client_tax_worksheets11_1_ by xusuqin

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									                                                                 2011
    Only complete the top half of this page if your information is not in our system or needs updating.


Personal Information                                                        S.S. Number          Date of Birth          Phone Numbers


                                                                        _____-____-_____ ____/____/____
Name (Husband or Single Filing Status)                                                                             Home


                                                                        _____-____-_____ ____/____/____
Name (Wife)                                                                                                        Work (His)


                                                                        _____-____-_____ ____/____/____
Dependent Name                            Relationship                                                             Work (Her)


                                                                        _____-____-_____ ____/____/____
Dependent Name                            Relationship                                                             Cell (His)


                                                                        _____-____-_____ ____/____/____
Dependent Name                            Relationship                                                             Cell (Her)


                                                                        _____-____-_____ ____/____/____
Dependent Name                            Relationship                                                             Email



                 Address                                                         City                 State                  ZIP

                                                                INCOME
                                                         (Bring Detailed Information)

Salary, Wages, Pension, Annuity, IRA Withdrawals                        Interest and Dividends
(Attach or bring all W-2's and 1099's)                                  (Attach or bring all 1099's - Very Important)

Small Business and/or Rental Income                                     Alimony Received:
(Please complete applicable worksheet)
                                                                        $_________________

Capital Gains/Losses                      (Attach or bring all brokerage statements and cost basis information)

Other Income                                                                            Description                       Amount
(Jury Duty, Settlements, Etc.)                                                                                     $
                                                                                                                   $
                                                                                                                   $


                                         Tax Credit for College Expenses
            List total tuition, fees, books, supplies and equipment paid for you, your spouse and/or dependents.
                                                                           Total Expenses        # of Calendar
              Student Name                      Institution                 Paid in 2011        Years in College

                                                                        $______________           ________
                                                                        $______________           ________
                                                                        $______________           ________


REMARKS:



    By signing this document, I affirm that I have read and understood the questions; that
    my responses are accurate and that, to the best of my knowledge, the information I have
By signing this document, I affirm that I have read and understood the questions; that
my responses are accurate and that, to the best of my knowledge, the information I have
supplied for tax preparation and/or furnished to my tax preparer is complete and
accurate.

                               Signature
                                                2011
                                   Personal Deductions Worksheet
                                             (Round to Whole Dollars)
MEDICAL                                                           CONTRIBUTIONS
(Do not include amounts reimbursed by insurance.)
Health, Dental & Cancer Insurance………           $________          Cash . . . . . . . . . . . . . . . . .   $_________
Medicare Premiums Paid………                      $________          Non-Cash ($500 or less)                  $_________
Long Term Care Insurance Premiums Paid………
                                        $________                    (If over $500 bring details)
Medical Miles …………………………                         ________         Charitable Miles………………….. _________
Prescription Drugs…………………                      $________
Doctors, Dentists, Hospitals……..               $________          OTHER DEDUCTIONS
Glasses, Contacts, Hearing Aids & Supplies     $________          Union & Professional Dues.…              $________
Lodging……………………………                             $________          Professional Publications.……             $________
Other (itemize)……………………                        $________          Safety Shoes & Equipment...…             $________
                                                                  Uniforms, Etc.………………                     $________
TAXES                                                             Teaching Supplies…………….                  $________
Real Estate………………………                           $________          Job Hunting Expense.………                  $________
Tax on Vehicle Tags.……………                      $________          Job Related Education………… $________
Sales Tax on Motor Vehicles, Boats, &                             Safe Deposit Box.…………….                  $________
Building Materials……………………….                   $________
                                                                  Investment Expenses….…….                 $________
ESTIMATED TAXES PAID                                              Tax Preparation & Consultation $________
Date Paid     Federal $            State $                        Alimony Paid…………………                      $________

                                                                  IRA (Traditional) - Taxpayer...……...…..……
                                                                                                   $________
                                                                  IRA (Roth) - Taxpayer...……...…..……
                                                                                                 $________
                                                                  IRA (Traditional) - Spouse……….……………
                                                                                                $________
                                                                  IRA (Roth) - Spouse……….……………
                                                                                            $________


                                                                  CHILD CARE EXPENSES
INTEREST                                                          List provider names, addresses,
Home Mortgages (1st & 2nd Homes) - Bring all 1098's               federal identification numbers and
Home Equity Line…………...….....….                $________          amount paid on a separate page.
Vendors Lien………………….                           $________          YOU MUST HAVE ID # TO FILE!
Paid To _____________________________

Address_____________________________                              ATTACH SUPPORTING DETAILS FOR:
____________________________________                              _______ Employee Business Expense
Investment Interest Paid………                    $________          _______ Casualty or Theft Loss
Student Loan Interest Paid……                   $________          _______ Moving Expenses
  RENTAL PROPERTY SCHEDULE          PROPERTY #1       PROPERTY #2       PROPERTY #3

ADDRESS>>>>>>>>>>>>>>




RENTS COLLECTED                 $                 $                 $
EXPENSES:
ADVERTISING                     $                 $                 $
AUTO MILES (NOT DOLLARS)
CLEANING, MAINTENANCE, & PEST   $                 $                 $
COMMISSIONS & FEES PAID         $                 $                 $
CONDO & ASSOCIATION FEES        $                 $                 $
INSURANCE                       $                 $                 $
INTEREST PAID - MORTGAGE        $                 $                 $
INTEREST PAID - OTHER           $                 $                 $
LEGAL & PROFESSIONAL FEES       $                 $                 $
MANAGEMENT FEES                 $                 $                 $
REPAIRS                         $                 $                 $
SUPPLIES                        $                 $                 $
TAXES                           $                 $                 $
UTILITIES                       $                 $                 $
OTHER (ITEMIZE BELOW):
                                $                 $                 $
                                $                 $                 $
                                $                 $                 $
                                $                 $                 $
                                $                 $                 $


TOTAL COST - IF NEW PROPERTY    $                 $                 $
LAND PORTION                    $                 $                 $
ADDITIONS & IMPROVEMENTS:
                                $                 $                 $
                                $                 $                 $


PLEASE COMPLETE THE FOLLOWING FOR VACATIONS HOMES:
# DAYS RENTED
# DAYS OF PERSONAL USE
# OF RENTAL INTERVALS
      SMALL BUSINESS SCHEDULE            AMOUNT              NOTES

SALES                                $
OTHER INCOME (EXPLAIN)               $


PURCHASES FOR RESALE                 $
ENDING INVENTORY VALUE               $


EXPENSES:
ADVERTISING                          $
COMMISSIONS & FEES PAID              $
CONTRACT LABOR
INSURANCE                            $
INTEREST PAID -MORTGAGE              $
INTEREST - OTHER                     $
LEGAL & PROFESSIONAL FEES            $
LODGING, AIRFARE, CAR RENTAL, ETC.   $
OFFICE EXPENSE & SUPPLIES            $
RENTAL - EQUIPMENT                   $
RENT - REAL ESTATE                   $
REPAIRS & MAINTENANCE                $
SUPPLIES - OPERATING                 $
TAXES, LICENSES, PERMITS             $
UTILITIES                            $
WAGES                                $
OTHER (ITEMIZE BELOW):
                                     $
                                     $
                                     $
                                     $
                                     $


                                                  ACTUAL METHOD MILEAGE METHOD
VEHICLE USE:
TOTAL MILES
BUSINESS MILES
EXPENSES                                          $            XXXXXXXXXXXXXX


MEALS & ENTERTAINMENT:
IN TOWN MEALS & ENTERTAINMENT        $
OUT OF TOWN MEALS & ENTERTAINMENT $
# OF NIGHTS OUT OF TOWN

								
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