Individual Income Tax Information Worksheet Page 2
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47. OTHER INCOME (Bring in all 1099 forms)
Taxpayer
Spouse
A. Unemployment Compensation Received
B. State Income Tax Refund
C. Alimony Received
D. Tip Income Not Reported on W-2
E. Social Security Benefits (bring in Social Sec forms)
F. Gambling Winnings (bring in W-2G forms)
G. IRA Distributions Received (bring in 1099-R forms)
H. Pension & Annuity Income (bring in 1099-R forms)
I.
Other Income (please list payee and amount)
Yes
No
J.
Sale of Investments (Bring in all 1099 forms)
Attach a list showing: Item Sold Date Sold Sale Proceeds Date Acquired Cost or Basis
K.
Business Income – Attach the schedule of Income and Related Expenses (yellow form)
L.
Rental income – Attach the Income and Expenses for Each Property (blue form)
M.
Partnerships, ‘S’-Corporations, Trusts & LLC’s – (Bring in all K-1 Forms)
N.
Did you Purchase or Sell your Personal Residence – (Bring in Closing Statement)
O.
Did you make any Solar, Wind, or Geothermal Energy Improvements to your home in 2013?
(Bring receipts)
P.
Did you receive employer sponsored dependent care benefits this year? (flex benefits)
Q.
Did you pay any student loan interest this year? – (Bring in Form 1098E)
R.
Did you pay college tuition for yourself or dependent this year? – (Bring in Form 1098-T and complete
section below)
S.
Did you or your employer contribute to a Health Savings Account in 2013?
T.
Are you or your spouse insured by a long-term care “partnership plan”? (Bring in certification)
**You will need to contact your insurance company if you do not have a copy of the certificate**
Indicate Year in
College as of 01/01/13
Child’s Name
Dates Paid
Amount Paid
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DEDUCTIONS
8. IRA PLANS
Taxpayer
Spouse
A. If eligible, how much do you want to contribute to an IRA?
B. Amount already contributed for 2013 (if any)
C. Type of IRA (Roth, Traditional, Other)
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