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ITEMIZED TAX DEDUCTION WORKSHEET PAGE 1 - JobertTax.com

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					                  JANE T JOBERT                    ITEMIZED TAX DEDUCTION WORKSHEET PAGE 1


  tax
 I N C O M E
                  510-654-3425        TEL
                                                   NAME
                  510-654-3429        FAX

                  j o ber t @jo ber t t ax.c o m   ADDRESS
 S E R V I C E
                  www.Jo ber t Tax.c o m           PHONE




MEDIC AL EXPENSES                                            INTEREST

        Medical Insurance: ____________________________      Mortgage Interest-Loan #1: ____________________________

           Nursing Home: ____________________________                          Loan #2: ____________________________

          Doctors/Dental: ____________________________       Interest Paid to an Individual: ___________________________

           Accupuncture: ____________________________                            Name: ____________________________

            Accupressure: ____________________________                         Address: ____________________________

     Medicine and Drugs: ____________________________            Social security number: ____________________________

         Herbal Medicine: ____________________________       ☐ Refinanced — Points/fees: ___________________________
             Optomotrist: ____________________________
                                                             CHARITABLE CONTRIBUTIONS
     Glasses/Contact Lens: ____________________________
                                                                Religious Contributions: ____________________________
             Hearing Aid: ____________________________
                                                                            United Way: ____________________________
          Lab Fees/ X-Ray: ____________________________
                                                                             Red Cross: ____________________________
                 Therapy: ____________________________
                                                                         Miscellaneous: ____________________________
    Transportation - Miles: ____________________________

                 Cab Fee: ____________________________       NON- C ASH CONTRIBUTIONS

             Ambulance: ____________________________                    Salvation Army: ____________________________

Insurance Reimbursement: ____________________________                         Goodwill: ____________________________

TAXES                                                             Donation of a Vehicle: ____________________________

Property Tax — Your Home: ____________________________                Place of Donation: ____________________________

    2nd Home/ Timeshare: ____________________________                 Date of Donation: ____________________________

             Vacant Land: ____________________________         Mileage for the donation: ____________________________

    Prior Year Balance due: ____________________________               of Time/Services: ____________________________

          DMV Fee Car #1: ____________________________

                  Car #2: ____________________________

  Boat/Trailer /Motorcycle: ____________________________
                       JANE T JOBERT                     ITEMIZED TAX DEDUCTION WORKSHEET PAGE 2


 tax
I N C O M E
                       510-654-3425        TEL
                                                         NAME
                       510-654-3429        FAX

                       j o ber t @jo ber t t ax.c o m    ADDRESS
S E R V I C E
                       www.Jo ber t Tax.c o m            PHONE




MISCELL ANEOUS DEDUC TIONS

   Professional /Union dues: ____________________________          Attorney Fees/Protection of Income: _____________________

         Tax Preparation fees: ____________________________                           Childcare: ____________________________

         Education/Seminars: ____________________________                       Child's Name: ____________________________

        Job seeking expense: ____________________________             Child's Social Security #: ____________________________

       Business publications: ____________________________                   Provider's Name: ____________________________

     Unreimbursed supplies: ____________________________                               Address: ____________________________

 Safety Shoes & equipment: ____________________________                           Soc. Sec. #: ____________________________

          Uniform & cleaning: ____________________________                            or FEIN #: ____________________________

        Investment expenses: ____________________________             ☐ Alimony — to whom: ____________________________
           Safety deposit box: ____________________________            Social security number: ____________________________


ESTIMATED TAX PAID


1 S T Q UA R T E R :                      F E DE R A L                        STATE                            DATE PA I D




2 N D Q UA R T E R :                      F E DE R A L                        STATE                            DATE PA I D




3 R D Q UA R T E R :                      F E DE R A L                        STATE                            DATE PA I D




4 T H Q UA R T E R :                      F E DE R A L                        STATE                            DATE PA I D




N OT E S / Q U E S T I O N S
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