Client Tax Information Sheet Page 2
ADVERTISEMENT
1
2
3Itemized Deductions
(List amounts and provide receipts, checks or other documentation.)
MEDICAL EXPENSES
INTEREST PAID
Doctors
Mortgage on Main Home
Dentists
Paid to Financial Institution (1098)
Other Medical Professionals
Paid to Individual
Prescription Drugs
Name:
SSN:
Surgical Procedures
Address:
Medical Lab Fees
Points Paid on New Mortgage
Hospitals
(Enclose Settlement Statement)
Glasses and Contact Lenses
Home Equity Loan/Second Mortgage
Medical Equipment Rental
Mortgage on Second Home
Prescribed Physical Aids
Paid to Financial Institution (1098)
Skilled Nursing Care
Paid to Individual
Medical Insurance
Name:
SSN:
Dental Insurance
Address:
Long Term Care Insurance
Investment Interest Paid
Medicare Part B
Medical Transportation
CHARITABLE CONTRIBUTIONS*
Medical Miles Driven in Your Vehicle
*Receipt required for single donations of $250 or more.
Other Medical (Describe)
Church/Temple/Mosque
United Way
Scouts
Other (list)
STATE & LOCAL TAXES
Home Real Estate Taxes
Other Real Estate Taxes
Non-Cash Contributions
Personal Property Tax (autos, boat)
(If $500 or more, enclose receipt with name/address of organization
and describe how fair market value was determined.)
Other State or Local Tax
CASUALTY OR THEFT LOSS
MISCELLANEOUS DEDUCTIONS
Type of Property:
Tax Return Preparation Fee (2006)
Describe Loss:
Safe Deposit Box (store investments)
Cost or Basis of Property
Investment Expenses (enclose list)
Insurance Reimbursement
Job Hunting Expenses (enclose list)
Fair Market Value Before Loss
Gambling Losses
Fair Market Value After Loss
Second Job Mileage
Employee Business Expenses and Miscellaneous Deductions
Prof. Association or Union Dues
$__________
Total Mileage on Vehicle in 2009
___________
Uniforms (not street clothes)
$__________
Out of Town Transportation
$__________
Uniform Cleaning
$__________
Out of Town Lodging
$__________
Safety Equipment
$__________
Office in Home Expense
Ask for form
Tools & Other Work Equipment
$__________
Job Hunting Expenses
$__________
Advertising & Marketing
$__________
Safe Deposit Box Rent
$__________
Business Meals & Entertainment
$__________
Tax Return Preparation
$__________
Business Vehicle Mileage 2009
___________
Investment Advice/Management Fee
$__________
Other ________________________ $__________
EDUCATOR AND EDUCATION EXPENSES
Educator Expense
Student Name
Student Name
Type Expense
Type Expense
Amount
$
Amount
$
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