TAX ORGANIZER

(Including Schedule C, E and 2106)

 

Mike Olmsted, CPA

1661 Fair Meadow Trail

South Lake Tahoe, CA 96150

530.544.0231

E-mail: info@mikeolmsted.com

 

 

FOR TAX YEAR   ___________ ( If you are a new client, please send a copy of last years tax return)

 

Your Name

 

 

S.S. #            -         -         

 

Birthdate           /        /

Spouses Name

 

S.S. #            -         -   

 

Birthdate          /         /

Mailing Address

 

Home Phone Number         Work or Cell Phone Number

(         )            -                       (         )           -

 

E-mail Address

            

 

DEPENDENTS

NAME

S.S. #

D.O.B.

RELATIONSHIP

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Was there anyone else you contributed support, that resides in the U.S., Canada or Mexico?

NAME

S.S. #

D.O.B.

RELATIONSHIP

% SUPPORTED

INCOME OF PERSON

 

 

 

 

 

$                       

 

 

 

 

 

$

 

CHILD OR DEPENDENT CARE

Did you pay a baby-sitter last year?

NAME  OF SITTER

S.S. #

ADDRESS

AMT. PD.

 

 

 

$

 

 

 

$

If your sitter is an adult & works in your home, you are required to file W-2 forms by January 31.  If you want us to prepare

these forms contact us right away.

 

 

ESTIMATED TAXES

CREDIT FROM PRIOR

YEAR’S VOUCHER

PAYMENTS

FIRST QUARTER (APRIL 15)

SECOND QUARTER

(JUNE 15)

THIRD QUARTER

(SEPT.  15)

FOURTH QUARTER

(JAN. 15)

TOTAL FOR YEAR

Federal

$

 

$

 

$

 

$

 

$

 

$

State

$

 

$

 

$

 

$

 

$

 

$

 

INCOME 

 

Wages, Salaries, Tips, Etc. (Attach W-2s)

 

Interest income from Seller-Financed Mortgages & Individuals:

 

Interests from Banks & Financial Institutions (Attach 1099 Int)

 

Include all that have your Social Security number on them.

NAME

AMOUNT

 

NAME

AMOUNT

_________________________

$________________

 

_________________________

$________________

_________________________

$________________

 

_________________________

$________________

 

Did you sell or turn in any U.S. Savings Bonds?

YES

 

NO

 

If yes, Please list information:___________________________________________________________________________

Nontaxable Interest: (Attach Information)

 

 

 

 

Did you have any foreign bank accounts?

YES

 

NO

 

If yes, please explain__________________________________________________________________________________

Did you have any penalties on Early Withdrawal of Savings Certificates?

YES

 

NO

 

If yes, list or attach information__________________________________________________________________________

Dividends: (Attach 1099Div’s) Capital Gain Distributions: (Attach 1099B’s) Education Distributions: (Attach 1099Q’s)

Nontaxable Distributions: (Attach 1099s)                                                      Pensions: (Attach 1099Rs)

Exclusions of Reinvested Dividends from Public Utility: Attach Information.  Did you serve in a Combat Zone? _______

Did you Contribute to your pension plan?__________  If yes, have you already recovered your contribution?__________

Did you have any Rollovers?_____ If yes, Attach 1099 Distribution & Rollover papers  Alimony: How much did you receive? $_____

 

OTHER INCOME

Estate & Trusts

$___________________

(Attach K-1s)

 

Jury Duty

$___________________

S-Corporations

$___________________

(Attach K-1s)

 

Other

$___________________

Partnerships

$___________________

(Attach K-1s)

 

Other

$___________________

Did you have any tips that you did not report to your employer? If not reported, how much did you receive? $________________

Prizes & Awards $_______________ State Tax Refund $_______________ Unemployment Compensation $_______________

Lump Sum Distributions $_______________ (Attach 1099R”s)    Gambling Winnings (Attach W-2 G’s) $__________________

 

Gains & Losses from Sale of Property, Stock, Etc. (Attach 1099 B’s)

 

Description

Date Bought

Date Sold

Sale Price

Cost & Expense

Gain or Loss

_______________________________

___/___/___

___/___/___

$___________

$___________

$__________

_______________________________

___/___/___

___/___/___

$___________

$___________

$__________

_______________________________

___/___/___

___/___/___

$___________

$___________

$__________

 

SALE OF RESIDENCE - Please send or bring escrows of purchase & sale of new house.  Also list improvements on old house.

 

DID YOU HAVE ANY OTHER INCOME FROM ANY OTHER SOURCE?

Source

_____________________________________

Amount

$_______________

Source

_____________________________________

Amount

$_______________

Source

_____________________________________

Amount

$_______________

 

SOCIAL SECURITY

How much did you receive? $_______________ How much did your spouse receive? $_____________ (Attach SSA 1099s)

 

If you paid any individuals or Partnership $600.00 or more for rent or services for business purposes, you are required to file 1099s prior to

February 28th.  If you would like us to prepare these, please contact us right away.

 

FARM INCOME - If you had any Farm Income, attach or bring in the information.

 

-----------------------------------------------------------------------------------------------------------------------------------------------------------

BUSINESS INCOME / EXPENSE - Schedule C -

 

 

What is the main business activity?________________________________________________________________________________________________

 

Business Name_____________________________________________________________________________________

 

Business Address____________________________________________________________________________________

 

 

 

How much is your TOTAL  business income ?  $____________________

 

 

HOW MANY MILES DID YOU DRIVE FOR BUSINESS PURPOSES? _______________________________

 

 

Merchandise

$________________

 

Real Estate Taxes

$________________

Costs of Goods

$________________

 

Other Taxes & Licenses

$________________

Materials & Supplies

$________________

 

Travel (no meals)

$________________

Advertising

$________________

 

Meals & Entertainment

$________________

Bad Debts

$________________

 

Utilities & Telephone

$________________

Car & Truck Expense

$________________

 

Wages & Salaries

$________________

Commissions

$________________

 

Bank Service Charges

$________________

Insurance (other than health)

$________________

 

Tools

$________________

Mortgage Interest

$________________

 

Uniforms

$________________

Other Interest Paid

$________________

 

Safety Items

$________________

Legal & Professional Fees

$________________

 

Freight & Shipping

$________________

Office Expenses

$________________

 

Dues & Publications

$________________

Rent on Business Property

$________________

 

Laundry & Cleaning

$________________

Equipment Rentals

$________________

 

(other)

$________________

Repairs

$________________

 

(other)

$________________

Supplies

$________________

 

(other)

$______________

 

 

Do you have any tools and equipment from prior years?_________________________

 

--------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------

 

INCOME FROM PROPERTY RENTS - Schedule E

 

 

RENTAL 1

RENTAL 2

RENTAL 3

Rents Received (Attach all 1099s)

$__________________

$__________________

$__________________

Advertising Costs

$__________________

$__________________

$__________________

Association Dues

$__________________

$__________________

$__________________

Auto & Travel

$__________________

$__________________

$__________________

Cleaning & Maintenance

$__________________

$__________________

$__________________

Commissions

$__________________

$__________________

$__________________

Gardening

$__________________

$__________________

$__________________

Insurance

$__________________

$__________________

$__________________

Legal & Professional Fees

$__________________

$__________________

$__________________

Licenses & Permits

$__________________

$__________________

$__________________

Management Fees

$__________________

$__________________

$__________________

Miscellaneous

$__________________

$__________________

$__________________

Mortgage Interest

$__________________

$__________________

$__________________

Other Interest Paid

$__________________

$__________________

$__________________

Painting & Decorating

$__________________

$__________________

$__________________

Painting Equipment ( brushes, ladders, etc. )

$__________________

$__________________

$__________________

Pest Control

$__________________

$__________________

$__________________

Plumbing & Electrical

$__________________

$__________________

$__________________

Repairs

$__________________

$__________________

$__________________

Supplies

$__________________

$__________________

$__________________

Cleaning Supplies

$__________________

$__________________

$__________________

Tools

$__________________

$__________________

$__________________

Taxes

$__________________

$__________________

$__________________

Telephone

$__________________

$__________________

$__________________

Utilities

$__________________

$__________________

$__________________

Wages & Salaries

$__________________

$__________________

$__________________

Other (list)

$__________________

$__________________

$__________________

Other (list)

$__________________

$__________________

$__________________

Other (list)

$__________________

$__________________

$__________________

 

 

 

RENTAL INCOME (Detail)

 

What type of property is the rental? (i.e. four bedroom house, warehouse, trailer park, etc.)

RENTAL 1________________________

RENTAL 2________________________

RENTAL 3________________________

When did you purchase your rental property? (Mm/Yy)

RENTAL 1................_______/_______

RENTAL 2................_______/_______

RENTAL 3 ...............________/_______

How much did the rental property cost you?

RENTAL 1 $______________________

RENTAL 2 $______________________

RENTAL 3 $_____________________

 

Did you have any Farm Rental Income? __________  If yes, attach information. Did you have any Royalties? __________If yes, attach information & 1099s. 

Did you receive an Education Distribution?______

 

_______________________________________________________________________________________________________________________

 

DEDUCTIONS - Schedule A

 

MEDICAL

Medicines

$_____________________

Drugs

$_____________________

 

 

NAME

Amount Paid After

Insurance Reimbursement

NAME

Amount Paid After

Insurance Reimbursements

Doctors:______________________________

$_____________

Specialists:_________________________

$_____________

 ____________________________________

$_____________

 _________________________________

$_____________

 ____________________________________

$_____________

 _________________________________

$_____________

Dentists: _____________________________

$_____________

Chiropractors:______________________

$_____________

 ____________________________________

$_____________

 _________________________________

$_____________

 ____________________________________

$_____________

__________________________________

$_____________

Orthodontists: _________________________

$_____________

Clinics:____________________________

$_____________

 ____________________________________

$_____________

 _________________________________

$_____________

 ____________________________________

$_____________

 _________________________________

$_____________

Practitioners:__________________________

$_____________

Hospitals:__________________________

$_____________

 ____________________________________

$_____________

 _________________________________

$_____________

 

 

 

 

Transportation  & Lodging_

$_____________

Insurance Premiums (include Medicare)

$_____________

 

Prenatal Care

$__________________

Postnatal

$__________________

Eyeglasses

$__________________

Hearing Aids

$__________________

X-Rays

$__________________

Lab Fees

$__________________

Medical Lodging

$__________________

Bandages

$__________________

Therapy Equipment

$__________________

Crutches

$__________________

Medical Supplies & Appliances

$__________________

Diabetic Expense

$__________________

Prosthesis Expense

$__________________

Therapy Pool

$__________________

Required Air Conditioning Expense

$__________________

Electrical Expense

$__________________

Repairs & Filters

$__________________

Stop Smoking Expense

$__________________

 

TAXES

Did you pay State Taxes last year? _____  How much? $__________Did you pay State Taxes last year for prior years? _____         How much? $__________

Did you pay  Sales Taxes on Major Purchases last Year?______ How much? $________

 

Auto License Fees

$___________________

Auto Sales Tax

$___________________

Real Estate Taxes

$___________________

Property Taxes

$___________________

Irrigation Taxes

$___________________

Personal Property Taxes

$___________________

Boat Taxes

$___________________

Other Taxes

$___________________

 

Did you buy any cars, boats, motorcycles, R.V.s, trailers, mobile homes, airplanes, etc.?_______________ (Attach Information.) 

 

DEDUCTIONS (CONTINUED)

 

INTEREST: (Attach all 1098s)

1ST HOME

NAME

AMOUNT

Mortgages..................

_______________

$_____________

2nd Home Mortgage..

_______________

$_____________

Late Charges..............

_______________

$_____________

Mortgage Insurance...

College Loan Interest

College Loan Interest

_______________

______________________________

$_____________$_____________

 

CONTRIBUTIONS

Churches

$__________________

 

Payroll Deductions

$__________________

Missions

$__________________

 

Youth Programs

$__________________

Evangelists

$__________________

 

Muscular Dystrophy

$__________________

Bazaar

$__________________

 

Salvation Army

$__________________

Public Schools

$__________________

 

County Fairs

$__________________

Jaycees

$__________________

 

Boy - Girl Scouts

$__________________

Heart Fund

$__________________

 

Xmas  / Easter Seals

$__________________

Cancer Fund

$__________________

 

United Way

$__________________

 

Did you donate any non - cash items such as food or used clothing? Please list description and value: __________________________ ___________________________________________________________________________________________________________

 

Miscellaneous

Union Dues

$__________________

 

Spouse Dues

$__________________

Tax Preparer Fee

$__________________

 

Audit Fees

$__________________

Extension Fees

$__________________

 

Business Dues

$__________________

Books & Publications

$__________________

 

Safety Items

$__________________

Fire Retardant Clothing

$__________________

 

Safety Boots

$__________________

Protective Eye Wear

$__________________

 

Mosquito Spray

$__________________

Gloves

$__________________

 

Work Watch

$__________________

Tools

$__________________

 

Flashlights

$__________________

Batteries

$__________________

 

Water Jugs

$__________________

Uniforms

$__________________

 

Telephone for Business

$__________________

Cleaning

$__________________

 

Protective Headgear

$__________________

Investment Expense

$__________________

 

Sales & Promo Costume

$__________________

Adoption Expense

$__________________

 

Safety Deposit Box

$__________________

Record Keeping Costs

$__________________

 

Safety Glasses

$__________________

Other ( list )

$__________________

 

Other ( list )

$__________________

 

CONTINUED EDUCATION & 1ST TWO YEARS COLLEGE STUDENT CREDIT

Name of Student

___________________

 

 

 

Name of  Institution

___________________

 

Travel Expense

$__________________

Education Purpose

___________________

 

Tuition Expense

$__________________

Dates Attended

___________________

 

Supplies Expense

$__________________

 

Name of Student

___________________

 

 

 

Name of  Institution

___________________

 

Travel Expense

$__________________

Education Purpose

___________________

 

Tuition Expense

$__________________

Dates Attended

___________________

 

Supplies Expense

$__________________

 

 

 

 

 

 

 

EMPLOYEE BUSINESS EXPENSE

 

Did you  use your personal vehicle to run errands, chase parts, carry job tools, etc. for your employer?  Include Job Hunting. 

Please explain : ______________________________________________________________________

 

How many miles did you drive for the year ? ________________    How many miles did you drive for business ? ________________

Description of vehicle:        Make ______________           Model _________________       Year_________________   

 

Did you purchase an automobile last year ? ________________  Please enclose purchase papers.

 

Auto License Fee

$__________________

 

Auto Sales Tax

$__________________

Auto Interest

$__________________

 

Parking & Tolls

$__________________

OPTIONAL

Oil & Lubrication

$__________________

 

Auto Club

$__________________

Washing & Polishing

$__________________

 

Tires, Batteries, Etc.

$__________________

Repairs

$__________________

 

Insurance

$__________________

Fuel

$__________________

 

Other ( list )

$__________________

TRAVEL & EXPENSES OTHER THAN AUTO

Plane & Rail Fares

$__________________

 

Bus Fares

$__________________

Taxi & Public Transit

$__________________

 

Car Rentals

$__________________

Lodging

$__________________

 

Meals

$__________________

Telephone, Fax, Postage

$__________________

 

Tips & Baggage Charge

$__________________

Laundry & Cleaning

$__________________

 

Other ( list )

$__________________

SALES EXPENSE

Lunches, Dinners, Etc.

$__________________

 

Show & Event Tickets

$__________________

Organization Dues

$__________________

 

Gifts

$__________________

Stationary & Postage

$__________________

 

Basic Phone

$__________________

Long Distance Phone

$__________________

 

Other ( list )

$__________________

 

 

 

 

 

Did you  make any modifications to your home for the handicapped ? Please Describe :_____________________________________

Cost of modifications  $______________________________

 

Did you move last year? ___________       How many miles did you move? ___________     Date Moved ____/____/____

Transportation Cost $___________     Storage Cost $__________      Travel & Lodging $___________    

How much were you reimbursed that was not included in your wages?  $___________

 

Did you or your spouse contribute to a REGULAR IRA, ROTH IRA, SIMPLE or KEOGH ? $_____________________________

 

Do you or your spouse have a retirement plan at work ? ________________________________

 

Did you  pay alimony ?  _________   How much  ? ____________________________________

 

Recipients Name & S. S. # ___________________________________________________

 

 

For use in Tahoe, Minden, Gardnerville, and Carson City and Santa Barbara.