo, ND 58103
th
(next to Petro Gas Station on 45
Street)
(If you are a new client, please send a copy of last years tax return)
FOR TAX YEAR 2015
Your Name
S.S. #
-
-
Birthdate
/
/
Spouses Name
S.S. #
-
-
Birthdate
/
/
Mailing Address
Home Phone Number
Work or Cell Phone Number
(
)
-
(
)
-
E-mail Address
DEPENDENTS
NAME
S.S. #
D.O.B.
RELATIONSHIP
Was there anyone else you contributed support, that resides in the U.S., Canada or Mexico?
NAME
S.S. #
D.O.B.
RELATIONSHIP
% SUPPORTED
INCOME OF PERSON
$
$
CHILD OR DEPENDENT CARE
Did you pay a baby-sitter last year?
NAME OF SITTER
S.S. #
ADDRESS
AMT. PD.
$
$
If your sitter is an adult & works in your home, you are required to file W-2 forms by January 31. If you want us to prepare
these forms contact us right away.
ESTIMATED TAXES
CREDIT FROM PRIOR
FIRST QUARTER (APRIL
SECOND QUARTER
THIRD QUARTER
FOURTH QUARTER
TOTAL FOR YEAR
YEAR’S VOUCHER
15)
(JUNE 15)
(SEPT. 15)
(JAN. 15)
PAYMENTS
Federal
$
$
$
$
$
$
State
$
$
$
$
$
$
INCOME
Wages, Salaries, Tips, Etc. (Attach W-2s)
Interest income from Seller-Financed Mortgages & Individuals:
Interests from Banks & Financial Institutions (Attach 1099 Int)
Include all that have your Social Security number on them.
NAME
AMOUNT
NAME
AMOUNT
_________________________
$________________
_________________________
$________________
_________________________
$
________________
_________________________
$
________________
OTHER INCOME
Estate & Trusts
$___________________
(Attach K-1s)
Jury Duty
$___________________
S-Corporations
$___________________
(Attach K-1s)
Other
$___________________
Partnerships
$___________________
(Attach K-1s)
Other
$___________________
Did you have any tips that you did not report to your employer? If not reported, how much did you receive? $________________
Prizes & Awards $_______________ State Tax Refund $_______________ Unemployment Compensation $_______________
Lump Sum Distributions $_______________ (Attach 1099R”s) Gambling Winnings (Attach W-2 G’s) $__________________
Gains & Losses from Sale of Property, Stock, Etc. (Attach 1099 B’s)
Description
Date Bought
Date Sold
Sale Price
Cost & Expense
Gain or Loss
_______________________________
___/___/___
___/___/___
$___________
$___________
$__________
_______________________________
___/___/___
___/___/___
$___________
$___________
$__________
_______________________________
___/___/___
___/___/___
$___________
$___________
$__________
SALE OF RESIDENCE - Please send or bring escrows of purchase & sale of new house. Also list improvements on old house.
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