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2009 Roth Ira Contributions document sample
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Michele Knight, CPA 2009 Individual Tax Organizer ph 303-598-4413
Knight Accounting Technology fax 303-374-5665
www.cpamichele.com email cpa@cpamichele.com
Taxpayer Spouse
Name Name
SSN SSN
Date of Birth Date of Birth
Occupation Occupation
Phone # Phone #
Email Email
yes / no Do you want $3 to go to the Presential Election Campaign? yes / no
Mailing Address (city, state, zip):
Direct Deposit:
Bank Routing # Account #
If you want your refund split between bank accounts or used to purchase US Savings Bonds, please note below.
Dependent Name SSN Date of Birth daycare* tuition**
* If child has daycare, please list Name, Address, Tax ID and amount paid to provider.
** If child has tuition, please attach 1098-T or detail of your qualified tuition expense.
Notes:
INCOME SOURCES - Please include copies of the following:
W-2: Wages, Salaries, Tips and Other Compensation
1099: 1099-R (pension), 1099-MISC (miscellaneous), 1099-INT (interest), 1099-DIV (dividends)
SSA-1099 (Soc Security), 1099-G (government payments), 1099-Q (education programs)
1099-B: Stocks, Bonds, Real Estate - must provide Purchase Price & Data, Sales Price & Date
W-2G: Gambling Income - must provide separate schedule totalling losses during the year
Schedule K-1: Partnerships, S Corporations, Trust or Estate
Other Income: Alimony, jury duty, tips, prizes, awards, unreported tips, or business income
ESTIMATED TAX PAYMENTS - these do not include W-2 or other witholdings:
Date Amount Date Amount Date Amount Date Amount
Federal $ - $ - $ - $ -
State $ - $ - $ - $ -
Any notes on items listed on this page?
Michele Knight, CPA 2009 Individual Tax Organizer ph 303-598-4413
Knight Accounting Technology fax 303-374-5665
www.cpamichele.com email cpa@cpamichele.com
DEDUCTIONS: Those with a * are deductible whether you itemize or not, so please fill out all applicable areas.
MEDICAL EXPENSES: (only list if you feel they may exceed 7.5% of your income)
Prescription Drugs $ - LongTerm Care-taxpayer $ -
Insurance Premiums $ - LongTerm Care-spouse $ -
Doctors, Dentists $ - Medical Eqpt & Supplies $ -
Hospitals, Clinics $ - # Miles Driven for Medical Purposes
Eyeglasses, Contacts $ -
* TAXES:
Real estate taxes paid on principal residence $ -
Real estate taxes paid on add'l homes or land $ -
Car Registration Taxes (OWN portion on receipt) $ -
Total sales tax paid on large purchases (if greater than state income tax paid) $ -
HOME MORTGAGE INTEREST - Please include copies of Form 1098 for each loan:
Lender Interest $ - PMI $ -
Lender Interest $ - PMI $ -
Lender Interest $ - PMI $ -
Points Paid on Mortgage $ - Date Paid Length of Mortgage
* CHARITABLE CONTRIBUTIONS: Attach list if additional space is needed.
CASH: Knight Acctg & Tech does not need receipts, but you must keep in your records (exception is tax credits)
Name of Charity $ donated Name of Charity $ donated
$ - $ -
$ - $ -
$ - $ -
$ - # Charitable Miles Driven?
NON-CASH: See Salvation Army Donation Guide posted on www.cpamichele.com, under Downloads
Charity Name/Address, Describe Items Donated (NOTE: Est. Thrift Purchase Date
ADDRESS IS REQUIRED) Store Value Price Donated
$ - $ -
$ - $ -
$ - $ -
MISCELLANEOUS DEDUCTIONS: (only list if you feel they may exceed 7.5% of your income)
Union & Prof Dues $ - Investment Advisor Fees $ -
Prof. Subscriptions $ - Tax Return Prep Fee $ -
Uniforms $ - Safe Deposit Box Rental $ -
Job Search Costs $ -
Any notes on items listed on this page?
Michele Knight, CPA 2009 Individual Tax Organizer ph 303-598-4413
Knight Accounting Technology fax 303-374-5665
www.cpamichele.com email cpa@cpamichele.com
ADJUSTMENTS TO INCOME: Taxpayer Spouse
Educator Expenses (for classroom teachers) $ - $ -
Health Savings Account Contributions $ - $ -
Was high-deductible health plan for self-only, or family?
What was your annual plan deductible? $ -
Moving Expenses Transportation Expenses $ -
Date of Move Storage of Goods $ -
# of Miles Moved Travel Expenses $ -
Lodging Expenses $ -
Traditional IRA contributions made for 2009 $ - $ - * write "calc" if you want
Roth IRA contributions made for 2009 $ - $ - us to determine your
SEP, Keogh, Individual 401(k) or SIMPLE Plans $ - $ - maximum contribution
Student Loan Interest Deduction $ - $ -
(only list if the taxpayer or spouse is the responsible party for the loan)
OTHER THOUGHTS TO CONSIDER - Please describe if you feel that any of the items relate to your family's situation:
Did you receive an Economic Recovery Payment in 2009? If so, how much was it? $ -
Did you add energy efficient property to your home?
Cost $ - Description
Did you purchase a new car, truck, motor home or motorcycle?
Cost $ - Sales Tax $ - Please include copy of receipt showing sales tax.
Did you change address or filing status?
Do any dependents have earned income > $5,700 or investment income > $950? Do you need us to file a return?
Did you operate/close/operate a busines? See Small Biz Organizer if you have income/expenses to report.
Did you rent out your home or property? See Rental Property Organizer if you have income/expenses to report.
Amount of alimony paid? $ - Recipient's SSN
Did you inherit money or property?
Did you earn foreign source income?
Did you adopt a child? Please total expenses incurred?
Did you suffer a casualty loss/theft? yes / no Date of Loss Cost Basis $ -
FMV Before Event $ - FMV After Event $ - Total Loss? yes / no
Amount of proceeds from Series EE or I US Savings Bonds used to pay for Higher Education Expense? $ -
Did you have any non-business bad debt? Please provide amount of bad debt, as well as a description of your
collections efforts, including the name and SSN of the debtor.
Any notes on items listed on this page? Any other sources of income not reported elsewhere?
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