Income Tax Worksheet
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5LEVY, LEVY AND NELSON
A PROFESSIONAL ACCOUNTANCY CORPORATION
20501 VENTURA BLVD. SUITE 120 WOODLAND HILLS, CA 91364
PHONE: (818)346-8034 FAX: (818)346-6409
TAX RETURN YEAR_______________INCOME TAX WORKSHEET
NAME
BIRTHDATE
OCCUPATION
Taxpayer ________________________________________ ________________________
Spouse
_______________________________________ ________________________
Home Address ___________________________________ City ______________________ State ________ Zip _____________
Home Phone: _________________________
Cell (Yours) ___________________
Cell (Spouse)_________________________
Email (Yours): ___________________________________________
Email (Spouse): ________________________________
DEPENDENTS
- (If different from last year) INCLUDE CHILDREN AND OTHERS YOU SUPPORT
NAME
BIRTHDATE
SOCIAL SECURITY#
INCOME
1 .
2 .
3 .
4 .
CHILD CARE INFORMATION
CHILD CARE INFORMATION
EDUCATION EXPENSES
Child's Name __________________________
Child's Name __________________________
Name of Provider ______________________
Name of Provider ______________________
Tuition Paid _______________________
Address ______________________________
Address ______________________________
Students Name _____________________
_____________________________________
_____________________________________
If College applies, please check
City
State
Zip
City
State
Zip
check the level completed last year:
Phone Number _________________________
Phone Number _________________________
Freshman
Junior
Identification Number ___________________
Identification Number ___________________
(MANDATORY)
(MANDATORY)
Sophomore
Senior
Amount Paid ___________________________
Amount Paid___________________________
Grad Student
QUESTIONS
YES
NO
1. Did you have health insurance last year? ______________________________________________
2. Do you have the same checking account
as last year for direct deposit of refund? _______________________________________________
3. Did you marry or divorce last year? __________________________________________________
4. Did you pay or receive alimony? ____________________________________________________
5. Are there any changes to your dependents?_____________________________________________
6. Did you sell any stocks or investments last year? ________________________________________
7. Do you have any foreign bank accounts or foreign brokerage accounts? ______________________
8. Did you purchase a new home or refinance? ___________________________________________
(Please provide lender's closing statement)
9. Did you sell any real estate last year? ________________________________________________
10. Did you receive a distribution from your IRA or pension last year?_________________________
11. Did you contribute to an Individual Retirement Account (IRA) last year? ____________________
12. Did you move (rollover) your IRA? ________________________________________________
13. Did you give anyone a gift over $14,000 last year?_____________________________________
If you received an IRS or Franchise Tax Board notice last year please provide a copy
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Parent category: Financial