Individual Income Tax Information Worksheet Page 3
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49. ALIMONY
Amount
Social Sec #
Amount paid this year and recipient’s Social Security Number
10. CHILD CARE – (Daycare Center or Baby Sitter)
Amount flexed through your employer _______________
1.
Name
I.D or Soc Sec #
Address
Amount Paid
Name of children attending
2.
Name
I.D or Soc Sec #
Address
Amount Paid
Name of children attending
11. EMPLOYEE BUSINESS EXPENSE –
(Mileage must be supported by a written log or expense report to be eligible for deduction.)
Business miles driven
Total of all miles driven, including personal
Cost of business related meals (only if you are not using per diem)
Lodging costs
Number of days away from home overnight on business
12. MOVING EXPENSES – Attach a list of any moving expenses as a result of a job related relocation
13. MEDICAL EXPENSE
Medical insurance premiums you paid (do not include Medicare)
Prescription drugs, insulin, doctors, dentists,
hospitals, chiropractors and clinics you paid
Eyeglasses, hearing aids, dentures, etc.
Long-Term Care Insurance premiums paid
Taxpayer
Spouse
Lodging costs while away from home for medical treatment
Miles driven for medical care
14. TAXES
Real estate tax on residence paid in 2015 (Must bring in 2014 Real Estate tax statement)
Taxes paid on second home, vacation home, lake cabin, etc.
15. INTEREST
Home mortgage interest and points paid to financial institutions (Bring in Form 1098)
Second mortgage interest paid on personal residence
Home mortgage interest paid to individuals (person’s name, SS# and address)
Investment interest paid
Mortgage Insurance Premium paid
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