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Itemized Deduction Worksheet 2010

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					                                               Itemized Deductions


         Taxpayers' Names                                                                                          Tax Year      2010



         Unreimbursed Medical Expenses                   PAID IN 2010                                            Amount
            Doctors, Hospitals & Lab Fees
            Eyeglasses and Contact Lenses
            Prescriptions    Do not include Rx purchased outside of the US
            Convalescent or Nursing Home
            Other Expenses - Explain
            Medical Insurance - Exclude Medicare & Rx Premiums on Form SSA-1099
            Long-Term Care Insurance - Husband
            Long-Term Care Insurance - Wife
            Medical Related Mileage                                        miles @24¢/mile
         Notes    Provide totals by category only. Do not submit medical bills or receipts.
                  All amounts should be reported NET of insurance reimbursements.
                  Do not include insurance paid through a Sec 125 payroll deduction.




         Mortgage Interest        Indicate [M] for Mortgage or [E] for Home Equity Loan or Line of Credit or [P] for Points
                                            Name of Lender                                        M, E or P             Amount




         Notes    Attach copy of Form 1098 or statement from lender.
                  Do not include interest paid on mortgages for rental properties.
                  If points were paid on a mortgage refinance, indicate # of years for the new mortgage. ______ years
                  The interest deduction on Home Equity Loans and Lines of Credit may be limited. Therefore,
                      please indicate below the amount borrowed on such loans and purpose or use of the funds.
                  Amount      $                              Purpose
                  Amount      $                              Purpose




         Real Estate and Motor Vehicle Taxes             PAID IN 2010
                    Property Address or Vehicle Description                       City/Town         Date(s) Paid              Amount




         Notes    If Real Estate taxes were not paid through a mortgage escrow account, attach a copy of your real estate tax
                      bills for payments paid in 2010 and be sure to indicate actual dates of payments made in 2010.
                  Do not include real estate taxes paid on rental properties.
                  Attach copy of automobile tax bills and indicate actual dates of payments made in 2010.
                  If you purchased a car, truck, boat or airplane attach bill of sale showing sales tax paid.
                                                                                                                                   2010

Z:\FORMS\Itemized Deduction Worksheet 2010.xls
                                              Itemized Deductions


         Taxpayers' Names                                                                                          Tax Year    2010



         Charitable Contributions                          PAID IN 2010
                                       Name of Organization                                                        Amount
            Paid by Cash, Check or Credit Card




            Other Non-Monetary Contributions




         Notes    If paid by cash, you may only deduct amounts for which you have a receipt or acknowledgement.
                  If paid by check or credit card you must have a receipt or acknowledgement for contributions of $250 or
                      more to any one organization. [Submit copy of any receipt of $250 or more]
                  Submit acknowledgement for any contribution of a motor vehicle.
                  Submit dated receipts for any non-monetary contributions, such as items to Goodwill, including $ value.
                      If total non-monetary contributions exceed $500 you must provide name & address of each
                      organization, fair market value of donated items and method used to determine the values.




         Miscellaneous Itemized Deductions              PAID IN 2010                                                        Amount
            Union Dues
            Unreimbursed Job Related Expenses [Enter detail below]
            Investment Fees [Obtain fee information from your broker(s)]
            Tax Preparation Fees
            Safe Deposit Box
            Gambling Losses [Not to Exceed Winnings] for which you have evidence or support
            Uninsured/unreimbursed casualty or theft losses


         Notes    Identify job related expenses, including licenses, continuing education, uniforms, tools, etc.




                                                                                                                                 2010

Z:\FORMS\Itemized Deduction Worksheet 2010.xls
                                       Other Deductions and Tax Credits


         Taxpayers' Names                                                                                        Tax Year   2010



         Estimated Tax Payments - Be sure to include payments made in 2011 for 2010
                    Federal Estimates                             State of                                State of
             Date Paid              Amount                Date Paid             Amount             Date Paid            Amount




         Energy Efficient Improvements               ATTACH DOCUMENTATION                          Date Paid            Amount




         Notes     Only improvements to your principal and second (non-rental property) residence qualify.
            Indicate amount paid for qualified windows, doors, siding, insulation, new furnace or water heater, excluding labor.
            Provide certification from dealer.




         Dependent Care Credit Information

         Provider Name & Address                                       Whom Cared For     Provider Tax ID Number        Amount




         Notes     Child must be under age 13 and qualify as your dependent.
                   A spouse or other dependent who is physically or mentally incapable of self care may also qualify.
                   You must provide the providers tax ID number to be able to claim the credit.




         IRA and Other Retirement Plan Contributions            FOR 2010                    H/W      Plan Type          Amount
         Paid to
         Paid to
         Paid to
         Paid to
         Notes     Indicate Plan Type as: [R] for Roth IRA or [T] for a Traditional IRA
                   Indicate Plan Type as: [SEP] [Simple] [401K]
                   Indicate contribution amounts made FOR calendar year 2010 including payments made in 2011 for 2010.
                   If you want to maximize your contribution, indicate "MAX" in the amount box above.




                                                                                                                              2010

Z:\FORMS\Itemized Deduction Worksheet 2010.xls
                                         Other Deductions and Tax Credits


         Taxpayers' Names                                                                                         Tax Year          2010



         Educator Expenses                                 PAID IN 2010                               Amount            $
            Notes      The first $250 of educator classroom expenses may be deductible on page 1 of your return.
                       The balance may be deductible as a miscellaneous itemized deduction.




         Student Loan Interest Deductions                  Attach Forms 1098- E                   Student                       Amount




                                                                                                             Year in        Amount for Course
         Tuition and Fees Deductions         Attach Form 1098-T                    Student          F/P      College        Materials & Books




         Notes      Eligible amounts include amounts paid for Tuition & Fees. Room and Board do not qualify.
                    Also indicate amounts paid for books and other required course materials.
                    Indicate F for full-time student or P for part-time student.




         Withdrawals from Education Accounts                  Attach Form 1099-Q                   Student                      Amount




         Contributions to Education Accounts                                            Student             Plan Type           Amount
         Paid to
         Paid to
         Paid to
         Notes      Indicate Plan Type: Qualified Tuition Program as [529] or Education Savings Account as [ESA]
                    Identify student/beneficiary and amount contributed FOR calendar year 2010 including payments
                       made in 2011 for 2010.




                                                                                                                                       2010

Z:\FORMS\Itemized Deduction Worksheet 2010.xls

				
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