PERSONAL INFORMATION


Full Name

Social Security Number

Relationship

Date of Birth

Self

Spouse

Dependent

Dependent

Dependent

Childcare Costs

[ ] Cancelled checks or invoices
[ ] Provider's name ____________________________
[ ] Provider's address ________________________________________________
[ ] Provider's tax ID or social security number ______________________________

Educational Costs

[ ] Tuition bills or cancelled checks for post-high school education

Adoption Costs

[ ] Social Security number or I.D. number of adopted child __________________
[ ] Receipts or cancelled checks for:
[ ] Legal fees
[ ] Transportation
[ ] Other costs

INCOME INFORMATION


Income from Jobs

[ ] W-2 forms for all employers for whom you and your spouse worked.

Investment Income

[ ] Interest income - Form 1099-INT
[ ] Dividend income - Form 1099-DIV
[ ] Proceeds from the sale of stocks, bonds, etc. - Form 1099-B
[ ] Confirmation slips or brokers' statements for all stocks, etc. that you sold.
[ ] Schedule(s) K-1 (Form 1065) from investments in partnerships
[ ] Income from foreign investments – Amount of foreign taxes paid (you can find this on the brokers' statement) ___

[ ] Income from stock option exercises and sales:
[ ] Stock option agreement (showing type of options you received)
[ ] Stock option statement showing exercise prices of options
[ ] Form 1099-B for proceeds from stock sale
[ ] Sale of employee stock purchase plan shares:
[ ] Form 1099-B for proceeds from stock sale
[ ] Stock price on grant date ______________
[ ] Stock price on purchase date ___________
[ ] If stock sale occurred before qualifying period begins, Form W-2 showing "compensation income" from a disqualifying disposition

Income from State and Local Income Tax Refunds

[ ] Form 1099-G from state or local governments
[ ] State income tax return from the previous year.
[ ] City income tax return from the previous year, if any

Alimony

[ ] Bank statements or record of deposits

Unemployment Income

[ ] Form 1099-G from your state unemployment agency, OR
[ ] Unemployment check stubs and deposit records

Business or Farming Income

[ ] Books/accounting records for your business, OR:
[ ] Invoices or billings
[ ] Bank statements
[ ] Cancelled checks for expenses
[ ] Payroll records

In addition you need:

[ ] Invoices for major machinery, equipment, furniture, etc. purchases
[ ] Logs or other records listing vehicle mileage
[ ] Inventory records, if your business maintains an inventory of goods or materials

If you Use your Home for Business

[ ] Square footage of your home office area _______________
[ ] Total square footage of your home _____________________
[ ] Total rent paid, if home is rented _____________________
[ ] Mortgage interest reported on Form 1098 _______________
[ ] Property tax payments from assessor's bill, cancelled checks, or impound records ________________
[ ] Homeowner's insurance premium payments _______________
[ ] Invoices for repairs and maintenance on your house
[ ] Utility bills

IRA/Pension Distributions

[ ] Form 1099-R for payments from IRA or retirement plans
[ ] Account summary form for the year for your IRA accounts, OR
[ ] Deposit receipts and contribution records
[ ] If you received a distribution from an IRA account – The most-recently filed Form 8606, if you made contributions to IRAs that weren't deductible on your return

Rental Property Income

[ ] Profit and loss statements from your property manager, OR
[ ] Checkbook or cancelled checks for expenses
[ ] Form 1099-Misc or other records for rental income paid to you
[ ] Mortgage interest reported on Form 1098
[ ] Property tax payments from assessor's bill, cancelled checks, or impound records
[ ] Record of suspended rental losses from prior years (usually shown on last year's return)

Social Security Benefits

[ ] Form SSA-1099

Income from Sales of Property If the property was sold:

[ ] Sales proceeds - Bill of sale, closing statement or other records
[ ] Cost of the property you sold – Invoices, receipts, or cancelled checks
[ ] Improvements made to the property – Invoices or construction contracts and cancelled checks

If the property was sold at a profit before this year on the installment basis:

[ ] Previous year's return – Form 6252, Installment Sales
[ ] Amount of principal collected on the installment note owed to you
[ ] Amount of interest collected on the note
[ ] Name, address and social security number of the buyer

Miscellaneous Income

[ ] Jury duty pay records
[ ] Form(s) W-2G for gambling and lottery winnings
[ ] Receipts for all gambling purchases
[ ] Form 1099-MISC for prizes and awards you received
[ ] Form 1099-MSA for distributions from medical savings accounts
[ ] Scholarship records (if you used the money for anything other than tuition, books, and supplies)
[ ] Director's fees receipts if you received money for serving on a corporate board of directors


ADJUSTMENTS


IRA Contributions

[ ] Year-end account summary or bank statements

Student Loan Interest

[ ] Form 1098-E showing interest paid, OR
[ ] Loan statements

Medical Savings Account Contributions

[ ] Account statements OR
[ ] Cancelled checks

Moving Expenses

[ ] Invoices from moving companies, OR
[ ] Cancelled checks AND
[ ] Paycheck stub for moving expense reimbursements

Self-employed Health Insurance

[ ] Insurance premium bills, OR
[ ] Cancelled checks

Keogh & SEP Pension Plans

[ ] Year-end account summary, OR
[ ] Cancelled checks

Alimony

[ ] Cancelled checks

Educator Expenses

[ ] Cancelled checks for expenses paid for classroom supplies, etc.


ITEMIZED DEDUCTIONS


Medical and Dental Expenses

[ ] Medical bills or cancelled checks
[ ] Form SSA-1099 for Medicare premiums paid from your social security benefits
[ ] Year-end pay stub if premiums were paid through your wages (only if the deductions were after-tax)
[ ] Mileage records for trips to the doctor, clinics, etc.
Taxes
State and local income taxes:
[ ] Last year's state income tax return
[ ] W-2s
[ ] Cancelled checks for state estimates paid

Real estate taxes:

[ ] Tax collector bills or cancelled checks
[ ] Form 1098 or closing statement if you bought, sold, or refinanced property in the current year

Personal property taxes:

[ ] Tax bills or cancelled checks
[ ] Automobile licensing bills, if fees are charged annually based on value
Interest You Paid
Home mortgage interest: [ ] Form 1098, OR
[ ] Your mortgage statement or bill for January

Points:

[ ] Form 1098 if you purchased a home
[ ] Your last year tax return if you refinanced in prior year

Interest paid on investment loans:

[ ] Brokers' statements showing margin interest paid
[ ] Loan statements for loans taken out to purchase investments

Charitable Donations
Cash donations:

[ ] Charity bills, receipts, or cancelled checks
[ ] Records of the mileage incurred for charitable purposes (Scouts, etc.)

Donations of Property:

[ ] Receipts from charitable agency
[ ] Estimated value of property given _____________
[ ] Appraisal fees for expensive donations ____________

Other charitable donations:

[ ] Prior years' tax returns if you have unused charitable contributions (carryovers) from earlier years
[ ] Year-end paycheck stub if donations were paid through your wages

Casualty and Theft Losses

[ ] Description of property damaged or stolen
[ ] Receipts or cancelled checks showing cost of property
[ ] Insurance policy and insurance reports showing reimbursement
[ ] Appraisal fees if applicable _______________

Job Expenses

[ ] Reimbursement check stubs or reports from your employer
[ ] Job travel information:
[ ] Invoices, receipts, or ticket stubs for transportation
[ ] Mileage records per vehicle used
[ ] Hotel bills
[ ] Restaurant tickets showing name and address of establishment
[ ] Parking fee receipts
[ ] Union dues – Paycheck stub for automatic withdrawals
[ ] Gifts to clients, etc. – Receipts showing date, cost, description
[ ] Supplies – Receipts or bills
[ ] Property purchased for use in your work – Invoices, receipts
[ ] Uniform and special clothing costs – Bills or paycheck stubs showing deductions
[ ] Seminar fees – Receipts or invoices
[ ] Professional publications and books – Receipts or invoices
[ ] Receipts for small tools and supplies you purchased
[ ] Job search expenses:
[ ] Long-distance call bills
[ ] Resume costs (printing, mailing, resume service, etc.)
[ ] Transportation bills and mileage records
[ ] Employment agency fees
[ ] Career counseling costs
[ ] Job-related educational expenses:
[ ] Tuition, fee, and book receipts for education that maintains or improves your present skills
[ ] Transportation receipts
[ ] Lodging receipts if you take classes away from home

Other Miscellaneous Deductions

[ ] Tax return preparation fees – Invoices or cancelled checks
[ ] Cost of tax return preparation software and books – Receipts or cancelled checks
[ ] Safe deposit box rental fees from bank invoice or statement _______
[ ] IRA custodial fees (if paid from a non-IRA account) ________
[ ] Payroll records for office workers managing your investments
[ ] Investment advice costs: invoices or bills


INFORMATION ON HOUSEHOLD EMPLOYEES

[ ] Wages paid ________________
[ ] Employee's social security number ________________

TAX PAYMENTS

[ ] Quarterly estimated tax payments – Records showing the date paid and amount
[ ] If you applied a tax overpayment from the previous year – your 2001 income tax return
[ ] If you filed for an extension for last tax return – Cancelled checks for payments you made with the extension


DIRECT DEPOSIT INFORMATION



If you want your refund deposited directly into your bank account, you need your:

[ ] Routing number from the lower left side of one of your checks (usually the first nine digits): ________________________
[ ] Bank account number from the bottom of check or on bank statement:

________________________________