2745 High Ridge Blvd, Suite #15
PO Box 79
High Ridge, MO 63049
636-376-5273
[email protected]
www.selenasaccounting.com
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Selena’s Accounting Services
January 4, 2017
Dear Client:
First I would like to take a moment to wish you and your family a happy and prosperous new year. I look forward to
serving your tax and financial needs in the coming year. Enclosed is a 2016 tax year organizer, it is hard to believe that
2016 has came to a close. If you would complete the organizer and return it with all W-2’s, 1099’s and any other tax
related correspondence you have received I would greatly appreciate it. Completing this organizer is not required, but
it will reduce the cost of preparing your tax return, benefiting you.
Tax filing season will not officially "open" until January 23rd this year and many returns will not begin being processed
until February 15th due to increased security on what the IRS considers high risk returns. For many of my business
owners, you may have a change in due date this year. If you are a Partnership or a C-Corporation, you now have new
due dates for your tax returns which I will be sure to remind you of, but Partnership returns will now be due on March
15th and C-Corporation returns have been pushed back to April 15th beginning this year.
Please note every client who had health insurance thru the exchange will receive a 1095-A; I must have this to prepare
your return. Also, if you did not have insurance at any part of the year I must know this as well. Please look thru my
planner even if you do not complete it, as many of these questions are included in here. You can print additional copies
of this planner and get other updates on my website which is www.selenasaccounting.com I would like to encourage all
of my clients to utilize my website for many things including my monthly newsletter that you can subscribe to as well
as easy links under the tax center to check the status of your refund and more. I have redesigned my website recently
and there is a wealth of information for you on there; I hope you find it beneficial and easy to use (feedback is
appreciated).
Although I am no longer accepting new clients for tax return preparation, I am happy to send all of your referrals to
Jessica Doll, she is the owner of JDoll Acccounting, LLC. Her business telephone number is 636-671-7481, her email
address is [email protected] and we share an office so her address is the same as mine.
I prefer that you drop your information off to me if it is convenient and I will contact you just before preparing your
return. Last year the average turnaround time for drop off’s prior to March 15th was 10 to 15 business days. Please
note that I charge an additional fee for appointments unless you have circumstances that require an appointment (I can
determine this).
I will e-file every individual return that is eligible unless you request otherwise. I strongly recommend e-filing your
return because it eliminates the chance of your return not making it to the proper taxing agency and it significantly
speeds up your receipt of any refund you may be entitled to. Also, if you want direct deposit, please for your
convenience attach a copy of a voided check to your planner or indicate that you want to use the same account you used
last year. You can deposit into multiple accounts and you can also deposit directly into most investment and retirement
accounts. Please let me know if you do not want your return e-filed before I prepare your return as there are additional
forms that must be submitted with all non-electronically submitted returns as well as additional copies must be printed
and assembled for mailing. I will need to speak with every client, but this can usually be done by phone. Please
return all requested information by March 31, 2016 or an extension will be necessary.
Sincerely,
Selena K. Lambrich
Tax Season Office Hours for Drop Off’s (beginning February 1st):
Monday:
By appointment only
Tuesday – Friday:
8:00 – 5:30
Saturday:
9:00 – 2:00
Accounting for Your Future!
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Email Address: _________________________________________ Did you get tax planner via email; yes or no? ____
TAXPAYER INFORMATION:
You: _________________________________
SSN: ___________________
Birth Date: _________________
Spouse: ______________________________
SSN: ___________________
Birth Date: _________________
Occupation
Home Phone
Cell Phone
You: _________________________________
_______________________
___________________
Spouse: ______________________________
_______________________
___________________
Address: ______________________________________________
City/State/ZIP: ____________________________
FILING STATUS _______________________________________
STATUS CHANGES THIS YEAR (Ending dates) ** if MFS or Divorced this year you may need to sign a conflict of
interest form for me, please contact me about this.
Married _______ Separated _______ Divorced _______ Spouse Deceased _______ Dependent Deceased _______
Moved _______ Sold Home _______ Sold Property _______
Legally blind: You _____ Spouse _____
65 or over You_____ Spouse _____
County of residence _________________________________
YOUR DEPENDENTS: List the names of all dependents that received more than one-half of their support from you.
Do not list your spouse.
** S=Son D=Daughter R=Relative O=Other
FULL NAME
SOC. SEC. NUMBER BIRTHDATE **
INCOME
STUDENT
_________________________
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(Attach a separate sheet if needed)
Did a dependant child under age 24 have unearned income over $1,050? _____ Over $2,100? _______
Did you make a Missouri MOST payment?
Yes _____ No _____ If yes, amount: _______
____________
CHILD & DEPENDANT CARE
Child Name ________________________
Child Care Provider:
Name: ________________ SSN/EIN: ___________________
Address: __________________________________________
City/State/Zip: _____________________________________
Amount Paid: ________________________
Child Name ________________________
Child Care Provider:
Name: ________________ SSN/EIN: _______________
Address: _______________________________________
City/State/Zip: __________________________________
Amount Paid: ________________________
ATTACH ALL W2’S, W2-G’S AND 1099-R’S
NUMBER OF W2’S ATTACHED _______________
NUMBER OF 1099-R’S ATTACHED ____________
ATTACH SOCIAL SECURITY/RAILROAD RETIREMENT STATEMENT
ATTACH ALL 1099’S / 1098’S
1099DIV – Dividends
1099B – Broker’s Sale of Stock
1099S – Sales of Residence
1099G – Government Payments
1098 E – Student Loan Interest
1098T – Tuition Payment Statements
1099C - Cancellation of Debt
all other 1099's and 1098's received
Number of 1099’s / 1098’s Attached: __________________
ATTACH K1’S FROM TRUSTS, ESTATES, PARTNERSHIPS, S CORPORATION
PRACTITIONER USE ONLY
______________________________
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Other Income
Taxpayer
Spouse
Alimony received……. ________
________
Unemployment………
________
________
Jury Duty……………
________
________
Gambling Winnings…
________
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Other………………...
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PREPARERS NOTES:
_____________________________________________
_____________________________________________
_____________________________________________
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Deductions or Adjustments
Deductible IRA……………
Non-Deductible IRA………
Roth IRA…………………
SEP……………………….
Simple……………………
Health Savings Accounts…
Self-Employed Health Ins….
Alimony Paid……………….
To Whom: ________________
Student Loan Interest
Taxpayer
Spouse
________
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SSN: _____________
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ESTIMATED TAXES PAID
Date Due
Date Paid
Federal
________
State
________
First Quarter
April 18, 2016
_______
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Second Quarter
June 15, 2016
________
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Third Quarter
Sept. 15, 2016
________
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Fourth Quarter
Jan. 16, 2017
________
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Applied From Prior Years Refund
SCHEDULE A – ITEMIZED DEDUCTIONS
MEDICAL EXPENSES YOU PAID
Amount
Health Insurance Premiums****. __________
TAXES YOU PAID
** other than Medicare and if from paycheck supply check stubs
Long Term Care Insurance……
Medicine and Drugs………….
Glasses / Contact, Dentures
And hearing aids………
Hospitals………………………
Doctors (all types)……………
Ambulance…………………..
Travel and Lodging ………….
Mileage ……..…....…………
Other (list separate)………….
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*** Be sure 1099 SA is enclosed to reflect HSA expenses
MISCELLANEOUS EXPENSES
Educational Expenses – Job Related………….
Un-reimbursed Employee Expense……………
Safety Equipment, Small Tools, & Supplies….
Required Uniforms, Protective Clothing,
Glasses, Shoes………………………...
Required Physical Examination………………
Union Dues, Professional & Trade Publications…
Safe Deposit Box ……………………………....
Legal and Accounting Fees…………………….
Tax Preparation Fees……………………………
Custodial Fees for IRA/Keogh Accounts ………
Job Hunting Expenses…………………………
Gambling Losses ……………………………..
Teachers Supplies ……………………………..
Reservists Expenses …………………………..
Real Estate on main home …………………..
Real Estate on additional homes / land ……..
Personal Property ……………………...……
Auto Sales Tax………………………………
Other Large Items Sales Tax ……………….
Other (provide detail)……………………….
____________________________
Amount
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INTEREST YOU PAID
Home Mortgage & points on Form 1098:
__________
Home Equity Interest………………………..
__________
* Boat, Camper or Second Home (need info)…
__________
Mortgage Insurance Premiums on 1098
__________
Mortgage to individual* (not on 1098)…………
__________
Name: ______________________________________
Address: _________________________ SSN/EIN: ___________
Investment Interest You Paid:
__________
Amount
__________
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CONTRIBUTIONS (*NEED RECIEPT IF CASH)
Charitable contribution by cash or check………. $______
Other than by cash or check……………$______
Non Cash Donation Please Note
If the amount exceeds $500 TOTAL – the Fair market
value of clothing, furniture, etc. contributed MUST
include date acquired, date donated, and receipt from
organization donated to, showing name and address.
Volunteer Mileage for 2016
______________
NEED TO BE DISCUSSED WITH TAX PRACTITIONER (Please check all that apply)
_____ Did you go without health insurance for three or more months in 2016
_____ Did you receive the first-time home buyer credit in 2009
_____ Did you sell a home or convert to a non-primary residence a home that you received the first-time homebuyer credit for
_____ Adoption expenses
_____ Bankruptcy or Foreclosure
_____ Education expenses & interest (Submit forms)
_____ College & Voc-Tech expenses (Submit 1098T & supporting schedules)
_____ Losses from damaged or stolen property (including flood losses)
_____ Moving expenses that are job related
_____ IRA Distribution before age 59-1/2; Reason for distribution _____________________________________________
_____ Purchased, sold or refinanced home (Submit refinance or closing documents)
_____ Gifts over $14,000 per donee received or given
_____ (Incentive) Stock Options Exercised
_____ Conversion of IRA or 401K
_____ Are you currently involved in an installment sale (owner financing another individual)
_____ Energy saving remodeling done to residence
_____ Have any of your stocks been deemed worthless.
_____ Other: _____________________________________
Age 65 This Year _____ Next Year _____
Age 70 This Year _____ Next Year _____
RENTAL INCOME AND EXPENSES
Description and Location (Attach Separate Sheet if needed)
Date Acquired
A. ____________________________________________________________________________
B. ____________________________________________________________________________
C. ____________________________________________________________________________
______________
______________
______________
Was property(s) used for personal purposes more than 14 days or 10% of total days and rented to others? Yes ____No ____
Did you dispose of property during the tax year?
Yes _____ No _____
___A___
Income:
Rents received ………………………………………………..
Expenses:
Advertising …………………………………………………..
Auto Ex. __________________ Miles……………………………
Cleaning and Maintenance …………………………………..
Commissions ………………………………………………….
Insurance……………………………………………………..
Legal/professional fees ……………………………………….
Management fees ……………………………………………..
Mortgage Interest …………………………………………….
Other Interest …………………………………………………
Repairs ………………………………………………………
Supplies ……………………………………………………..
Taxes ………………………………………………………..
Utilities ……………………………………………………..
Other __________________________________________
Other __________________________________________
___B___
___C___
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CAPITAL IMPROVEMENTS (Purchased in current year only, Attach sheet if needed):
Date Purchased
Item
____________ __________________________________________________________________
____________ __________________________________________________________________
____________ __________________________________________________________________
Amount
____________
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SELF-EMPLOYED BUSINESS INCOME AND EXPENSES (if new client, please attach business card)
Business Owner
Business Name
Business Address
Federal ID Number
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
______________________Dates in Business if not full year__________________
Amount
Gross Sales or Receipts……………………………………………………………………….
____________
Sales Returns and Allowances ………………………………………………………………..
____________
Interest Income ……………………………………………………………………………….
____________
Other Income ______________________________________________________________
____________
Beginning Inventory ……………………………………………………………………………
Purchases ………………………………………………………………………………………..
Personal Use of Inventory ………………………………………………………………………
Ending Inventory ……………………………………………………………………………….
Is Inventory Valued at Cost? …………………. Yes _____ No ______
Advertising ……………………………………………………………………………………….
Auto Expenses ____________ Bus. Miles / See Schedule ……………………… Total Miles ….
Bad Checks ……………………………………………………………………………………….
Bank Charges …………………………………………………………………………………….
Commissions ……………………………………………………………………………………..
Contract Labor (any one person over $600?) …… Yes _____ No _____ ………………………
Dues & Publications ……………………………………………………………………………..
Education & Seminars …….………………………………………………………………………
Freight ……………………………………………………………………………………………
Gifts to Clients ($25 maximum each gift / each person) ......……………………………………
Insurance – Health ……………………………………………………………………………….
Insurance – Other: Liability, Work Comp, etc (NOT LIFE INS.) ……………………………….
Interest paid to banks ……………………………………………………………………………
Interest to others …………………………………………………………………………………
Laundry & Cleaning ………………………………………………………………………………
Legal & Professional ……………………………………………………………………………..
Meal & Entertainment ……………………………………………………………………………
Office Expenses ………………………………………………………………………………….
Open House Expenses (Client relations) …………………………………………………………
Rent or Lease – Machinery & Equipment ………………………………………………………
Rent - Other ……………………………………………………………………………………….
Repairs & Maintenance ………………………………………………………………………….
Small Tools (Under $500 each) ………………………………………………………………….
Supplies …………………………………………………………………………………………..
Taxes, Licenses & Permits ……………………………………………………………………….
Telephone – separate line …………………………………………………………………………
Telephone – Cellular (LESS PERSONAL USE) …………………………………………………
Travel & Lodging …………………………………………………………………………………
Uniforms ………………………………………………………………………………………….
Utilities …………………………………………………………………………………………..
Wages …………………………………………………………………………………………….
Other _______________________________________________________................................
Other _______________________________________________________................................
Number of gallons of fuel used OFF ROAD for business purposes _______
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EQUIPMENT, FURNITURE, FIXTURES, COMPUTERS, AND OTHER FIXED ASSETS (2016 purchases only)
Date Purchased
___________
___________
___________
___________
___________
Item
________________________________________________________________
________________________________________________________________
________________________________________________________________
________________________________________________________________
________________________________________________________________
Amount
____________
____________
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Auto Expenses
CHECKLIST OF AUTO BUSINESS EXPENSES
Auto #1
Auto #2
Auto #3
Auto #4
Beginning Odometer Reading…………………..
________
________
________
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Ending Odometer Reading ……………………
________
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Total Mileage ………………………………….
________
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Business Mileage ………….................................
(home to office not usually allowable)
Year & Make of Auto ………………………………..
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Date Purchased ………………………………………
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Cost of Auto (Including Sales Tax) ………………….
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Gas, Oil, Lubrication ………………………………..
________
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Repairs ………………………………………………
________
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Tires …………………………………………………
________
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Washes & supplies for auto ………………………..
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Insurance …………………………………………..
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License & Inspection ………………………………
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Motor Club …………………………………………
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Interest ……………………………………………..
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Personal Property Tax ……………………………..
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Parking Fees & Tolls ………………………………
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Short Term Rentals ………………………………..
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Lease Payments ……………………………………
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Avg. daily round commuting distance …………….
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If you sold the vehicle in 2016, date sold ………….
________
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Selling price ………………………………………..
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Do you (or your spouse) have another vehicle available for personal purposes?
Yes ____ No ____
If your employer provided you with a vehicle, is personal use during off duty hours permitted? Yes ____ No ____ N/A ____
Do you have evidence to support your deduction? Yes _____ No _____
If yes, is the evidence written?
Yes _____ No _____
Does your employer reimburse you?
Yes _____ No _____
If yes, how much was your reimbursement? ______________________________________
“OFFICE IN HOME” EXPENSES
Total Square Feet of:
Home: _______ Office: _______ Storage: _______
Expenses:
Rent: _______ Utilities _______ Insurance: _______ Taxes: _______ Interest: ________
Condo/Mgmt. Fees: _______ Other _______ Maintenance & Repairs: Office: _______ Other: _______
Purchase Price: ________________ Date of Purchase: ________________