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When Is the Last Day Employers Can Mail Out W2 Forms

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When Is the Last Day Employers Can Mail Out W2 Forms document sample

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									              Indy Tax Service
              TAX QUESTIONNAIRE
              Tel: 317.248.0770 Fax: 317.248.0771
              Email: mehnazq@indytaxservice.com
Important: Make sure this questionnaire was saved to your computer before filling it out!


General Information
                             TAXPAYER                                                                         SPOUSE
                                                                                You must complete the applicable spouse fields if married.

          First Name:                                                                       First Name:
         Middle Initial:                                                                   Middle Initial:
          Last Name:                                                                        Last Name:
     Social Security #:                                                                Social Security #:
         Date of Birth:                                                                    Date of Birth:
            Employer:                                                                         Employer:
          Occupation:                                                                       Occupation:

            U.S. Citizen                                                                     U.S. Citizen
            Green Card                                                                       Green Card
              U.S. Visa           Citizen of:                                                  U.S. Visa           Citizen of:

   Telephone:
                   Work
                  Mobile
                  Home

   Email Addresses:                                                              ← I will send email to you at this address



   Referred By:
   (new clients)

   Current Address: (street, city, state, zip)                                                                     From (mm/dd/yy)           To (mm/dd/yy)
                                                                                                                                             Present

   Mailing Address for IRS correspondence, if different (i.e., PO Box, work address, etc.).


   Complete if you lived at any other location:
   Taxpayer (T), Spouse (S), Joint (J)
   T/S/J Address (street, city, state, zip)                                                                        From (mm/dd/yy)           To (mm/dd/yy)




   Employers during 2009:
   Taxpayer (T), Spouse (S)                                                                                                            Where worked
   T/S    Employer:                               Occupation                          From                    To                       (state or country)
                                                                                                                    Dependent Care or
  DEPENDENTS (don't list spouse)             Date of Birth           Social Security #                              Childcare Expenses
  First Name, Initial, Last Name              (mm/dd/yy)                (required)            Relationship to You   (incurred & paid in 2009)




  ELECTRONIC FILING: I will set your return up for electronic filing unless there is a reason why it cannot be e-filed
  (e.g., if you file Form 1040NR).

  DIRECT DEPOSIT
  Name of US Bank                                              (must be a U.S. bank)


  Routing Number                             (9-digit number on the bottom left of a check)
  Account Number

  ELECTRONIC FUNDS WITHDRAWAL (only if e-filing)
  If there is a tax balance due, do you want the funds withdrawn from your bank account on April 16?                  Yes        No


  IRA CONTRIBUTIONS: Tax Year 2009, maximum contribution is $5,000 per person (to age 49), and $6,000 (age 50 and older).
                                         TAXPAYER            SPOUSE
                 IRA Traditional     $                  $
              or IRA Roth            $                  $

  Student Loan Interest Paid:        $                  $

Foreign Residents in the U.S. on a Visa
                                                  TAXPAYER                                                                   SPOUSE
           Type of visa held on 12/31/09:                                         Type of visa held on 12/31/09:
                             Date Issued:                                              Date Issued (mm/dd/yy):
                               Prior Visa:                                                            Prior Visa:
                   Dates Prior Visa Held:                                                 Dates Prior Visa Held:
    Number of days spent in U.S. in 2009:                                  Number of days spent in U.S. in 2009:
                  Date First Entered US                                                  Date First Entered US
   Date permanently departed U.S. (if any)                                Date permanently departed U.S. (if any)
                               Citizen of                                                             Citizen of


Employee Business Expenses

   Please go to the    Employee tab to list business expenses related to W-2 income that you were not reimbursed for.
                                                               Yes      No
  If you have other situations or questions, list them here, call, or send me an email:
  Note: To start a new line, press ALT-ENTER.
PLEASE SAVE THIS QUESTIONNAIRE, THEN SEND IT TO ME AS AN E-MAIL ATTACHMENT

Thank you for completing the questionnaire. If you mail me any documents, please keep the originals and send me
photocopies (unstapled, no signature required for delivery). If you're a new client, I'll also need a copy of your
previous year's tax returns, if filed. Please do not send me expense receipts; We just need totals for each expense.




                                        INDY TAX SERVICE
                      2601 Fortune Circle East, Suite 204B, Indianapolis, IN 46241
                                  Tel: 317.248.0770 Fax: 317.248.0771
dd/yy)

t




dd/yy)
 are or
penses
in 2009)




SE
end me
 ur
pense.
                  Unreimbursed Employee Business Expenses
                                             General - Vehicle - Home Office

   Taxpayer:                                                     Spouse:

   Occupation                                                    Occupation

    Only list unreimbursed expenses related to W-2 income!

   Note: If your combined employee business expenses do not add up to more than 2% of your adjusted gross income,
   they will not be deductible.

General Expenses



                                             TAXPAYER       SPOUSE
   Travel & Lodging (out of town):       $              $
   Meals & Entertainment*                $              $
   Business Gifts (limit $25 a person)   $              $
   Seminars/Training:                    $              $
   Trade Publications:                   $              $
   Computer Equipment:                   $              $
   Computer Supplies:                    $              $
   Office Supplies:                      $              $
   Telephone (business use):             $              $
   Internet (business use):              $              $
   Postage/Courier                       $              $
   Taxes Paid in Other Countries         $              $
   Home Mortgage Interest                $              $
   Medical Expenses                      $              $
   Laundry fees                          $              $
   Tax Preperation fees                  $              $
   Moving Expenses                       $              $
   Other: Description
                                         $              $
                                         $              $
                                         $              $
                                         $              $
                                         $              $

Vehicle Expenses

Related to W-2 Income

*Commuting is not deductible, so do not include it in your business mileage figure. Commuting means your
trip from home to office and then from office to home. Other trips for business during the day would count,
however.

                        TAXPAYER                                                    SPOUSE

Year, make and model                                             Year, make and model
   Dates used:       From                to                         Dates used:       From                to
      Total miles driven during those dates                            Total miles driven during those dates
  Total business* miles during those dates                         Total business* miles during those dates
                                                  Yes   No                                                     Yes   No
Is another vehicle available for personal use:   Yes   No       Is another vehicle available for personal use:   Yes   No
                     Is your vehicle leased?     Yes   No                            Is your vehicle leased?     Yes   No
      If owned, purchase price of vehicle $                           If owned, purchase price of vehicle $
                           Date of purchase                                                Date of purchase

                 Tolls (business portion) $                                      Tolls (business portion) $
               Parking (business portion) $                                    Parking (business portion) $

You can generally claim either the standard mileage rate or actual expenses, whichever is greater (some exceptions apply).
If you want me to calculate actual expenses, I need the total for the year of each expense:

                        From       1/0/00 to      1/0/00                                From       1/0/00 to      1/0/00
    List total expenses incurred between the dates above:           List total expenses incurred between the dates above:
    I will calculate percentage applied as business use.            I will calculate percentage applied as business use.
                                 Gas & oil $                                                     Gas & oil $
                             Repairs/tires $                                                 Repairs/tires $
                          Lease payments $                                                Lease payments $
                           Auto Insurance $                                                Auto Insurance $
                              Garage rent $                                                   Garage rent $
                         Auto Club (AAA) $                                               Auto Club (AAA) $
Home Office

Related to W-2 Income

If you primarily work at your employer's office and you do not meet clients at your home, you will not
qualify for this deduction

General Rules:
To qualify, a portion of your home or a separate structure must be used exclusively on a regular basis:
(1) As the principal place of your business (this includes a place where you conduct administrative or management
activities of the business if there is no other fixed location to conduct them), or
(2) as a place where you meet clients in the normal course of business, and
(3) your home office is for your employer's convenience.

See IRS Publication 587 for more information.

If you lived at more than one location during the year, or used the home office for more than one employer,
please list expenses separately:

Note: Do not fill in an amount for rent if you own your home.

                      TAXPAYER                                                                     SPOUSE
   Location 1: Address                                                         Location 1: Address
   0                                                                           0
   Employer:                                                                   Employer:
   Dates worked: From                    to                                    Dates worked: From                    to
         Percent of time worked from home                                            Percent of time worked from home
                 Total area of home (sq. ft.)                                                Total area of home (sq. ft.)
Area used exclusively for business (sq. ft.)                                Area used exclusively for business (sq. ft.)
   Rent $             X     months = $                   0                     Rent $             X     months = $                    0
Utilities $           X     months = $                   0                  Utilities $           X     months = $                    0
    Repairs and maintenance expense $                                           Repairs and maintenance expense $
                 Home insurance (total) $                                                    Home insurance (total) $

    Location 2: Address                                                         Location 2: Address

   Employer:                                                                   Employer:
   Dates worked: From                    to                                    Dates worked: From                    to
         Percent of time worked from home                                            Percent of time worked from home
                 Total area of home (sq. ft.)                                                Total area of home (sq. ft.)
Area used exclusively for business (sq. ft.)                                Area used exclusively for business (sq. ft.)
   Rent $             X     months = $                   0                     Rent $             X     months = $                    0
Utilities $           X     months = $                   0                  Utilities $           X     months = $                    0
    Repairs and maintenance expense $                                           Repairs and maintenance expense $
                 Home insurance (total) $                                                    Home insurance (total) $

Home Owners:
If you own your home and you wish to claim depreciation of the office portion, please complete the following:

        Adjusted Basis of Property:
         $                        Purchase Price of Property
         $                        Settlement Costs (abstract fees, legal fees, recording fees, surveys, transfer taxes, title insurance)
         $                        Capital Improvements made to property before it was made available for rent:
         $         0           = TOTAL ADJUSTED BASIS

        Value of land in price of property:
$   (Note: Land is not a depreciable asset)
                                          2009 Higher Education

Degree/Program Study at Eligible Educational Institution during 2009

   TAXPAYER                Freshman or Sophomore           Undergraduate - Other   Graduate - MBA        Graduate - Other


   SPOUSE                  Freshman or Sophomore           Undergraduate - Other   Graduate - MBA        Graduate - Other


   * Other, Specify:


   Name of college or university attended:

Tuition & Fees Paid in 2009

                                                       TAXPAYER         SPOUSE
   Total amount of tuition & fees                  $                $
   Required books & supplies                       $                $

   The expenses above may qualify for you for the hope credit, lifetime learning credit, or tuition deduction.

Scholarship and Fellowship Income Received in 2009

     $                     1 Total amount of scholarship/fellowship grants received
     $                     2 Amt of line 1 received for performing services (e.g., teaching, research, or any other service).
                             This should be reported on a Form W2 or Form 1042-S (income codes 16-19). It is taxable as wages.
     $                 0   3 (Amt of scholarship received for which no services were performed.)
     $                     4 Enter the amount from line 3 that your scholarship or fellowship required you to use for anything
                             other than tuition, fees, books & supplies (e.g., room & board, travel, etc.)
     $                 0   5
     $                     6 Enter the amount from line 5 that was used for tuition, fees & required books, supplies.
                             (This is the tax-free part of your scholarship)
     $                 0   7
     $                 0   8 (This is the taxable part of your scholarship)

   Did you participate in an employer provided educational assistance program?               Yes    No


Work Related Education Deduction

   If you qualify, you may be able to deduct your graduate tuition and course expenses in full.
   Warning: Because the deduction is often large and the rules are subject to interpretation, the IRS has increased
   audits in this area.     Click here to read more information before answering the following questions.
          so, do you want to take the improve your skills in a expense?
       IfDid your graduate education education as a businessprofession you had already established?
                                                                                                            Yes    No
         If so, do you want to claim the work related education deduction?       Yes       No



Claiming a credit for your dependent child's tuition

   Amount of tuition and fees you paid for your child's college/university education during 2009:             $

   Child must be:
   1 Claimed as a dependent on your tax return
   2 Between the ages of 18 and 23 during 2009
3   A full-time student

Name of child:
College Attended:                            Freshman or Sophomore   Undergraduate - Other


    Click here to go back to questionnaire
duate - Other        Other*

duate - Other        Other*




 other service).
  It is taxable as wages.

o use for anything




has increased


                No
aduate - Other   Graduate
          Capital Gains and Losses (Schedule D)
Name:
SSN:      000-00-0000

SHORT TERM Capital Gains and Losses - Assets Held One Year or Less
Part I, Line 1
Number of                                  Date        Date       Sales    Cost
 Shares        Name of Security         Acquired       Sold        Price   Basis   Gain/Loss
                                                                                       0.00
                                                                                       0.00
                                                                                       0.00
                                                                                       0.00
                                                                                       0.00
                                                                                       0.00
                                                                                       0.00
                                                                                       0.00
                                                                                       0.00
                                                                                       0.00
                                                                                       0.00
                                                                                       0.00
                                                                      $0      $0        $0

LONG TERM Capital Gains and Losses - Assets Held More Than One Year
Part II, Line 8
Number of                                  Date        Date      Sales     Cost
 Shares         Name of Security        Acquired       Sold      Price     Basis   Gain/Loss
                                                                                       0.00
                                                                                       0.00
                                                                                       0.00
                                                                                       0.00
                                                                                       0.00
                                                                                       0.00
                                                                                       0.00
                                                                                       0.00
                                                                                       0.00
                                                                                       0.00
                                                                                       0.00
                                                                                       0.00
                                                                      $0      $0        $0
                                  Additional Foreigner Information
                                          Information for Forms 1040NR & 8843,
                                               Temporary Living Expenses

        Taxpayer:                                                               Spouse:

Information for Form 1040NR
    Please fill out this section if :
    a) you were a student, trainee, or teacher (e.g., F, J & M visas), or
    b) you arrived in or left the U.S. permanently during the year, or
    c) you spent more than half the year outside the U.S.

    You do not need to complete this part if you lived or worked for the entire year on one of these visas:
    H, B, E, L, O, P, R, or TN.
From the information you provide below, I'll determine whether you need to file Form 1040NR:
                      TAXPAYER                                                                 SPOUSE

        Permanent address in home country:                                      Permanent address in home country:




           Number of days spent in the U.S.: 2007                         Number of days spent in the U.S. during:   2007
                                             2008                                                                    2008
                                             2009                                                                    2009
                                                             0                                                                0


      U.S. Visa Type at end of the year:           #REF!                      U.S. Visa Type at end of the year:      #REF!
                           Date Issued:            #REF!                                          Date Issued:        #REF!
                             Prior Visa:           #REF!                                             Prior Visa:      #REF!
                            Dates Held:            #REF!                                           Dates Held:        #REF!
                 Date First Entered US             #REF!                                     Date Entered US          #REF!
     Date permanently departed (if any)            #REF!                     Date permanently departed (if any)       #REF!
                 Country of Citizenship            #REF!                                 Country of Citizenship       #REF!

        Trips into and out of the U.S. during 2009                             Trips into and out of the U.S. during 2009
    Date mm/dd/yy                                                          Date mm/dd/yy
 Left U.S. Entered U.S.    Destination      Work/Pleasure               Left U.S. Entered U.S.    Destination      Work/Pleasure




If you were based working in New York State:
     If you spent time working outside New York State, please complete the NY nonresident income allocation section below.

If you were based working in another state:                            If you were based working in another state:
        State you were based working in                                        State you were based working in
        No. of business days spent working in another state                    No. of business days spent working in another state
        No. of business days spent outside the U.S.                            No. of days spent on business outside the U.S.
Students, Teachers, or Trainees on F, J or M visas
                     TAXPAYER                                                  SPOUSE

         Country which issued passport:                           Country which issued passport:
                     Passport Number:                                         Passport Number:

    Academic Institution Attended:                           Academic Institution Attended:
           Name:                                                    Name:
         Address:                                                 Address:

       Telephone:                                                Telephone:
 Program Director:                                         Program Director:

Indicate the letter of the visa you held for each of the     Indicate the letter of the visa you held for each of the
following years. (For years with no visa, leave blank)       following years. (For years with no visa, leave blank)
Visa type in each year: F, J, M, H, O, P, Q, R, etc.         Visa type in each year: F, J, M, H, O, P, Q, R, etc.
                         2009                                                         2009
                         2008                                                         2008
                         2007                                                         2007
                         2006                                                         2006
                         2005                                                         2005
                         2004                                                         2004
                         2003                                                         2003
                         2002                                                         2002
                         2001                                                         2001
                                Self-Employment Information
Please fill in all fields that apply to you.

          Taxpayer:                                                    Spouse:

Type of Business:                                               Type of Business:
(please be specific, e.g., if consultant, in what field?)


Self-Employment Income
                           TAXPAYER                                                  SPOUSE
    Reported on Form 1099-MISC
    Payer                                              Amount          Payer                                       Amount
                                                   $                                                           $
                                                   $                                                           $
                                                   $                                                           $
                                                   $                                                           $
                                                   $                                                           $
                                                   $                                                           $
                                                   $                                                           $

    Cash Income                                    $                   Cash Income                             $

Self Employment Expenses
                           TAXPAYER                                                  SPOUSE
                                                       Amount                                                      Amount
                            Advertising            $                                           Advertising     $
                   Health Insurance                $                                  Health Insurance         $
                    Other Insurance                $                                   Other Insurance         $
    Last Year's Tax Preparation Fee                $                   Last Year's Tax Preparation Fee         $
      Other Legal/Professional Fees                $                              Computer Equipment           $
               Computer Equipment                  $                     Other Legal/Professional Fees         $
                     Office Supplies               $                                    Office Supplies        $
          Office Rent (other than home)            $                         Office Rent (other than home)     $
                                Repairs            $                                               Repairs     $
         Supplies (other than office)              $                        Supplies (other than office)       $
                   Travel & Lodging                $                                  Travel & Lodging         $
              Meals & Entertainment                $                             Meals & Entertainment         $
                             Research              $                                            Research       $
                            Telephone              $                                           Telephone       $
                                Internet           $                                               Internet    $
                        Dues & Fees                $                                       Dues & Fees         $
            Client Gifts (limit $25 each)          $                           Client Gifts (limit $25 each)   $
              Education & Seminars                 $                             Education & Seminars          $
                                Postage            $                                               Postage     $
                Local Transportation               $                               Local Transportation        $
                  Trade Publications               $                                 Trade Publications        $
    LIST OTHER SELF-EMPLOYMENT BUSINESS EXPENSES:
    Description                    Amount                                 Description                             Amount
                                 $                                                                           $
                                 $                                                                           $
                                 $                                                                           $
                                 $                                                                           $
                                 $                                                                           $
                                 $                                                                           $
                                 $                                                                           $
                                 $                                                                           $
                                 $                                                                           $
                                 $                                                                           $

Self-Employed Retirement Plan (Keogh and SEP)

    If you've already contributed to a SEP or Keogh:
    SEP contribution                 $                                    SEP contribution                   $
    Keogh contribution               $                                    Keogh contribution                 $

    If not, do you want me to calculate your maximum 2009 SEP contribution?
    Taxpayer:       Yes     No                                   Spouse:                  Yes       No


Home Office

General Rules:
To qualify, a portion of your home or a separate structure must be used exclusively on a regular basis:
(1) As the principal place of your business (this includes a place where you conduct administrative or management
activities of the business if there is no other fixed location to conduct them), or
(2) as a place where you meet clients in the normal course of business.

Note: Do not fill in an amount for rent if you own your home.

If you lived at more than one location during the year, please complete expenses separately:
                    TAXPAYER                                                            SPOUSE
    Location 1: Address                                               Location 1: Address
    0                                                                 0
    Dates worked: From                     to                         Dates worked: From                     to
                 Total area of home (sq. ft.)                                      Total area of home (sq. ft.)
 Area used exclusively for business (sq. ft.)                      Area used exclusively for business (sq. ft.)
    Rent $           X       months = $           0                   Rent $           X       months = $              0
 Utilities $         X       months = $           0                Utilities $         X       months = $              0
      Repairs and maintenance expense $                                 Repairs and maintenance expense $
          Home insurance (total for year) $                                 Home insurance (total for year) $

    Location 2: (If you moved during the year)                        Location 2: (If you moved during the year)

    Dates worked: From                     to                         Dates worked: From                     to
                 Total area of home (sq. ft.)                                      Total area of home (sq. ft.)
 Area used exclusively for business (sq. ft.)                      Area used exclusively for business (sq. ft.)
    Rent $           X       months = $           0                   Rent $           X       months = $              0
 Utilities $         X       months = $           0                Utilities $         X       months = $              0
      Repairs and maintenance expense $                                 Repairs and maintenance expense $
          Home insurance (total for year) $                                 Home insurance (total for year) $

Home Owners:
If you own your home and you wish to claim depreciation of the office portion, please complete the following (unless
previously provided):
Adjusted Basis of Property:
 $                        Purchase Price of Property
 $                        Settlement Costs (abstract fees, legal fees, recording fees, surveys, transfer taxes, title insurance)
 $                        Capital Improvements made to property before it was made available for rent:
 $         0           = TOTAL ADJUSTED BASIS

Value of land in price of property:
 $                          (Note: Land is not a depreciable asset)
Vehicle Expenses

List only vehicle expenses that apply to self-employment (see Employee Expenses tab for W-2 related vehicle use)

Note: If you used more than one vehicle during the year, please I will need the expenses listed separately
for each vehicle.

    Vehicle 1:                                                       Vehicle 2:
Year, make and model                                             Year, make and model
    Dates used:       From                  to                       Dates used:       From                  to
           Total miles (personal & business)                                Total miles (personal & business)
                         Total business miles                                             Total business miles
Is another vehicle available for personal use:        Yes   No
                                                                 Is another vehicle available for personal use:        Yes   No
                      Is your vehicle leased?         Yes   No                         Is your vehicle leased?         Yes   No
       If owned, purchase price of vehicle $                            If owned, purchase price of vehicle $
                           Date of purchase                                                 Date of purchase
                                       Tolls $                                                          Tolls $
                                    Parking $                                                        Parking $

If you want me to calculate actual expenses, which
may be more than standard mileage:

List total expenses incurred between the dates below:                List total expenses incurred between the dates below:
(I will calculate the business percentage)                           (I will calculate the business percentage)
                        From         1/0/00 to    1/0/00                                 From         1/0/00 to    1/0/00
                                  Gas & oil $                                                      Gas & oil $
                              Repairs/tires $                                                  Repairs/tires $
                          Lease payments $                                                 Lease payments $
                            Auto Insurance $                                                 Auto Insurance $
                               Garage rent $                                                    Garage rent $
                          Auto Club (AAA) $                                                Auto Club (AAA) $

Estimated Tax Payments
                TAXPAYER                                                         SPOUSE

FEDERAL PAYMENTS                Date paid if                     FEDERAL PAYMENTS                Date paid if
  QTR    Due Date           later than due date       Amount       QTR    Due Date           later than due date       Amount
   1      04/15/09                                $                 1      04/15/09                                $
   2      06/15/09                                $                 2      06/15/09                                $
   3      09/15/09                                $                 3      09/15/09                                $
   4      01/15/10                                $                 4      01/15/10                                $

STATE:                                                           STATE:
   1        04/15/09                              $                 1        04/15/09                              $
   2        06/15/09                              $                 2        06/15/09                              $
   3        09/15/09                              $                 3        09/15/09                              $
   4        01/15/10                              $                 4        01/15/10                              $

Locality:                                                        Locality:
  1         04/15/09                              $                1         04/15/09                              $
  2         06/15/09                              $                2         06/15/09                              $
  3         09/15/09                              $                3         09/15/09                              $
  4         01/15/10                              $                4         01/15/10                              $
                                      Foreign Income & Accounts
Foreign Income

    All tax residents filing Form 1040 are required to report worldwide income.

    Please do not include any foreign income & foreign tax payments that are reported on Form 1099-DIV

Taxpayer (T), Spouse (S), Joint (J)
        Type of Income:                                Currency        Gross Income        Income Converted    Gross Tax Paid      Tax Converted
T/S/J   (wages, interest, etc.)   Name of Payer        (euro, etc.)   (foreign currency)    to US Dollars*    (foreign currency)   to US Dollars*




    * Please use the Currency Converter below.

                   Currency Converter                  Average        Foreign Currency        US Dollar
                                                         2009              Amount             Conversion
                   EMU MEMBERS              Euro         1.4579                                  0
                   UNITED KINGDOM           Pound        1.6226                                  0
                   AUSTRALIA                Dollar       0.9021                                  0
                   BRAZIL                   Real         1.7508                                  0
                   CANADA                   Dollar       1.0537                                  0
                   CHINA                    Yuan         6.8275                                  0
                   HONG KONG                Dollar       7.7526                                  0
                   INDIA                    Rupee       46.5273                                  0
                   JAPAN                    Yen         89.9509                                  0
                   MEXICO                   Peso        12.8622                                  0
                   NEW ZEALAND              Dollar       0.7169                                  0
                   POLAND                   Zloty       3.12398                                  0
                   RUSSIA                   Rouble     31.81504                                  0
                   SINGAPORE                Dollar      1.39620                                  0
                   SOUTH AFRICA             Rand        7.48480                                  0
                   SOUTH KOREA              Won       1163.3109                                  0
                   SWITZERLAND              Franc       1.03010                                  0

    For additional countries, please see:      Oanda.com        or Federal Reserve Foreign Exchange Rates
Foreign Accounts

     If you had more than $10,000 in a foreign account at any time during 2009, please provide the account information below.
     Such information is required to be reported to the Treasury Department. Noncompliance could result in penalties.

Taxpayer (T), Spouse (S), Joint (J)
T/S/J          Type of Account:                      Maximum Value of Account:               Account Number:
                  Bank                                  Under $10,000
                  Security                              $10,000-$99,999                      Name of Financial Institution
                  Other                                 $100,000-$1,000,000
                                                        Over $1,000,000                      Country in which account is held:


T/S/J          Type of Account:                      Maximum Value of Account:               Account Number:
                  Bank                                  Under $10,000
                  Security                              $10,000-$99,999                      Name of Financial Institution
                  Other                                 $100,000-$1,000,000
                                                        Over $1,000,000                      Country in which account is held:


T/S/J          Type of Account:                      Maximum Value of Account:               Account Number:
                  Bank                                  Under $10,000
                  Security                              $10,000-$99,999                      Name of Financial Institution
                  Other                                 $100,000-$1,000,000
                                                        Over $1,000,000                      Country in which account is held:


T/S/J          Type of Account:                      Maximum Value of Account:               Account Number:
                  Bank                                  Under $10,000
                  Security                              $10,000-$99,999                      Name of Financial Institution
                  Other                                 $100,000-$1,000,000
                                                        Over $1,000,000                      Country in which account is held:
                            Rental Property Worksheet

General Information:

  Taxpayer:                                                            Spouse:

  If married, is the house owned jointly?   Yes               No   → If not, who is the owner?       Taxpayer   Spouse
  Do you [and spouse] own 100% of the property?                Yes   No   → If not, list ownership percentage

  Address of property:

  Date property was placed in service (made available for rent). This can be in a past year:

  Date, if any, property was no longer available for rent:

                                                         Yes         No
  Is the entire property available for rental use?                        → If not, percentage rented out

Rental Income and Expenses

  Rental income for the entire tax year:             $

  Rental Expenses:                         Amount
                       Advertising     $
                            Travel     $
          Cleaning & maintenance       $
                    Commissions        $                     Rental amount (if not fully rented)
                        Insurance      $                        0%        $              0
         Legal & professional fees     $
                Management fees        $
                 Mortgage interest     $                        0%        $              0
                 Real estate taxes     $                        0%        $              0
                           Repairs     $
                          Supplies     $
                   Water & sewer       $                        0%        $              0
                 Garbage removal       $                        0%        $              0
  Description
                                       $
                                       $
                                       $

  List any capital improvements made to the property during the tax year:
  These are improvements made to your home that add to its value, prolong its useful life, or adapt it to new uses.
  (Examples include replacements or additions such as roof, carpet, boiler, rooms, patio, driveway,
  central air, windows, etc.)

  Type of Improvement                      Cost              Date
                                       $
                                       $
                                       $
                                       $
                                       $
Cost Basis of Property

      Adjusted Basis of Property:
       $                        Purchase Price of Property
       $                        Settlement Costs (abstract fees, legal fees, recording fees, surveys, transfer taxes, title insurance)
       $                        Capital Improvements made to property before it was made available for rent:

        $            0              = TOTAL ADJUSTED BASIS

            (Note: If you converted a personal property to a rental property, your basis is the lesser of the fair market
            value or the adjusted basis of the property).

      Value of land in price of property:
       $                          (Note: Land is not a depreciable asset)


      For more information, see        IRS Publication 527: Residential Rental Property

								
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