VIEWS: 12 PAGES: 6 POSTED ON: 8/24/2012
DATA SHEET – Tax Year 2005 Refund Direct Deposit Information I request that my refund be direct deposited. Bank Name: _______________ Account #:____________ Routing #: ___________ Type: Checking OR Savings Estimated Tax Payments Federal State (____) 1st Quarter: ___/___/05 $________ ___/___/05 $________ 2nd Quarter: ___/___/05 $________ ___/___/05 $________ 3rd Quarter: ___/___/05 $________ ___/___/05 $________ 4th Quarter: ___/___/___ $________ ___/___/___ $________ Medical Expenses Doctor/Dentist: $_________ Prescriptions: $_________ Glasses/Contacts: $_________ Other(________): $_________ Health/Dental Insurance (NOT pre-tax): $___________ Medical Supplies, etc: $___________ Medical Miles: ________ Long-Term Care Insurance Taxpayer Amount: $__________ Policy Number: ____________ Insurance Company: _________________________ Spouse Amount: $__________ Policy Number: ____________ Insurance Company: _________________________ Real Estate Taxes Primary Residence: $________ Secondary Residence: $________ Cabin: $________ Other(_________): $__________ Mortgage Interest Name: ______________ Amount: $________ Primary Res. Secondary Res. Cabin Home Equity Loan/Line Name: ______________ Amount: $________ Primary Res. Secondary Res. Cabin Home Equity Loan/Line Name: ______________ Amount: $________ Primary Res. Secondary Res. Cabin Home Equity Loan/Line Investment Expenses Mgmt Fees: $_______ Internet Expenses: $_______ Investment/Margin Interest Expense: $______ Newspaper: $______ Charitable Contributions Donations made by Cash or Check: $__________ Donations made to Goodwill, etc (please enclose receipts): Name: ____________ Address: ________________ Description: ____________ Value: $________ Date: ___/___/05 Name: ____________ Address: ________________ Description: ____________ Value: $________ Date: ___/___/05 Name: ____________ Address: ________________ Description: ____________ Value: $________ Date: ___/___/05 Miscellaneous Items Safety Dep. Box: $___________ Tax Preparation: $___________ Alimony ( Paid OR Received): $____________ License Tabs Vehicle #1 Description: ________________ Amount: $__________ Vehicle #2 Description: ________________ Amount: $__________ Other Description: ________________ Amount: $__________ Job-Seeking Expenses Newspaper: $__________ Internet: $__________ Office Supplies: $__________ Meals & Ent: $__________ Phone: $________ Travel: $________ Miles Driven: ________ Other(________): $_________ DATA SHEET – Tax Year 2005 (page 2) Business Income & Expenses – TAXPAYER Income: $________ Newspaper: $________ Office Supplies: $________ Phone: $________ Meals & Ent.: $________ Internet: $________ Travel: $________ Business Gifts: $________ Rent: $________ Other(_________): $________ Business Income & Expenses – SPOUSE Income: $________ Newspaper: $________ Office Supplies: $________ Phone: $________ Meals & Ent.: $________ Internet: $________ Travel: $________ Business Gifts: $________ Rent: $________ Other(_________): $________ Business Vehicle Expenses Vehicle #1: _________________ Vehicle #2: _________________ Vehicle #3: _________________ Taxpayer OR Spouse Taxpayer OR Spouse Taxpayer OR Spouse Total 2005 Miles: ____________ ____________ ____________ Business Miles 1/1 to 8/31: ____________ ____________ ____________ Business Miles 9/1 to 12/31: ____________ ____________ ____________ Oil Changes: $____________ $____________ $____________ Insurance: $____________ $____________ $____________ Repairs: $____________ $____________ $____________ Car Washes: $____________ $____________ $____________ Fuel & MPG: $____________ $____________ $____________ Lease Payments: $____________ $____________ $____________ Loan Interest Paid: $____________ $____________ $____________ License Tabs: $____________ $____________ $____________ Home Office Expenses Taxpayer OR Spouse Total Sq. Feet of Home: ________ Total Square Feet of Office: ________ Insurance: $_________ Repairs: $_________ Utilities (water, trash, electric, gas): $_______ Association Fee: $________ Rent: $_______ Improvements: $________ Rental Property Income: $_______ Mortgage Int.: $________ Property Taxes: $________ Insurance: $________ Utilities: $________ Advertising: $_______ Travel: $______ Repairs/Maint.: $______ Improvements: $______ Other(______): $________ Higher Education (College) Expenses Student #1 Name: _____________________ Freshman Sophomore Junior Senior Tuition: $________ Books: $________ Supplies, etc: $________ Scholarships Received: $_________ Student #2 Name: _____________________ Freshman Sophomore Junior Senior Tuition: $________ Books: $________ Supplies, etc: $________ Scholarships Received: $_________ Student Loan Interest Taxpayer: $____________ Spouse: $____________ Minnesota K-12 Expenses Student #1 Name: _____________________ Grade: ________ Tuition: $__________ Books/Supplies: $__________ Musical Instrument (rent or purchase) $__________ Gym Clothes $________ Transportation: $__________ Individual or Group Lessons: Class Type: __________ Instructor: _____________ Amount: $________ Student #2 Name: _____________________ Grade: ________ Tuition: $__________ Books/Supplies: $__________ Musical Instrument (rent or purchase) $__________ Gym Clothes $________ Transportation: $__________ Individual or Group Lessons: Class Type: ____________ Instructor: ___________ Amount: $________ Daycare Expenses: Child #1 Name: _____________________ Provider Name: _________________ Provider Tax ID# _____________ Provider Address: ________________________________ Amount Paid: $__________ Child #2 Name: _____________________ Provider Name: _________________ Provider Tax ID# _____________ Provider Address: ________________________________ Amount Paid: $__________ CLIENT ENGAGEMENT LETTER – Tax Year 2005 I have engaged Myslajek, Ltd. to prepare my individual federal and state income tax returns for the year ended December 31, 2005. I understand that it is my responsibility to provide Myslajek, Ltd. with all of the required information in order to complete my tax return. In that regard, I state that, to the best of my knowledge and belief: 1. I have provided true, correct and complete information regarding my income as listed on the attached Forms W-2, 1099 and/or attached written summaries. I understand that it is my responsibility to provide all necessary information to complete the returns. I will retain for a minimum of seven years all documents, receipts, canceled checks and other records required to substantiate the items of income and expense claimed on my return. 2. I have provided true, correct and complete information regarding amounts to claim as tax deductions, and have maintained written documentation supporting all amounts, including calendars, logbooks and receipts. I understand that if a question arises regarding the interpretation of tax law, and a conflict exists between the tax authorities’ interpretation of the law and other supportable positions, that Myslajek, Ltd. will use professional judgment in resolving the issues. I understand that Myslajek, Ltd. will follow whatever position I request, so long as it is consistent with the codes and regulations and interpretations that have been promulgated. If the IRS should later contest the position taken, there may be an assessment of additional tax plus interest and penalties. I further understand that Myslajek, Ltd. will assume no liability for such additional penalties or assessments. 3. I understand that taxing authorities may examine the returns, and that documentation should be retained to support the information I provide to Myslajek, Ltd., especially business travel and entertainment deductions, business use percentage of autos and other assets, barter activities, and charitable contributions over $250. I understand that penalties may be imposed on returns that are late, underpaid, or incorrect. I further understand that if I have any questions as to the type of records and documents required, I can ask Myslajek, Ltd. for advice in that regard. 4. I understand that Myslajek, Ltd. will not verify any information I provide, that Myslajek, Ltd. may require clarification or additional information, and that Myslajek, Ltd. will not be responsible for disallowed deductions or the inclusion of additional unreported income or any resulting taxes, penalties, or interest. 5. I understand that I will be charged an additional fee if Myslajek, Ltd. is asked to assist or represent me in a tax examination or inquiry. I understand that, in the event of preparer error, I am responsible for additional tax that may be due, and the extent of Myslajek, Ltd.’s responsibility is to pay for any penalty that the IRS or state revenue department may assess. 6. I will contact Myslajek, Ltd. immediately if I discover additional information that will lead to a change in my return, or if I receive any letters from the IRS or state taxing authorities. 7. I understand that upon request, Myslajek, Ltd. will put all tax advice in writing. Any unwritten advice may be tentative, incomplete, or not fully reviewed. 8. I understand that my bill from Myslajek, Ltd. will be due and payable upon completion of these returns, and that additional services will not be performed until the bill for these services is paid in full. Likewise, I understand that any past-due balance must be paid before my 2005 returns are prepared. 9. If there are other services or tax returns that I expect Myslajek, Ltd. to prepare, such as estate, gift, sales, fiduciary, property, or other states or cities, I will note them at the bottom of this letter. 10. I understand that Myslajek, Ltd. must receive all of my tax information as soon as possible, but not later than April 1, 2006 to ensure that Myslajek, Ltd. will have adequate time to review my data by April 15, 2006. If Myslajek, Ltd. has not received all of my information by April 1, 2006 and/or my return is not completed by April 15, 2006, I may be subject to late filing or late payment penalties. 11. I understand that it is the policy of Myslajek, Ltd. to electronically file all individual tax returns. I will return Form 8879 or Form 8453 as well as any additional required forms deemed necessary for electronically processing of the return in a timely manner, as my return cannot be sent to the proper agencies until Myslajek, Ltd. receives the above-mentioned forms. 12. I understand that it is my responsibility to carefully examine and approve my completed tax returns. The terms described in this letter are acceptable and are hereby agreed to and shall remain in effect until terminated by either party in writing. Accepted by: Taxpayer: Date: Spouse: ____________________________________ Date: Myslajek, Ltd: ____________________________________ Date: QUESTIONNAIRE - Tax Year 2005 YES NO Did your marital status change? How? __________________________________________ Is there a change in the number of dependents you can claim? update data sheet Do you have children that earned investment income? include their 1099’s Did you contribute to a Roth IRA for 2005? Taxpayer: $__________ Spouse: $__________ Did you contribute to a Traditional IRA for 2005? Taxpayer: $________ Spouse: $_______ Did you make gifts of more than $11,000 to any individual? Are you covered by a pension or retirement plan? Did you incur moving costs due to a job change? Move Date: ___/___/05 include list of expenses Did you incur a casualty or theft loss? Description: _________________________________ Did you have an allowance or expense account at work? Did you have any non-reimbursed business expenses? update data sheet Did you use your car on the job, other than for commuting? update data sheet Did you work out of town for part of the year? Days out of town: ____ include list of expenses Did you incur any job-seeking expenses? update data sheet Did you or your dependents incur any higher-education expenses? include 1098-T’s & data sheet Did you pay any student loan interest? include 1099’s and update data sheet Did you pay any daycare expenses? update data sheet Do you want to allocate $3 to the Presidential Election Campaign Fund? Did you sell, exchange, or purchase any real estate? include closing statements Did you take out a home equity loan? include all 1098’s and update data sheet Did you refinance? include closing statement/paperwork Did you sell or dispose of any stock? include all 1099’s, brokerage statements, and cost basis info Did you own any stock that became worthless in 2005? include brokerage statements Did you sell an existing business or rental property? include closing statements Did you start a new business or purchase rental property? include closing statements Did you have ownership interest in a partnership or S-Corporation? include K-1’s Did you have any foreign income or pay foreign taxes? include documentation Did you receive any income from property sold prior to 2005? Did you receive correspondence from the IRS or the State? include copies Did you have a home office? update data sheet Did you receive a payment &/or make a withdrawal from a retirement account? include 1099-R’s Did you make a withdrawal or contribution to a retirement plan due to Hurricane Katrina? Did you make a withdrawal from an education savings/529 Plan? include 1099-R’s Did you make a withdrawal or contribution to an HSA or MSA? include documentation Did you receive any disability income? Did you receive any unemployment income? include 1099-G’s Did you receive any gambling winnings? include W2-G’s Losses: $___________ Did any of your life insurance policies mature, or did you surrender a policy? Did you cash any Series EE or I U.S. Savings bonds issued after 1989? Did you own a business? update data sheet Did you own rental property? update data sheet Did you make any major purchases in 2005 (car, boat, etc)? Description: __________________ Do you want to contribute to the MN Wildlife Fund? Amount: $_________ Did you make any purchases in 2005 for which sales or use tax was not paid? Amount: $________ Would you prefer to receive this mailing via email next year? Email Address: ________________ CHECKLIST - Tax Year 2005 Please gather the following tax information and mail all items in the envelope provided at least one week prior to your appointment. Signed 2005 Client Engagement Letter. W-2 Forms for wages, salaries, and tips. 1099 Forms for interest, dividends, stock sales, miscellaneous income, etc. Brokerage Statements showing investment transactions for stocks, bonds, etc. We will also need the cost basis for all investments sold in 2005. Cost basis includes the date purchased and price paid for each investment. You may need to review statements prior to 2005 or contact your broker to obtain this. We are unable to complete your return until we receive this information. K-1 Forms showing income from partnerships, S-corporations, estates, and trusts. 1098 Forms for mortgage interest. Property Tax Statements for 2005 and 2006 if you own your home. 2006 statements are mailed in late March. CRP Forms (Certificates Of Rent Paid) if you rent your home. A Copy of Your 2004 Tax Return, if not prepared by our office. A List Of All Estimated Tax Payments. See data sheet. A Categorized List of Income and Expenses for rental and business (sole proprietor/single member LLC) income. If you use Quickbooks, please send us a backup of your data. A Categorized List of Unreimbursed Business Expenses. Any Tax Notices Sent To You by the IRS or other taxing authority. This completed Checklist, Questionnaire, and Data Sheet.
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