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Document Sample
Individual Tax Return Due Date:__________
SCOR TAX SERVICES DIV
26041 Cape Drive Ste.228 Laguna Niguel CA 92677 Tel. / Fax (949)348-9888 Tel. V/M (949)891-8377
e-mail: swstcal@sbcglobal.net Web site: scortax.com
The Tax Formula:
Gross Income - Deduction for Adjusted Gross Income = Adjusted Gross Income - Greater of Itemized Deduction or
the Standard Deduction – Exemptions = Taxable Income x Tax rate = Gross Tax Liability – Tax Credits and
Prepayments = Tax Due or Refund
This form is just a guide on what information we will need in the preparation of your Individual Tax Returns. It is
not necessary to fill in all the Information. New client please send copy of prior year 1040.
First Middle Last
Name: ________________________________________________________SSN/ TIN ______________________DOB_______________
Spouse: ___________________________________________________SSN/TIN_____________________DOB_____________
Address:_______________________________________________________________________________________________
Tel.:________________________CELL__________________________E-MAIL______________________________________
DEPENDENTS: First Middle Last
NAME__________________________________________________________ SSN/TIN______________________DOB______________
_________________________________________________________________ _____________________________ __________________
_________________________________________________________________ _____________________________ __________________
_________________________________________________________________ _____________________________ __________________
Please, provide us with following Documentation and write down total amount:
Please attach an additional piece of paper for additional information you want to furnish.
1. 1099 (INT) INTEREST RECEIVED
(FROM BANKS OR CREDIT UNIONS, BONDS):$________________ Issuer_______________________________________________
2. 1099 (DIV) DIVIDENDS RECEIVED: $ _______________________ Issuer________________________________________________
3. 1099 (R) IRA, PENSIONS RECEIVED:$ _______________________ Issuer________________________________________________
4. 1099 (B) BUSINESS INVESTMENT ACTIVITIES
(Stocks, Bonds, Land, Bldg, etc): $_______________________________ Issuer________________________________________________
5. 1099 (MISC) BUSINESS, INDEPENDENT CONTRACTOR INCOME: $_______________Issuer_____________________________
6. 1099 (G) GAMBLING WINNINGS:$__________________________ Issuer________________________________________________
Tell us about the following:
1. STATE TAX REFUNDS: $__________________________________ Issuer___________________________________________
2. SOCIAL SECURITY BENEFITS: (You) $______________________ Spouse $_____________________________________________
3. UMENPLOYMENT:(You) $_________________________________ Spouse $ _____________________________________________
4. ALIMONY:(You) $_________________ _______________________ Spouse $______________________________________________
5. STUDENT LOAN: AMOUNT $_______________________________ INTEREST $___________________________________________
6. TIPS/GRATUITY: AMOUNT $________________________________________________________________________________________
7. K1FROM (LLC’S, Partnership, S-Corp): $ __________________Issuer________________________________________________________
Signature: Taxpayer _______________________________Spouse ____________________________ 1
Individual Tax Return Due Date:__________
SCOR TAX SERVICES DIV
26041 Cape Drive Ste.228 Laguna Niguel CA 92677 Tel. / Fax (949)348-9888 Tel. V/M (949)891-8377
e-mail: swstcal@sbcglobal.net Web site: scortax.com
ALLOWABLE ITEMIZED DEDUCTIONS AUTO TRK
Medical and Dental Expenses Total Mileage for the year:________________
(Unreimbursed by Employer or not covered by insurance) Business Mileage for the year:_____________
Prescription Drugs & Medicines $_______________ Commuting Mileage:_________________
Medical Health Insurance:…… $_________________ Auto/Truck Exp.:/Maint $_________________
Dental Insurance:…………….$_______________ Toll Road Pkg. Fees: $_______________
Doctors Visits & Co pay……….$_________________ Travel & Lodging:…… $_________________
Dental Exp. Visits & Co pay…..$_________________ Training Semnrs. Conv $_________________
Hospital Bills Co pay…………..$_________________ Meals & Entertaiment $_________________
Surgeries Other Med. Procedure$_________________ Public Transportation… $_________________
Ambulance / Medical Transport.$_________________ Job Search / Resume.Int$_________________
Eye Exam,Glasses contacts,supp$_________________ Dues & Subscription… $_________________
Plastic Surgeries (Med. Purpose.$_________________ Internet, Cable, DSL…. $_________________
Maternity, Well Baby care Exp $_________________ Tel./Cellphn./ Pager… $_________________
Hearing Aid, Exam.,Supplies….$_________________ Computer/Sftwr.Supplie$_________________
Orthopedic Equipt. Supplies… $_________________ Elec. Device & Equipt.. $_________________
Stop Smoking Programs……….$_________________ Small Tools & Equipt…$_________________
Exercise Wt Red. (Obese only)..$_________________ Safety Equipment & Ac $_________________
Home Improvemt(med. Reason.$_________________ Uniform & Upkeep… $_________________
Convalescent Home (Med Trmt.$_________________ Dry Clean, Laundry… $_________________
Physical Exam. Lab Test fees…$_________________ Union Professional due $_________________
Long Term Care Premiums…....$_________________ Cont. Educ. Books,Sup $_________________
_________________________ .$_________________ Errors & Omission Insu $_________________
_________________________. $_________________ Malpractice Insurance...$_________________
Taxes Casualty, Loss, Theft… $_______________
Personal Property (Boat, Planes $_________________ Disaster Losses……… $_________________
DMV Registration, Rnwl Fees. $_________________ Auto Accdnt LossUnrbr $_________________
Real Estate (Primary Residence) $_________________ Bank Deposit Losses… $_________________
Real Estate (Rental Inc Prop.) $_________________ Investment Losses……. $_________________
Sales Tax……………………… $_________________ Fraud Sales offer Loss $_________________
Other Taxes…………………… $_________________ Moving Expense(50 mi) $_________________
__________________________ $_________________ Investment Interest Paid
Mortgage Interest Land………………… $_________________
Primary Residence 2nd Home Vac. Rntl Inc Prop Stocks………………. $_________________
Ist$____________ $___________ $____________ Business……………… $_________________
2nd$____________ $___________ $____________ ___________________ $_________________
3rd $____________ $___________ $____________ ___________________ $_________________
Charities Gifts : Cash Checks Contrib $___________ Auto Vehicle Donations $_________________
Donations : Non Cash Contrbtn $____________ Charitable Travel /Miles__________________
SMALL BUSINESS, SELF EMPLOYED, INDEPENDENT CONTRACTOR
Home Office Total Residence Sqft.__________________ Home Office Sqft…… :_________________
Rent / Lease Office, Shop, Warehouse. $_____________ Utilities Elec/Gas/Wtr/e$_________________
Rent / Auto Truck Vehicle Equipt $_____________ Inventory Purchases $_________________
Office Operating Expense/ Comp.Supp. $_____________ Shop Supplies $_________________
Business Telephone, Fax $_____________ Internet, Cable DSL $_________________
Advrtsng Prom$____________Sales & Marketing, $______________ D/C Laundry $_________________
Bank Charges $____________Interest Fin. Charge$______________ Repair & Maint.$_________________
G/L, W/C Ins $____________Copy Printing Exp..$______________ Other Misc.Exp $_________________
Signature: Taxpayer _______________________________Spouse ____________________________ 2
