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TAX YEAR 2012
INCOME TAX GUIDE & CLIENT ORGANIZER
Gail Miller Anderson Tax & Financial Services 9326 Swinton Avenue
North Hills, CA 91343
Phone: (818) 891-8194
Fax: (818) 894-3234
Email: [email protected]
Website: www.gmataxes.com
This questionnaire is provided to assist you in compiling the necessary information to prepare your tax
return accurately and to assure that all income, credits and allowable deductions are properly taken into
account. While every attempt has been taken to cover all cases, you may have additional information that
requires review. If so please note your questions and return them with this form.
Please include your last year’s return (only if you are a new client), all W-2, 1099 and K-1 forms.
Upon completing this Tax Organizer, please read and sign below.
I have gathered and submitted the information contained in this questionnaire and to the best of my
knowledge it is true, correct, and complete.
Signed: _______________________________________________________
PERSONAL INFORMATION
□ Check here if there are no changes from last year □Married during year (date______________) □ Lost a dependent
□Divorced during year (date______________) □ Gained a dependent
□ Spouse died during year (date______________) □ Legally blind? □ You □ Spouse
□ Moved during year (date________________) □ Disabled? □ You □ Spouse
Telephone: Home__________________ Office (H)_______________ Office (W)________________
Taxpayer: __________________ ___ __________________________________ First Name M.I. Last Name
Occupation _____________________ Social Security Number ________________
Street Address _______________________________________________________
City ________________________________ State ______ Zip Code __________
Spouse: ____________________ ___ __________________________________ First Name M.I. Last Name
Occupation _____________________ Social Security Number ________________
Street Address _______________________________________________________
City ________________________________ State ______ Zip Code __________
Dependents:
□Check here if no change from last year. You must provide a Social Security # for all dependents.
Children living at home: (Social Security Numbers are required for all dependents.)
Name (First M.I. Last) Social Security Number Birth date
1. ___________________________________________ _____________________ ___________
2. ___________________________________________ _____________________ ___________
3. ___________________________________________ _____________________ ___________
4. ___________________________________________ _____________________ ___________
Other dependents: (Social Security Numbers are required for all dependents.) Month % of
in Support Name (First M.I. Last) SSN DOB Relationship Home by you
1. _____________________________ ______________ _________ __________ ______ _______
2. _____________________________ ______________ _________ __________ ______ _______
3. _____________________________ ______________ _________ __________ ______ _______
If filing Head of House and qualifying person is your child but not your dependent above, enter child’s
name here: ________________________________________________________________________
INCOME
H* Withheld Taxes**
W Name of Employer Gross Earnings Federal State Local
__ ___________________________ _____________ ___________ ____________ ___________
__ ___________________________ _____________ ___________ ____________ ___________
__ ___________________________ _____________ ___________ ____________ ___________
__ ___________________________ _____________ ___________ ____________ ___________
__ ___________________________ _____________ ___________ ____________ ___________
* H=Husband, W=Wife ** Include all copies of W-2 wage statements.
INTEREST INCOME
T/S/J* Name of Payer Interest Amount Exempt
____ ______________________________________ ____________________ __________________
____ ______________________________________ ____________________ __________________
____ ______________________________________ ____________________ __________________
____ ______________________________________ ____________________ __________________
____ ______________________________________ ____________________ __________________
* T=Taxpayer, S=Spouse, J=Joint
DIVIDEND INCOME
Total Ordinary Qualified Capital
T/S/J* Name of Payer Dividends Dividends Gains Non-taxable
____ _____________________ _____________ _____________ _____________ _____________
____ _____________________ _____________ _____________ _____________ _____________
____ _____________________ _____________ _____________ _____________ _____________
____ _____________________ _____________ _____________ _____________ _____________
____ _____________________ _____________ _____________ _____________ _____________
* T=Taxpayer, S=Spouse, J=Joint
CAPITAL GAINS AND LOSSES
Date Date Sale Cost of
T/S/J* Description Acquired Sold Price Basis
____ _________________________________ __________ __________ __________ __________
____ _________________________________ __________ __________ __________ __________
____ _________________________________ __________ __________ __________ __________
____ _________________________________ __________ __________ __________ __________
____ _________________________________ __________ __________ __________ __________
* T=Taxpayer, S=Spouse, J=Joint
MISCELLANEOUS INCOME It is important to list the items below, even if not taxable. Show losses in brackets < >.
Amount Child Support payments/assistance ___________
Jury duty (or other public services) ___________
Tips/gratuities (not reported to IRS) ___________
Prizes/awards/lottery winnings (explain) ____________________________ ___________
Commissions/bonuses (not reported on W-2) ___________
Pensions/annuities (furnish Form 1099-R or details) ___________________ ___________
IRA/Keogh/SEP/SIMPLE Distribution ___________
Veteran’s benefits/disability income ___________
Business/self employment/farm/rental (furnish a schedule) ___________
Unemployment compensation ___________
Barter and exchanges ___________
Scholarship and fellowships ___________
Workers compensation/loss of time payments ___________
Other (explain) ________________________________________________ ___________
Other (explain) ________________________________________________ ___________
SOCIAL SECURITY
Use amount reported in box 5 of Social Security Benefit Statement (SSA-1099) and attach a copy.
Taxpayer ________________ Spouse________________
INCOME TAXES PAID OR REFUNDED
If someone else prepared your return last year please provide a copy.
Balance paid on last year’s tax return: Federal __________ State___________ Local ___________
Refunds received from last year’s return: Federal __________ State___________ Local ___________
Estimated Taxes Paid (if not paid by due date list actual date paid)
1st Qtr dated 4/15 Federal __________ State___________ Local ___________ Date ___________
2nd
Qtr dated 6/15 Federal __________ State___________ Local ___________ Date ___________
3rd
Qtr dated 9/15 Federal __________ State___________ Local ___________ Date ___________
4th Qtr dated 1/15 Federal __________ State___________ Local ___________ Date ___________
DEDUCTIONS AND CREDITS Check the following deductions and credit lists carefully. From your cancelled checks, paid invoices, or
other records, determine your deductions/expenditures during the past year. Enter the amount in the
space provided after each deduction item. Also enter items you think are deductible that do not appear on
the deduction list so it can be determined whether they are allowable. Keep all paid receipts, contracts,
and cancelled checks for these deductions at least three years after the due date for filing.
MEDICAL – Only the amount of un-reimbursed medical expenses in excess of 7.5% of Adjusted Gross
Income is allowed.
Prescription & Drugs (Doctor Prescribed only) ____________________
Insulin (General Drugs not allowed) ____________________
Eye Glasses/Contact Lenses ____________________
Hearing Aids & Supplies ____________________
X-Ray/Lab Fees ____________________
Ambulance/Paramedics ____________________
Nurses (Board & Fees) ____________________
Medical Aid Rental ____________________
Equipment (Prescribed) ____________________
Nursing Home Medical Care ____________________
Medical Part B Service Payments ____________________
Smoking Cessation Program ____________________
Medical Insurance Code: Pre-Tax ________________ After Tax ______________
Insurance-Paid by you ____________________
Group Health Plan (Deducted by Salary) ____________________
Medicare Premiums ____________________
Other Insurance ____________________
Other: _______________________________________ ____________________
Other: _______________________________________ ____________________
TAXES
Description of Tax State Amount
Real Estate Taxes (home) ______ ______________
Real Estate Taxes (other) ______ ______________
Property Tax rebates ______ ______________
Personal Property Tax ______ ______________
Auto License ______ ______________
State or Local Income Taxes ______ ______________
Sales Tax (other) ______ ______________
INTEREST Amounts, names and social security numbers must match Form 1098 issued by financial institution.
Amount
Primary Residence paid to financial institution _______________
Home mortgage paid to individuals _______________
Name _____________________________________________
Address ___________________________________________
SSN _________________________
Second Residence paid to financial institution _______________
Home mortgage paid to individuals _______________
Name _____________________________________________
Address ___________________________________________
SSN _________________________
Other: ____________________________________________________________________
Other Loans: Amount Home Improvement _______________
Interest on investments _______________
Points paid to acquire new mortgage _______________
Interest on school loans _______________
MOVING EXPENSES
If your residence has changed because you transferred to a new place of employment or because you
change employers, the cost of the move may be deductible. The information below is necessary to
determine amount allowable.
1. Distance from former residence to new business location _________ miles
2. Distance from former residence to former business location _________ miles
3. Subtract line 2 from 1 _________ miles
If line 3 is less than 50 miles stop here, you may not deduct moving expenses.
Date new employment began? ________________ Transportation of family: Amount
Expenses for train, bus, air travel, auto (include mileage), etc. ___________
Cost of lodging en route ___________
Cost of moving furniture & personal effects (date of move) ____/____/_______ ___________
Moving expenses paid by employer ___________
CASUALTY OR THEFT LOSSES From fire, storm, theft, etc. If more than one, provide similar details for each.
Kind of Property or item _______________________________ Date acquired ___/____/____
Cost or Basis _________________ Insurance reimbursement _____________________
Describe how or what happened ___________________________________________________
Fair market value-before _________________ Fair market value-after _______________
Kind of Property or item _______________________________ Date acquired ___/____/____
Cost or Basis _________________ Insurance reimbursement _____________________
Describe how or what happened ___________________________________________________
Fair market value-before _________________ Fair market value-after _______________
CONTRIBUTIONS Charitable contributions of $250.00 or more at one time require written acknowledge from the charitable
organization. This information must be obtained prior to filing your tax return. In addition, all cash
contributions require substantiation.
Church and religious organizations Amount
Church: Name _______________________________________ _______________
Other Religious: Name _________________________________ _______________
Other charitable organizations Amount
Name ______________________________________________ _______________
Name ______________________________________________ _______________
Name ______________________________________________ _______________
Name ______________________________________________ _______________
Name ______________________________________________ _______________
Non-cash contributions Name of organization Item(s) donated Date Value
_______________________ ________________________________ ___________ ___________
_______________________ ________________________________ ___________ ___________
_______________________ ________________________________ ___________ ___________
_______________________ ________________________________ ___________ ___________
Volunteer work - mileage (church, hospital, or non-profit organization) Name of organization Activity Performed Parking Miles Driven
_______________________ ________________________________ ___________ ___________
_______________________ ________________________________ ___________ ___________
_______________________ ________________________________ ___________ ___________
Meals, lodging, and other expenses may also be allowed-list full detail ________________________________________________________________________________ ________________________________________________________________________________
MISCELLANEOUS DEDUCTIONS Tax preparation fees ________________ Safe deposit box fees ________________
Union Dues ________________ Professional dues ________________
Dues/Subscriptions ________________ Tools/shoes/glasses ________________
Uniforms (cost & upkeep) ________________ Employment agency fees ________________
Second job mileage _______________ Job hunting expenses ________________
Handicapped job expenses _______________ Job related education ________________
Investment expenses _______________
Telephone _______________ Explain requirement ________________________________________
Alimony Paid _____________ Paid to ______________________________ SSN _______________
HOUSEHOLD EMPLOYEES Name of person Address ID# Amount paid _______________________ ____________________________ _________________ __________
_______________________ ____________________________ _________________ __________
_______________________ ____________________________ _________________ __________
_______________________ ____________________________ _________________ __________
CHILD AND DEPENDENT CARE
If you or your spouse paid someone to care for your child or other qualifying person so either of you
could work or look for work, you may be able to take a credit for child and dependent care expenses. A
qualifying person is any dependent child under age 13 or your disabled spouse who is not able to care for
himself or herself.
Childcare Provider Address Phone # ID# Amt Paid ____________________ ____________________________ ____________ ___________ ________
____________________ ____________________________ ____________ ___________ ________
____________________ ____________________________ ____________ ___________ ________
OFFICE IN HOME
Justified for business or professional use by: □ Taxpayer □ Spouse □ Both
Date acquired ____________ Cost of land ____________ Cost of home _____________
Cost of improvements _____________ Repair/maintenance _______________
Interest ____________ Utilities ____________ Taxes _____________ Insurance ___________
Other: Description ______________________________________________ Amount _____________
Square footage of living area ________________ Square Footage of office area _______________
EMPLOYEE BUSINESS EXPENSES
For outside salespersons or individuals not fully reimbursed by employer.
Vehicle Mileage (odometer reading) Vehicle 1 Vehicle 2 End of year ________________ __________________
Beginning of year ________________ __________________
Business Miles ________________ __________________
Commuting Miles ________________ __________________
Personal Miles ________________ __________________
Total Miles Driven ________________ __________________
Vehicle expenses (If both husband and wife have deductions use vehicle 1 for husband, 2 for wife)
Vehicle 1 Vehicle 2 Vehicle 1 Vehicle 2 Gas and Oil _________ _________ Parking and Tolls _________ _________
Washing and Lube _________ _________ Licenses _________ _________
Repair/maintenance _________ _________ Lease payments _________ _________
Tires/accessories _________ _________ Interest _________ _________
Insurance _________ _________ Garage rent _________ _________
Make Year Model Date acquired Cost or basis Vehicle 1 _________ _________ _________ _____________ __________________
Vehicle 2 _________ _________ _________ _____________ __________________
Travel Expenses: Number of nights away from home _____________
Taxpayer Spouse Taxpayer Spouse Transportation ___________ ___________ Auto Rentals ___________ __________
Lodging ___________ ___________ Cabs, Bus, etc ___________ ___________
Meals and tips ___________ ___________
Other business expenses: (must have supportive record for entertainment and gifts)
Taxpayer Spouse Taxpayer Spouse Entertainment ___________ ___________ Commissions ___________ ___________
Tickets/events ___________ ___________ Gifts/cars ___________ ___________
Postage/freight ___________ ___________ Office supplies ___________ ___________
Phone ___________ ___________ Dues/subscriptions ___________ ___________
Furniture/equipment ___________ ___________ Required education ___________ ___________
Total of above expenses reimbursed: Taxpayer ___________ Spouse _____________
Did you purchase any other business equipment during the year? □ Yes □ No
If yes, provide a list of dates bought, cost and description and trade-in deals. I have adequate records and
sufficient evidence to support the use of vehicles and deductions listed above.
Signed: __________________________________ ______________________________________
EARNED INCOME CREDIT
If you have more than three qualifying children, only list the three youngest children.
Child’s name DOB Relationship # of months lived full –time student (First, MI, Last) in your home under the age of 24
_________________________ ___________ ____________ ______________ □ Yes □ No
_________________________ ___________ ____________ ______________ □ Yes □ No
_________________________ ___________ ____________ ______________ □ Yes □ No
PARTNERSHIP, S-CORP, ESTATES AND TRUSTS
Enclose your copies of Schedules K-1, returns or other documents. Enter name, address, and Federal
Employer Identification Number from any partnership, joint venture, limited liability company, S
corporation, estate or trust, for which you do not have the Schedule K-1.
__________________________________________________________________________________
__________________________________________________________________________________
QUESTIONS
For “yes” answers, supply details.
1. Were you eligible to be claimed as a dependent on another tax return?
□ Yes □ No __________________________________________________________________
2. Were you notified by the IRS, State or City of any changes to any prior year’s tax return?
□ Yes □ No __________________________________________________________________
3. Did you make any gifts of over $13,000 in value to any individual?
□ Yes □ No __________________________________________________________________
4. Did you have living expenses in a foreign country as a result of income earned abroad?
□ Yes □ No __________________________________________________________________
5. Do you have any worthless stocks or uncollectible bad debts?
□ Yes □ No __________________________________________________________________
6. Did you receive any reimbursement (medical, insurance) for any expense claimed as a deduction on
a prior tax return? □ Yes □ No _________________________________________________
7. Do you expect any significant changes in income or tax liabilities in the coming year?
□ Yes □ No __________________________________________________________________
8. Did you receive any income from a source not listed in this booklet?
□ Yes □ No __________________________________________________________________
9. Do you wish to designate (at no cost to you) $3.00 of your taxes to the Presidential Campaign Fund?
□ Yes □ No _________________________________________________________________
OTHER CREDITS
Did you pay college tuition for yourself, spouse, or dependent?
□ Yes □ No (If “yes” attach Form 1098-T and the student account record for each student.)
Did you make any energy efficient improvements to your principal residence, such as insulation,
windows, doors, furnace, etc.?
□ Yes □ No (If “yes” please provide details on a separate sheet and include receipts.)
Did you purchase an electric vehicle or electric plug-in vehicle?
□ Yes □ No (If “yes” attach manufacturer’s certification and purchase statement.)
CHECK LIST AND CERTIFICATION
Review amounts and details listed in this tax booklet for completeness and include the following items (as
applicable to your return) when presenting your information for preparation of your tax returns:
□ 1. This completed Client Organizer
□ 2. All W-2 forms
□ 3. Estimated tax forms
□ 4. Partnership, limited liability companies, joint ventures, S corporation estates and trust documents
□ 5. Form(s) 1099 indicating dividend and interest income
□ 6. Buy/sell statements to cover stock sales, real estate transactions, and installment sales
□ 7. Copies of sales contracts to determine finance charges
□ 8. If you are a new client, provide copies of last year’s tax return
□ 9. Check if payroll reports were filed for household help
□ 10. Check if you have disability income
□ 11. Check if you were audited during the past year. Enclose results.
OTHER QUESTIONS OR COMMENTS Please note any other questions or comments on a separate piece of paper and keep it with this booklet.
I have reviewed the information contained in this booklet and to the best of my knowledge it is true, correct, and complete.
Signed: ____________________________________________________
When complete, print this form out and sign the appropriate boxes. Then mail it to the address below, fax it to (818) 894-3234, email to [email protected] or drop it off at my office:
Gail Miller Anderson Tax & Financial Services 9326 Swinton Avenue
North Hills, CA 91343
CALL FOR AN APPOINTMENT: (818) 891-8194