Tax Organizer

Every year we need to obtain essential information to complete your tax return.  This enables us to assure that all deductions/credits are taken that may be available to you and hopefully, ensure that you don’t forget to report various    types of income.  The Tax Organizer will assist with organizing your information, such as:

  • Personal Information (Social Security Number, Dependents, etc.)
  • Wage/Salary Income
  • Interest/Dividend Income
  • Qualifying Expenses
  • Tax Credits

 

Start Your Personal Tax Organizer Today! – Click Here to Request

 


 

2015 TAX RETURN CUSTOMER DATA SHEET

Primary                        

Name____________________________________

SSN____________________________________

Birth Date_______________________________

Occupation______________________________

Work Phone_____________________________

Cell Phone______________________________

E-mail  _________________________________

HOME Address____________________________ 

Spouse

Name__________________________________

SSN___________________________________

Birth Date______________________________

Occupation_____________________________

Cell Phone_____________________________

Home Phone____________________________

E-mail  ________________________________

City___________________State___Zip______

 

Filing Status                          Single              Married Filing Jointly             Married Filing Separately

(Circle your status)                  Head of Household                Qualifying Widow(er)

 

State Info

What state(s) did you live in during the tax year?

State____ Beginning___/___/___ Ending___/___/___   State____ Beginning___/___/___ Ending___/___/___

 

Dependent's Name      Birth Month & Year      Dependent's SSN      Relationship      # Months Lived in                                                                                                                                                         Your Home

_________________      ________________       _______________      ___________       _______________

_________________      ________________       _______________      ___________       _______________

_________________      ________________       _______________      ___________       _______________

_________________      ________________       _______________      ___________       _______________

 

If your child lived with you, but cannot be claimed as a dependent, check here and by their name above_____

If your child did not live with you, but is claimed as a dependent, check here and by their name above______

If someone else can claim you as a dependent check here______

 

Child Care Information  (This is required for each provider)

Provider’s Name________________________________________SSN/EIN__________________________

Address_____________________________________City_______________________Zip_______________

Amount Paid to Provider  $______________________

 

Provider’s Name________________________________________SSN/EIN__________________________

Address_____________________________________City_______________________Zip_______________

Amount Paid to Provider  $______________________

 

HEALTH INSURANCE INFO:  The new Affordable Care Act (Obamacare) requires that each tax return includes information on coverage for the past year.  If you and all your Dependents were covered for the entire year of 2015 please indicate here _____ and provide a copy of tax Form 1095.

If you had insurance coverage for all of 2015 by Medicare/Medicaid indicate here:  ____

If you did not have coverage for all of 2015 indicate here:  ____ and call our office 574-246-1165 to discuss.  We want to be pro-active, so your tax return filing is not delayed.

 

Which Items Pertain to You?  Please include documents for each item checked representing income:

__ Wage Statement (W-2)                  __ 1099-Misc              ­­­                        __ Pensions (1099R) 

__ Sale of Stocks/Bonds                   __ Installment Sales                            __ IRA /401k distribution

__ Gambling/Lottery                          __ Estates/Trusts                                __ I Rental Income

__ Interest (1099 Int)                         __ Sale of Residence                           __ Social Security Benefits

__ Unemployment                             __ Student Loan Interest Paid               __ Partnership/S Corp (K-1)

__ Dividends (1099 Div)                     __ Alimony Rec’d – Amt. $_____          __ Tip Income

__ Any other income                         __ Alimony Paid – Amt. $ _____           __ Other

__ Self Employment                          __ Operate My Own Business           

 

Can I Itemize My Deductions?   Please include documents for each item checked:

__ Did you itemize deductions last year?     Yes ___ No___              __ Real Estate Taxes

__ Estimated Taxes Paid – Please List Each on Page 3                   __ Medical Expenses (over 10% AGI)

__ Theft/Casualty Losses                                                               __ Home Mortgage Interest (Form 1098)

__ Auto Excise Tax $_____                                                            __ Charitable Gifts                

__ Unreimbursed Employee Expense (Please List)                            __ Investment/Tax Fees         

__ Deduct Sales Tax – Amt. of Sales Tax on Car / Boat Purchases $________

 

Other Tax Preferences – Please note if you may wish to claim one of the following:

__ Job-Related Moving Cost   __ College Tuition Paid        __ Educator Expenses (Teachers only)

__ Student Loan Interest        __ IRA Contribution              __ Health Savings/Self-Employed Insurance

__ IRA Early Withdrawal         __ Other                             __ Self-Employed SEP, SIMPLE contributions 

 

Direct Deposit Information for Refunds:

 Federal Refund Direct Deposit  Yes______ No______     State Refund Direct Deposit  Yes______ No______

 Name of Institution___________________________________________________________

 Routing #_____________________________ Account #_____________________________

 Checking______ or Savings_______  (please check one)

 

Child Care Information  (This is required for each provider)

Provider’s Name________________________________________SSN/EIN__________________________

Address_____________________________________City_______________________Zip_______________

Amount Paid to Provider  $______________________

 

Provider’s Name________________________________________SSN/EIN__________________________

Address_____________________________________City_______________________Zip_______________

Amount Paid to Provider  $______________________

 

ESTIMATED TAX PAYMENTS (Sent by Mail):

                                                                    Federal                       State

            Quarter 1 – Date:  _____                    ______                        _____

            Quarter 2 – Date:  _____                    ______                        _____

            Quarter 3 – Date:  _____                    ______                        _____

            Quarter 4 – Date:  _____                    ______                        _____

 

Out-of-State Purchases:  ____ None or Amount of Purchases: $ __________

Note:  States now require that this be reported on the state tax return and that Use (sales) taxes be paid.

 

Other Matters - Please list below any you wish to discuss:

  ______________________________________________________________

  ______________________________________________________________

  ______________________________________________________________

 

All of the above information was provided by:

 

(Signature)                                                                                                      (Date)

 

Email us at:  Office@OasisCPA.com