2010 Tax Organizer
Name
Social Security No.
Date of Birth
Taxpayer:
Spouse:
Dependents
Social Security No.
Date of
Birth
Student
Yes
Yes
Yes
Yes
Street Address:
City:
, State
Phone #:
Email:
Marital Status: (provide details if status has changed)
Single
Married
Divorced
Head of Household
Taxes Paid (include receipts)
Federal
State
S.S. #
Amount
S.S. #
Student 1
Donations by Check
Church
Health Research
Humane Society
Public TV/Radio
School
United Way
Other
Amount
Child Care Expenses
Provider /ID #
Description
Tuition
Fees
Books & Supplies
Amount of any Grants,
Scholarships or other tax free
educational funds received
What year is student
Student 2
Charitable Gifts
Alimony Paid
Paid To:
Form 1099-DIV
Form 1099-B
Form 1098-E
Educational Expense (include 1098-T statements)
Alimony Received
Received From:
No
No
No
No
Widowed
Items Included in Envelope (check all that apply& include forms in envelope)
Form W-2
Form 1099-MISC
Form 1099-R
Form 1099-INT
Form K-1
Form 1099-S
Form 1099-OID
Form 1099-INT
Form 1098
Form 1099-SA
Form 1099-LTC
Form 1098-T
SSA-1099
Form RRB-1099
Other:
Real Estate
Property
Autos
Estimated
Date
Taxes
Taxes Paid
Due
4/15
6/15
9/15
1/15
Grade
Amount
Non Cash Donations (provide receipts)
Food Drives
Good Will
Supplies for Charity
Miles Driven for charity only
Amount
QUESTIONS (You and/or Spouse)
Please provide backup documentation
1.
2.
3.
4.
5.
6.
7.
8.
9.
Were you notified by the IRS or State of any change to your tax return?
Are any of your claimed dependents not residents or citizens of the U.S.?
Did you make any gifts of over $13,000 to any individual?
Do you have any foreign income or foreign bank accounts?
Did you have living expenses in a foreign country as a result of income earned abroad?
Did you become disabled during the year?
Did you receive any distribution from an IRA, Profit Sharing or Pension Plan?
Have you used bartering to exchange any goods or services?
Did you receive any insurance or other reimbursement from prior year causality, theft
loss or medical deduction?
10. Did you start a business during the year?
11. Do you expect any significant changes in income, withholding taxes or your tax liability
for the coming year?
12. Did you donate a partial interest in any goods to charitable organizations?
13. Did you have a Medical or Health Savings Account (MSA or HSA) during the year?
14. If you reached the age of 70½, have you begun your mandatory retirement savings
withdrawals?
15. Did you receive employer-provided educational assistance?
16. Did you pay long term healthcare insurance premiums or receive benefits during the year?
17. Are you paying off a student loan?
18. Did you make any major purchases during the year requiring payment of sales tax?
19. Did you purchase any energy efficient equipment during the year? (hybrid car,
air conditioner/furnace, windows, hot water heater, etc.)
20. Did you have qualified military combat pay or Military Retirement?
21. If over the age of 70½, did you make a direct contribution to a charity from an IRA?
22. Was there a death of spouse or dependant during the year?
23. Did you move, change your email address or phone number during the year?
(If yes please provide updated information)
24. Did you buy or sell a home in 2010? (If yes please include HUD statement)
25. Did you contribute to a CHET (CT 529) education fund?
26. Did you purchase goods or services from any merchant, either in CT or out of state,
that did not charge you CT sales tax? If so please complete enclosed sheet.
27. Do you own Rental Property? (If yes please use enclosed worksheet)
28. Do you have a Schedule C Business (If yes please use enclosed worksheet)
29. Are you a Real Estate Professional (If yes please use enclosed worksheet)
30. Do you have employee business expenses, or other itemized deductions,
i.e. Union Dues, Job Search Costs, Medical Expenses, Mortgage Interest, etc.?
(if yes please use enclosed worksheet)
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
No
No
No
No
No
No
No
No
No
Yes
Yes
No
No
Yes
Yes
Yes
No
No
No
Yes
Yes
Yes
Yes
Yes
No
No
No
No
No
Yes
Yes
Yes
Yes
No
No
No
No
Yes
Yes
Yes
No
No
No
Yes
Yes
Yes
Yes
No
No
No
No