Concetta R Lupardo CPA PA

1751 Avenida Del Sol Boca Raton FL 33432

Ph (954) 692-1350 Fax (954) 607-2844 Email concetta@lupardocpa.com

2016 INDIVIDUAL TAX ORGANIZER

Name Birthday SS#

Taxpayer
Spouse
Dependent #1
Dependent #2
Dependent #3
Dependent #4

Address

Contact Information Cell Phone

Email Address

Direct Deposit Information for Tax Refund

Bank Name Routing #

Account Type Account #

Income Information - Please Provide the Following Documentation

√ Form Income Description

________ W-2 Wages
________ 1099 INT Interest Income
________ 1099 DIV Dividend Income
________ 1099G Unemployment Benefits & State Tax Refunds
________ 1099B Capital Gains/Losses (Provide Schedule of Gains/Losses)
________ 1099R Retirement and Annuity Income Including Roth Rollovers
________ K-1 Partnership, S-Corp, & Trust/Estate Income
________ 1099C/1099A Cancellation of Debt Income
________ 1095A/1095B-1095C Healthcare Tax Forms (From Private and Government Policies)
________ SSA-1099 Social Security Benefits
________ W-2G Gambling Income
________ 1099-MISC Prizes
________ No Form Alimony
________ See Supplemental Schedule Unincorporated Businesses (Schedule C)
________ See Supplemental Schedule Rental Properties (Schedule E)

Deduction Information - Please Provide Documentation on the Following

√ Moving Expenses If you relocated for Work & were not reimbursed in full (Transportation, Storage, Travel etc)
________ Retirement Plan Contributions SEP, SIMPLE, IRA, & ROTH
________ Alimony Paid Provide Name and Social Security #
________ Education Expenses Student Loan Interest, Tuition (Form 1098T), & Books
________ Medical Expenses Health Savings Account, Health Insurance (Not Pre Tax), LTC Insurance, Doctors, Hospitals, & Rx
________ Real Estate Tax Residence, Second Home, Vacant Land etc
________ Personal Property Tax Vehicles
________ Sales Tax New Vehicles & Permanent Home Improvements
________ Mortgage Interest First Mortgage, Second Mortgage & Home Equity Loan
________ Charitable Contributions Cash/Check/Credit Card/Goods (See Donation value Guide if value is more than $499)
________ Job Hunting Expenses Mileage, Resume Services, Head Hunter Fees, Travel etc
________ Unreimbursed Business Expenses Auto Expenses (Provide Total Mileage and Business Mileage), Union Dues, Uniforms, Telephone, Travel
Meals/Entertainment, Office Expenses & Supplies etc
________ Tax Preparation
________ Safety Deposit Box
________ Investment Expenses Investment Interest, Advisory Fees, Newsletters, Paid Websites
________ Gambling Losses List by Casino

Payments/Credits - Please Provide Documentation on the Following

√
________ Estimated Tax Payments to IRS Dates and Amount
________ Estimated Tax Payments to State Dates and Amount
________ Child & Dependent Care Name, Address, Tax ID of Facility, Child Name & Amount Paid
________ Residential Energy Credit Heat Pumps, Air Conditioners, Water Heater, Windows, Doors Instulation, Roofs, & Solar Devices
________ Adoption Credit Adoption Fees, Court Costs, Travel

Real Estate Transactions - Please Provide Closing Documents

√
________ Purchase of Real Estate HUD-1 Form
________ Sale/Foreclosure of Real Estate HUD-1 Form
________ Refinance of Real Estate HUD-1 Form

Supplement Schedule Self Employment Income (Form Schedule C)

Gross Receipts

Purchase of Goods for Resale Advertising

Automobile Expenses Insurance
Commissions/Fees/Casual Labor Office Expense
Purchase of Assets Supplies
Professional Fees Travel
Equipment Rent Office Rent
Repairs/Maintenance Utilities
Taxes, Licenses, Fees Meals/Entertain
Other Other

Supplemental Schedule Rental Real Estate (Form Schedule E)

Rent Received

Advertising Auto/Travel
Cleaning/Maintenance Commissions
Professional/Management Fees Insurance
Mortgage Interest Repairs
Appliance Purchases Improvements
Real Estate Tax Supplies
HOA/Condo Fees Utilities

Supplemental Schedule Home Office

House Square Footage

Office Square Footage

Rent Insurance
Repairs/Maintenance Utilities
HOA/Condo Fees Other