2009 Roth Ira Contributions
2009 Roth Ira Contributions document sample
Shared by: amb17575
Michele Knight, CPA 2009 Individual Tax Organizer ph 303-598-4413 Knight Accounting Technology fax 303-374-5665 www.cpamichele.com email firstname.lastname@example.org 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 email@example.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 firstname.lastname@example.org 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?