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									                           2011 PERSONAL INCOME TAX ORGANIZER

     Name___________________________________Email address: _________________________________
     Best Phone # if we have questions: ______________________Can we contact you by email? Y N
                                       DOCUMENTS WE NEED
   We must have the actual documents (for items that apply to you) in order to prepare your return
       1098 Form*                                                             *Please indicate on each 1098
       1099 forms (all varieties)                                             if the interest was for your
       W-2 forms                                                              first mortgage, equity loan or
       Tip income not on W-2                                                  rental property.
       Property tax bills
       K-1’s from all partnerships, S-corporations, estates or trusts
       Alimony paid or received (don’t include child support)
       Closing documents on sale of any real estate
       Closing documents on any real estate purchased or refinanced property
       Any correspondence received from IRS or State
       All year end brokerage statements
       Did you pay private mortgage insurance (PMI)? If yes, when did you take out the loan?________________
       Energy improvements to home you live in
       Any information you think should be brought to our attention
       Any changes in dependents Reason for change: _______________________________
           Name: ______________________ SS#: ___________________ DOB:______/______/______

                      List interest and dividend income below          (ATTACH ALL 1099’s)
      Bank Interest Income         Bank Name                             Dividend Income              Payer Name

                           PENSIONS / 1099Rs Retirement Distributions
             Company                          Amount Taxable                    Tax Withheld

                          * Please use the other side of this sheet to list additional information.
                                                  Electronic Filing
                       All qualifying returns are electronically filed at no extra charge.
                   You must attach a voided check if you want your refund direct deposited.
                       *Direct deposit for joint returns must be made to a joint account

                          Attach voided check here
                                      2011 IMPORTANT – Please answer each question

       Y   N      In order to help you pay the least amount of tax Answer Yes or No to the following questions;

1.       Did you move this year? Date________________________ If yes, Was this move over 50 miles?
                   Reason for move__________________________________________________________________
2.       Your marital status change during 2011? Date:__________Explain:_________________________
3.       Civil Union or Gay Marriage? If yes, Date:_______State:____Partner’s
4.       Did you have a casualty loss in federally declared disaster area?
5.       Adopt a child or begin adoption proceedings during 2011?
6.       Did you contribute to a medical savings account (MSA) or health savings account (HSA) during 2011?
7.       Withdraw any amount from an educational IRA or 529 accounts?
8.       Pay an individual for domestic services performed in your home? Amount
9.       Do you have receipts for all donations you are claiming? Were all non-cash donations in good or better
10.      Did you or your spouse receive distributions from long-term care insurance contracts? (Provide 1099-LTC)
11.      Did you make gifts of more than $13,000 to any individual or trust? (Provide name, address, SS#, amount,
12.      Did you receive damage award other than for physical injuries or illness?
13.      Did you engage in any bartering transactions? Provide details &
14.      Did you do energy saving improvements to your personal residence such as insulation, new doors,
           windows, biofuel stoves, certain types of roofs, etc? Provide details.
15.      Did you have any stocks that became worthless? They will NOT show up on your 1099B
           Security_____________Purchase date___________purchase price______________
16.      Did you purchase a personal residence? Provide HUD closing statement.
17.      Did you refinance your home? Provide closing statement. What did you use the money was used
18.      Did you have any debt forgiven? Amount__________. Provide 1099C. I will need to speak to
19.      Do you have signing authority over a foreign bank account? If yes to either, provide bank name,
           account #, if it ever had a balance higher than $10,000.
19a.     Did you have financial assets in a foreign country that were worth > $50,000?
20.      Did you take $ out of your IRA prior to age 59 1/2? What did you use the $
20a      Did you lose money in a Ponzi scheme (such as Madoff) Amount___________________________
21.      Did you sell your home? If yes, did you live in it 2 of the last 5 years? Did you ever rent any
           portion of use a portion for business?
22.      Do you look forward each year to completing this form?___________________________
23.      Pay for childcare while you worked or looked for work? If yes, please complete the grid below.
                           Child Care Expenses:
                                                                                                         Amount paid
                      Childcare provider information                         Childs name
                                                                                                          per child
       Social Security or Tax ID #:
        Itemized Deductions                           2011                        Estimated Tax Payments
    Unreimbursed Medical
$             Prescription medicines & drugs                                       Federal Estimated Tax Payments
$             Medical insurance premiums (do not include
              Medicare premiums or pretax premiums)                      Amount              Date Paid
$             Long-term care insurance premiums paid (you)           $                       2005 Overpayment applied 2011 estimates
                                                                                           2010 overpayment applied to to 2006 estimate
$             Long-term care insurance premiums paid (spouse)        $                                          1t quarter 2011 due 4/17/11
$             Long-term care expenses                                $                                          2nd quarter 2011 due 6/15/11
$             Doctors, Dentists, mental health professionals.        $                                          3rd quarter 2011 due 9/15/11
$             Hospitals & Labs                                       $                                          4th quarter 2011 due 1/16/12
$             Eyeglasses & contacts                                             State Estimated Tax Payments
$             Lodging                                                    Amount      Date Paid
              Number of miles traveled for medical care              $                     2010 Overpayment applied to 2011 estimate
                       Taxes Paid                                    $                                          1st quarter 2011 due 4/17/11
$          Real estate taxes (non-rental only)                       $                                          2nd quarter 2011 due 6/15/11
$          Automobile taxes (paid to town only)                      $                                          3rd quarter 2011 due 9/15/11
$          Large sales tax amounts (no income tax states)
                                                                     $                                          4th quarter 2011 due 1/16/12
$          Other
             IRA Contributions 2011                                                                  Alimony
$             Contributed to a 2011 IRA                                               Paid        Received
$             Contributed to a 2011 spouse IRA
Roth Reg      The above IRA Type is:                                 Amount $____________________________________
Yes No        Not yet, help me figure it.                            Do not include child support

                                                                     Sale of Stocks, Mutual funds / other capital assets
           Charitable Contributions                                      Provide information for all worthless stocks, loans, or investments

$                                                                                                                                   Purchase     $
               Cash & check donations
                                                                         Stock, Mutual       Date       Date     Sale price less    price or
$              Non-cash donations valued under $500.00                   Fund or Other      Bought      Sold      Commission       Other Basis
$_________     Miles driven for charity.
               Non-cash donations $500.00 or more:
Donated to: _____________________________________
Address: __________________________________

Date: ___/___/___    Original cost: _____________

              Interest Paid (provide documents)                            In 2011 were you or your dependent a college student?
    $                                                                     ____________________Tuition & fees (even if from loan proceeds)
              Home mortgage interest paid to financial institution
    $         Equity loan interest paid to financial institutions
                                                                          _____________________Room, board, books &computer
    $         Balance on equity loan –end of year
    $                                                                     _____________________Amount distributed from a 529 plan
              Deductible points, attach HUD statement
                    Misc. Itemized deductions
    $         Union & professional dues                                   Grade achieved as of DECEMBER 2011 was Fr Soph Jr Sr
    $         Tax preparation & planning fees
    $         Safe deposit box                                             Students Name:__________________________________
    $         Uniforms & protective clothing
    $         Work tools                                                  Was the student attending at least 1/2 time in 2011? Y or N
    $         Professional subscriptions
    $         Educator Expenses (K-12 teachers only)                      Student loan interest: paid $_____________________
    $         Mortgage Insurance paid for new loans in 2011
                                               2011 BUSINESS INCOME & EXPENSES
                                                     Sole Proprietor or LLC Only
                                               *Do not use for corporations or partnerships
        Business Name: _________________________________________ Employer ID #: ___________________________
        Street: ___________________________________ City: ___________________________St: ______Zip: __________
      *Peachtree & QuickBooks users attach Profit/Loss & Balance sheet statements & do not fill out Income & Expenses
Y    N
   Did you hire any employees after 2/3/10 that had not worked more than 40 hours in the past 60 days AND Stayed into
  Did you pay for health insurance for any of your employees
  Filed a 1099 for non- corporate subcontractors? IRS is aggressively pursuing this issue.
   If you have inventory at the end of the year you MUST have taken a physical count at some point during the year.
                                                   Business Income & Cost of Sales
    Amount                                                                 Amount
                   Gross receipts or sales                                                    Materials & supplies
                   Merchandise purchased for resale                                           Cost of inventory on hand at year end

                                                             Business Expenses
                                        (Include office in home expenses in section at bottom of page)
    Amount                                                            Amount
                 Advertising                                                        Pension & profit-sharing plans
                 Bank charges                                                       Postage
                 Commissions & fees                                                 Rent - vehicles & machinery
                 Conferences & continuing education                                 Rent – other
                 Contract labor & subcontractors (provide 1099s)                    Repairs & maintenance
                 Dues & subscriptions                                               Supplies
                 Health insurance for employees                                     Taxes & licenses
                 Health insurance for owner                                         Taxes on payroll
                 Insurance – other                                                  Telephone
                 Interest – Mortgage                                                Tolls & Parking
                 Interest – other                                                   Travel ** (you must keep a travel log)
                 Legal & professional fees                                          Utilities
                 Meals & entertainment                                              Wages
                 Office expenses                                                    Equipment/furnishing purchase (detail below)
                                                      Vehicle use for this Business Only
                  Make & Model__________________________________________
 Y or N            Did you keep a mileage log?                                          Gross loaded vehicle weight Pickup, Van or SUV
                   Date placed in service                                               Excise Tax
                   Total miles put on vehicle in 2011                                   Fair market value of vehicle leased in 2011
                   Business miles 2011                                                  Purchase price (if purchased this year)
                   Gasoline, oil, repairs, insurance, etc.                              Vehicle rental / lease payments
                   Interest on vehicle loan                                Y or N       Have other vehicle for personal use?

                    Purchases & Sales of Business Property & Equipment (Provide purchase & sale documentation
                         Purchases – Description                              Date of Purchase                         Cost

                           Sales – Description                                    Date Sold                          Proceeds

                                 Office in Home (Provide TOTAL HOUSEHOLD expense for the year )
               % Business use (exclusive & regular) of home                            Utilities
               Repairs & Maintenance                                                   Homeowners insurance
               Rent Paid                                                               Other – Specify
                                      2011 RENTAL PROPERTY
                                       INCOME & EXPENSES
                                     *Use separate sheet for each property

 Property location: ______________________________________________________________
 Number of days property was rented: _______________________________________________
 Number of days property was used personally: _______________________________________
 Is the property owned by an LLC? __________If so, name of LLC_______________________________________

Amount                                                        Amount
                                                                             Interest – other
             Rental Income
             Other Income                                                    Legal & other professional fees
             Advertising                                                     Management fees
             Auto & travel                                                   Office expense
             Bank charges                                                    Plowing
             Bad debts                                                       Repairs
             Cleaning & maintenance                                          Supplies
             Commissions                                                     Taxes
             Condo fees                                                      Telephone
             Grounds care                                                    Utilities
             Insurance                                                       Water & Sewer
             Interest paid to bank for mortgage                              Equipment & furnishings
             Interest paid to individual for mortgage                        Other

                     Purchases & Sales (Provide HUD closing documents)
                       Purchases – Description                               Date of Purchase           Cost

                         Sales – Description                                    Date Sold            Proceeds

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