EDWARD F. CONNELLY

Certified Public Accountant

661 Highland Avenue

Needham, Massachusetts 02494

 

Tel                   781-449-8700

Fax                  781-449-8770

Email                Ed@128CPA.com

 
The CPA Firm on Route 128SM

 

Call For Your Free Initial Consultation

 

Income Tax Organizer

 

This five-section income tax organizer will help you to both organize your tax information and ensure that you don't overlook any deductions to which you're entitled. Please feel free to call us with any questions.

Taxpayer Information for Tax Year ____________________

First Name ____________________________________________ Initial _______

Last Name_____________________________________________

Social Security # _______________________________________

Occupation____________________________________________

Date of Birth ________________________

Street Address ______________________________________________________

City___________________________________ State_________ Zip____________

Home Telephone _____________________________

Work Telephone______________________________

Spouse Information

First Name ____________________________________________ Initial _______

Last Name_____________________________________________

Social Security # _______________________________________

Occupation____________________________________________

Date of Birth ________________________

 

Filing Status

smallbox.gif (120 bytes)Single

smallbox.gif (120 bytes)Married

smallbox.gif (120 bytes)Head of Household

smallbox.gif (120 bytes)Married Filing Separate

Salaries and Wages

W-2

 Gross Income 

Federal Withholding

    FICA    

1

$

$

$

2

$

$

$

3

$

$

$

4

$

$

$

5

$

$

$

 

W-2

   Medical   

State Withholding

    SDI    

1

$

$

$

2

$

$

$

3

$

$

$

4

$

$

$

5

$

$

$

Electronic Filing

Would you like electronic filing?

smallbox.gif (120 bytes)Yes

smallbox.gif (120 bytes)No

Automatic deposit?

smallbox.gif (120 bytes)Yes
(attached a VOIDed check)

smallbox.gif (120 bytes)No

Dependents

1. Name ________________________________________________________

Date of Birth_________________

Social Security #________________________

Relationship _____________________________

Months lived at home this tax year _________________

 

2. Name ________________________________________________________

Date of Birth_________________

Social Security #________________________

Relationship _____________________________

Months lived at home this tax year _________________

3. Name ________________________________________________________

Date of Birth_________________

Social Security #________________________

Relationship _____________________________

Months lived at home this tax year _________________

4. Name ________________________________________________________

Date of Birth_________________

Social Security #________________________

Relationship _____________________________

Months lived at home this tax year _________________

 

Other Income
Interest - Attach 1099 Forms

Payor

Amount

1

$

2

$

3

$

4

$

 


 

Dividends - Attach 1099 Forms

Payor

Total

Capital Gain

Ordinary Dividend

1

$

$

$

2

$

$

$

3

$

$

$

4

$

$

$

State Tax Refund
 Amount Received $___________________

smallbox.gif (120 bytes)Check if you did not itemize on your federal tax return last year.

Capital Gains (stocks, bonds, other investment property)

Description

Date Acquired

Date Sold

Sales Price

Cost or Basis

1

 

 

$

$

2

 

 

$

$

3

 

 

$

$

4

 

 

$

$

Pensions/IRA Distributions - Attach Form 1099 / W-2s

Payor  

Gross
Distribution

Taxable
Amount

1

$

$

2

$

$

smallbox.gif (120 bytes)Check box if Federal or State Tax was withheld

Alimony Received
Payor __________________________________________  Amount $___________

Payor's Social Security #____________________________

Unemployment Received
Taxpayer Amount $________________                Spouse Amount $_________________

Social Security Benefits Received
Taxpayer Amount $_______________                  Spouse Amount $_________________

Miscellaneous Income
Description:______________________________________________________________

 

Deductions
Medical and Dental Expenses
Insurance Premiums (Net) ___________________

Doctors, Dentists, etc. ______________________

Taxes Paid
State & Local Income Tax _____________________

Real Estate Taxes - Residence _________________

Real Estate Taxes - Other Property ______________

Auto License:
No. of Cars/Fees Paid _______________________

Personal Property Taxes _____________________

Other Taxes _______________________________

Interest Paid - Attach 1098 Forms
Home Mortgage Interest Paid (1st) ____________________

Home Mortgage Interest Paid (2nd) ____________________

Contributions - Attach Details
Contributions by Cash or Check ____________________

Contributions by Other than Cash ___________________

Miscellaneous Deductions
Unreimbursed Employee
Business Expenses ____________________

Union /Professional Dues ________________

Investment Expense ____________________

Tax Return Preparation Fees _____________

Safe Deposit Box Rental _________________


 

Business Income & Expenses
General Information

  Cash Basis

Accrual Basis

Name of Proprietor __________________________________________

Principal Bus./Profession _____________________________________

Business Name ____________________________________________

Business Address __________________________________________

City, State, Zip ____________________________________________

Other Accounting Method ___________________________________

Income
Gross Receipts or Sales $___________________________

Returns and Allowances $___________________________

Other Income $____________________________________

Cost of Goods Sold - If Applicable
Inventory at Beginning of the Year $_______________________

Inventory at End of the Year $____________________________

Purchases $____________________________

Cost of Items for Personal Use $_________________________

Cost of Labor $_________________________

Materials and Supplies $__________________

Other Costs $__________________________

Expenses
Advertising $_____________________________

Car and Truck Expenses* $__________________

Commissions $____________________________

Employee Benefit Programs $________________

Insurance (other than health) $________________

 

Health Insurance
Premiums for Self, Spouse, and Dependents* $________________________

Interest Expense*
(paid to banks, etc.) $______________________

Legal and Professional Fees $_____________________

Office Expense* $___________________________

Pension and Profit
Sharing Plan Contributions $____________________________

Rent - Vehicles, Machinery,
and Equipment $___________________________

Rent - Other Business Property $______________

Repairs $__________________________________

Supplies $_________________________________

Taxes - Real Estate $________________________

Taxes - Other $_____________________________

Travel $____________________________________

Total Meals
and Entertainment $_________________________

Utilities $__________________________________

Wages Paid $______________________________

* Attach details

Did you dispose of any business assets (including real estate)?

Yes    NoIf yes, attach details.

Did you have a home office during the year?

Yes    No

Rent $____________________ Utilities $________________

Insurance $________________ Janitorial $_______________

Misc._________________ % of exclusive business use_______

 

Rental Income & Expenses

  Check if property was purchased/converted to rental.

Property Address    

1.    ______________________2.    ________________________________3.   ___________________________________

Property

  1.  

  2.  

  3.  

Income:
Rents Received

 

 

 

Expense:
Advertising

 

 

 

Association Dues

 

 

 

Auto and Travel

 

 

 

Cleaning/Maintenance

 

 

 

Commissions

 

 

 

Gardening

 

 

 

Insurance

 

 

 

Labor

 

 

 

Professional Fees

 

 

 

Miscellaneous

 

 

 

Mortgage Interest

 

 

 

Other Interest

 

 

 

Repairs and Maintenance

 

 

 

Supplies

 

 

 

Taxes

 

 

 

Telephone

 

 

 

Utilities

 

 

 

Improvements

 

 

 

Other:

 

 

 

 


 

Adjustments To Income

Alimony Paid
Payee __________________________________________ 

Amount $_____________

Payee's Social Security # __________________________

IRA Deduction __________________________

Keogh/SEP Deduction ___________________

Penalty on Early
Withdrawal of Savings ____________________

Estimated Tax Payments

Federal

 Date Paid 

 Amount Paid 

Refund Applied From
Prior Year

 

 

1st Quarter

 

 

2nd Quarter

 

 

3rd Quarter

 

 

4th Quarter

 

 

 

State

 Date Paid 

 Amount Paid 

Refund Applied From
Prior Year

 

 

1st Quarter

 

 

2nd Quarter

 

 

3rd Quarter

 

 

4th Quarter

 

 

 


Miscellaneous Questions

Please answer the following questions, and where appropriate, include all pertinent details.

YES

NO

 

 

 

Were there any births, adoptions, marriages, divorces, or deaths in your immediate family during the year?

 

 

Are any of your unmarried children, who might be claimed as dependents, 19 years of age or older?

 

 

Can you be claimed as a dependent on another person's tax return?

 

 

Did you or your spouse receive any disability income during the year? If yes, enter amount $__________________.

 

 

Did you sell any stocks, bonds, or other investment property during the year? If yes, have you listed the description, date acquired, date sold, sales price, cost or other basis in Section Two of this organizer?

 

 

Did you receive any K-1s from partnerships, estates, trusts, LLCs? If so, please attach.

 

 

Did you purchase, sell, or refinance your principal home or your second home, or get a home equity loan during the year? If yes, please attach escrow papers and other relevant information.

 

 

Did you or your spouse "roll over" a profit sharing or retirement plan distribution into another plan? If yes, enter amount $_________________, and attach Form 1099-R.

 

 

Does anyone owe you money which has become uncollectable?

 

 

Did you incur a loss because of damaged or stolen property?

 

 

Did you incur moving expenses during the year due to a change of employment?

 

 

Did you use your car on the job (other than to and from work)?

 

 

Did you or your spouse work out of town for part of the year?

 

 

Did you have an interest in or signature over a bank or brokerage account in a foreign country, or were you a grantor of or transferor to a foreign trust?

 

 

Do you or your spouse want to allocate $3 to the Presidential Election Campaign Fund?

 

 

Were you audited by either the Internal Revenue Service or a state taxing agency during the year?

  CIRCULAR 230 NOTICE: The Internal Revenue Service regulations require us to advise you that, unless otherwise specifically noted, any  tax advice in this communication (including any attachments, enclosures, or other accompanying materials) was not intended or written to be used, and it cannot be used, by any taxpayer for the purpose of avoiding penalties under the Internal Revenue Code or applicable state or local law provisions.

 

 

Call For Your Free Initial Consultation