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Tax Deduction Recorder Tax Year Ended ALLEN L. KOCKLER CO. PO BOX 558, NEVADA, IA 50201 515-382-5481 Personal Information Taxpayer Name Taxpayer SSN # Spouse Name Spouse SSN# Address Taxpayer DOB City, State Spouse DOB Home Phone Your Occupation Spouse's Occupation Dependents M/F Date of Birth Social Security # Age Student Name Name Name Name Wage & Salary Income-Enclose W-2 Forms ~T/S~ Employer Total Wages Federal W/H Social Security Medicare State W/H Gambling Winnings/Losses Social Security Benefits Received ~T/S~ Amount ~T/S~ Amount Less Medicare Personal Deductions Interest and Dividend Income Doctor Expenses Interest Income RX Expenses Name of Payer Amount ** Health Insurance ** Long-term Care Insurance Dental Expenses Nursing Home Care Medical Mileage State and Local Taxes Real Estate Taxes Personal Property Taxes Vehicle License Home Mortgage Interest to Banks Home Mortgage Interest to Other Dividend Income Investment Interest Name of Payer Amount Cash Contributions Given Charitable Mileage Non-Cash Contributions Casualty/Theft Losses Unreimbursed Employee Expense Safety Deposit Box Fees Tax Preparation Fees ** Do not include employer paid benefits ** ~ T/S ~ Denotes Taxpayer or Spouse Miscellaneous Personal Expenses Tuition Paid Interest Paid on Student Loans Alimony Paid Teacher Educator Expenses Child Care Expenses Paid Provider 1 Provider 2 Care Provider's Name Care Provider's Address Care Provider's Federal EIN Number or SSN Qualifying Child's Name Qualifying Expenses Incurred and PAID this year College Savings Contributions Business Information Expenses Name of business: Advertising $ Address(if different) Bad Debts $ City, State Bank Charges $ Commissions $ Incomes Delivery and Freight $ Sales $ Dues and Subscriptions $ Employee Benefit Programs $ Returns and Allowances $ Gas/Oil for Equipment $ Insurance-not Health $ Beginning Inventory $ Insurance - Health $ Interest to Banks $ Ending Inventory $ Interest to Other $ Internet Service Fees $ Purchases $ Laundry and Cleaning $ Legal & Professional Fees $ Cost of Materials and Supplies $ License/Permits Fees $ Lodging Expense $ Cost of Labor $ Meals and Entertainment $ Office Expense $ Outside Services $ Parking Fees $ Pension/Retirement Plans $ Postage Expense $ Printing Expense $ Rent of Property $ Rent or Lease of Equipment $ Repairs/Maintenance Expense $ Salaries/Wages Expense $ Security Expense $ Supplies Expense $ Sales Tax Paid $ Payroll Tax Paid $ Real Estate Tax Paid $ Telephone Expense $ Cell Phone Expense $ Tools Expense $ Mileage for Travel Expense Uniforms Expense $ Utilities Expense $ Other-Please Specify $ Residential Energy Tax Credits Pesonal Energy Property Credit Taxpayers can claim a credit for certain home improvements placed in service in 2009 and 2010. This credit for personal energy property was also available for qualifying improvements placed in service in 2006 and 2007, but not in 2008 Allowable Credit: * The credit is equal to 30% of the cost of * There are no AGI or income limits so all qualified energy-efficient property or improvements individuals can claim the credit * The total amount of the credit that can be * For 2010, the credit can offset both regular tax and AMT. claimed in 2009 and 2010 is $1,500. Personal Energy Property Credit---Qualifying Property (2009) Credit summary: (1) credit equals 30% of cost of qualified property, (2) $1,500 Product Windows and Doors Exterior Windows Before 6/1/09: Must meet ENERGY STAR criteria; $ and Skylights After 6/1/09: U factor <- 0.30; SHGC 5 0.30. Storm Windows In combination with the exterior window over which it is installed; has a U-factor and SHGC of 0.30 or below; $ meets the IECC. Exterior Doors Before 6/1/09: Must meet ENERGY STAR criteria; $ After 6/1/09: U factor <- 0.30; SHGC <- 0.30 Storm Doors In combination with a wood door over which it is installed; has a U-factor and SHGC of 0.30 or below; meets the $ IECC. Heating, Ventilation and Air Conditioning (HVAC) Central A/C Split systems: EER >—13; SEER ? 16 $ Package systems: EER ? 12; SEER 14 Air Source Heat Split systems: HSPF > 8.5; EER >12.5; SEER ?.15 $ Pumps Package systems: HSPF > 8; EER 12; SEER > 14 Natural Gas or AFUE >— 95 $ Propane Furnace $ Oil Furnace AFUE 90 Gas, Propane, or AFUE > 90 $ Oil Hot Water Boiler Advanced Main Air No more than 2% of furnace total energy use. $ Circulating Fan Water Heaters Gas, Oil, Propane Energy factor > 0.82 or a thermal efficiency of at least $ Water Heater 90%. Electric Heat Pump Same criteria as ENERGY STAR: Energy factor ? 2.0 $ Water Heater Other Property Insulation Meets 2009 IECC & Amendments. For insulation to qualify, its primary purpose must be to insulate $ (Example: insulated siding does not qualify). Metal Roofs, All ENERGY STAR qualified metal and reflective asphalt $ Asphalt Roofs shingles. Biomass Stove Stove which burns biomass fuel to heat a home or heat water. Thermal efficiency rating of at least 75% as $ measured using a lower heating value. Residential Energy Efficient Property Credit Taxpayers can claim a tax credit for residential energy efficient property placed in service in 2006-2016. The Credit is equal to 30% of the cost of the following property no limit excet fuel cells: *Solar energy systems (water heating and elecricity) *Small wind energy systems *Fuel cells ($1,000 limit) *Geothermal heat pumps Sale of Assets Purchase of Assets Item 1 Item 1 Description Description Date Acquired Date Purchased Date Sold Purchase Price $ Sales Price $ Cost $ Item 2 Item 2 Description Description Date Acquired Date Purchased Date Sold Purchase Price $ Sales Price $ Cost $ Item 3 Item 3 Description Description Date Acquired Date Purchased Date Sold Purchase Price $ Sales Price $ Cost $ Item 4 Item 4 Description Description Date Acquired Date Purchased Date Sold Purchase Price $ Sales Price $ Cost $ Item 5 Item 5 Description Description Date Acquired Date Purchased Date Sold Purchase Price $ Sales Price $ Cost $ Item 6 Item 6 Description Description Date Acquired Date Purchased Date Sold Purchase Price $ Sales Price $ Cost $ **** Date Sold is Imperative**** Rental Income Property 1 Property 2 Property 3 Property 4 Property 5 Kind of Property Location of Property # of Days Rented # of Days of Personal Use Incomes Rents $ $ $ $ Royalities $ $ $ $ Expenses Advertising $ $ $ $ $ Association Dues $ $ $ $ $ Auto Expense $ $ $ $ $ Cleaning Expense $ $ $ $ $ Commissions $ $ $ $ $ Insurance $ $ $ $ $ **Interest Expense** $ $ $ $ $ Legal & Professional Fees $ $ $ $ $ License & Permits $ $ $ $ $ Management Fees $ $ $ $ $ Mortgage Interest to Banks $ $ $ $ $ Mortgage Interest to Other $ $ $ $ $ Pest Control $ $ $ $ $ Remodeling Expense $ $ $ $ $ Repairs & Maintenance $ $ $ $ $ Supplies $ $ $ $ $ Real Estate Taxes $ $ $ $ $ Other Taxes $ $ $ $ $ Telephone Expense $ $ $ $ $ Mileage for Travel Utilities Expense $ $ $ $ $ Wages/Salaries Expense $ $ $ $ $ Other-Please Specify $ $ $ $ $ Other-Please Specify $ $ $ $ $ ** Do not include Mortgage Interest here** Farm Income for Rental or Personal INCOMES Sale of Livestock purchased for resale $ Cost of Livestock $ Sale of livestock, produce, grains you raised $ Other Income-Please Specify Cooperative Distributions $ $ Agricultural Program Payments $ Other Income-Please Specify Commodity Credit Corporation Loans Reported $ $ Commodity Credit Corporation Loans Forfeited $ Other Income-Please Specify Crop Insurance Proceeds Received $ $ Custom Hire Income $ Federal Fuel Credit from Previous Year $ State Fuel Credit from Previous Year $ Cow/Calf Refund from Previous Year $ EXPENSES Advertising $ Bank Charges $ Breeding Expense $ Car & Truck $ Chemicals $ Conservation Fees $ Custom Hire $ Dues and Subscriptions $ Other Expense-Please Specify Employee Benefit Programs $ $ Feed Purchased $ Other Expense-Please Specify Fertilizers and Lime $ $ Freight and Trucking $ Other Expense-Please Specify Fuel and Oil $ $ Insurance-Do not include Health Insurance $ Other Expense-Please Specify Mortgage Interest Paid to Banks $ $ Other Interest Paid $ Other Expense-Please Specify Internet/DTN Fees $ $ Labor Hired $ Legal and Professional Fees $ Postage Expense $ Pension Plan Contributions $ Adminstrative and Educational Pension Costs $ Vehicles, Machinery and Equipment Rental or Lease Cost $ Land, Animals, Other Rental or Lease Cost $ Repairs and Maintenance $ Seeds and Plants Purchased $ Security Expense $ Storage and Warehousing $ Supplies Purchased $ Cell Phone Expense $ Telephone Expense $ Property Tax Expense $ Tools Expense $ Note Mileage for Travel Expense $ Mileage for Business Usage Utilities $ For Sole Prop Only Vehicle License Expense $ Number of Miles Veterinary and Medicine Costs $
"Tax deduction recorder"