Tax Organizer Form - North Dakota Page 3

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DEDUCTIONS MEDICAL
Medicines
$_____________________
Drugs
$_____________________
NAME
Amount Paid After
NAME
Amount Paid After
Insurance Reimbursement
Insurance Reimbursements
Doctors:______________________________
$_____________
Specialists:_________________________
$_____________
____________________________________
$_____________
_________________________________
$_____________
____________________________________
$_____________
_________________________________
$_____________
Dentists: _____________________________
$_____________
Chiropractors:______________________
$_____________
____________________________________
$_____________
_________________________________
$_____________
____________________________________
$_____________
__________________________________
$_____________
Orthodontists: _________________________
$_____________
Clinics:____________________________
$_____________
____________________________________
$_____________
_________________________________
$_____________
____________________________________
$_____________
_________________________________
$_____________
Practitioners:__________________________
$_____________
Hospitals:__________________________
$_____________
____________________________________
$_____________
_________________________________
$_____________
Transportation & Lodging_
$_____________
Insurance Premiums (include Medicare)
$_____________
Prenatal Care
$__________________
Postnatal
$__________________
Eyeglasses
$__________________
Hearing Aids
$__________________
X-Rays
$__________________
Lab Fees
$__________________
Medical Lodging
$__________________
Bandages
$__________________
Therapy Equipment
$__________________
Crutches
$__________________
Medical Supplies & Appliances
$__________________
Diabetic Expense
$__________________
Prosthesis Expense
$__________________
Therapy Pool
$__________________
Required Air Conditioning Expense
$__________________
Electrical Expense
$__________________
Repairs & Filters
$__________________
Stop Smoking Expense
$__________________
TAXES
Did you pay State Taxes last year? _____ How much? $__________Did you pay State Taxes last year for prior years? _____
How much? $__________Did you pay Sales Taxes on
Major Purchases last Year?______ How much? $________
Auto License Fees
$___________________
Auto Sales Tax
$___________________
Real Estate Taxes
$___________________
Property Taxes
$___________________
Irrigation Taxes
$___________________
Personal Property Taxes
$___________________
Boat Taxes
$___________________
Other Taxes
$___________________
Did you buy any cars, boats, motorcycles, R.V.s, trailers, mobile homes, airplanes, etc.?_______________ (Attach Information.)
DEDUCTIONS (CONTINUED)
INTEREST: (Attach all 1098s)
1ST HOME
NAME
AMOUNT
2ND HOME
NAME
AMOUNT
Mortgages..................
_______________
$_____________
Mortgages..................
_______________
$_____________
2nd Home Mortgage..
_______________
$_____________
2nd Home Mortgage...
_______________
$_____________
Late Charges..............
_______________
$_____________
F.H.A. Charges
_______________
$_____________
Mortgage Insurance...
_______________
$_____________
Real Estate Loan Fees
_______________
$_____________
College Loan Interest
_______________
$_____________
Points ……………….
_______________
$_____________
College Loan Interest
_______________
$_____________
College Loan Interest
_______________
$_____________
CONTRIBUTIONS
Churches
$__________________
Miscellaneous
$__________________
$__________________
$__________________
$__________________
$__________________
Did you donate any non - cash items such as food or used clothing? Please list description and value: _________________
________
_
MISCELLANEOUS
Union Dues
$__________________
Spouse Dues
$__________________
Tax Preparer Fee
$__________________
Audit Fees
$__________________
Extension Fees
$__________________
Business Dues
$__________________
Books & Publications
$__________________
Safety Items
$__________________
Fire Retardant Clothing
$__________________
Safety Boots
$__________________
Protective Eye Wear
$__________________
Mosquito Spray
$__________________
Gloves
$__________________
Work Watch
$__________________
Tools
$__________________
Flashlights
$__________________
Batteries
$__________________
Water Jugs
$__________________
Uniforms
$__________________
Telephone for Business
$__________________
Cleaning
$__________________
Protective Headgear
$__________________
Investment Expense
$__________________
Sales & Promo Costume
$__________________
Adoption Expense
$__________________
Safety Deposit Box
$__________________
Record Keeping Costs
$__________________
Safety Glasses
$__________________
Other ( list )
$__________________
Other ( list )
$__________________
CONTINUED EDUCATION & 1ST TWO YEARS COLLEGE STUDENT CREDIT
Name of Student
___________________
Name of Institution
___________________
Travel Expense
$__________________
Education Purpose
___________________
Tuition Expense
$__________________
Dates Attended
___________________
Supplies Expense
$__________________
Name of Student
___________________
Name of Institution
___________________
Travel Expense
$__________________
Education Purpose
___________________
Tuition Expense
$__________________
3

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