2012 Income tax organizer

If you need a tax organizer for 2012 you can print out the following or call us at 796-1040 and we can mail you a copy. I realize this is not the best format for a form to fill out. Thanks Larry Eisenzimer Tax Organizer Tax Year 2012 Name: Taxpayer ___________________________________ SS No. _____________________ Birthdate/Age _______ Spouse ____________________________________ SS No. _____________________ Birthdate/Age _______ Address: _______________________________________ Telephone (Home) (____)_________________________ ________________________________________ Telephone (Work) (____)_________________________ Cell Phone: (____)_________________________Cell Phone: (____)_______________________________ Email Address:_____________________________________________________________________________ Occupation: Taxpayer ________________________________ Spouse ________________________________ Check One:  Single  Married Filing Joint  Surviving Widow/Widower  Married Filing Separately (enter spouse’s name/SS No. Above)  Unmarried Head of Household Dependents Name Birthdate/ Age Social Security Number* Relationship No. of Months lived in your home in 2011 *A personal exemption is disallowed for any dependent unless the Social Security number is provided on the tax return. Members of your family attending college may make you eligible for a Hope Scholarship Credit, Lifetime Learning Credit, or Tuition and Fees Deduction. # Students_________ Taxpayer:  65 or over  Blind/Disabled Spouse:  65 or over  Blind/Disabled The checklist below could lead to helpful deductions. Please answer and provide supporting information. All questions below pertain to the year 2011. YES NO   Did you receive any employer-provided educational assistance? $ ____________   Did you incur any educational expenses on behalf of yourself, your spouse, or a dependent?   Did you contribute to a Qualified State Tuition Plan?   If you are an educator, did you have un-reimbursed work-related expenses? Amount: $________ (not yet extended)   Do you or your spouse have any kind of pension, profit-sharing, 401K, Retirement, Keogh, IRA, Roth or tax sheltered annuity plan? If yes, please circle above which ones.   If yes, were you or your spouse at least 70 ½ years of age on Dec. 31st?   Did you withdraw IRA or Keogh funds during the year? If so, please indicate the amount of funds: Withdrawn: $______________ Date: ___________ Re-deposited: $___________ Date: __________ Were any funds withheld?  Yes  No Amount: $_________________________ Were the withdrawn funds used to pay medial expenses?  Yes  No   Were you called to active duty before you withdrew the amounts?   If you are self-employed, did you pay health insurance premiums for yourself and your family? Amount: $ _____________   Did you pay alimony? If yes, paid to: _____________________________________________________ SS no.: __________________________________ Amount Paid: $ ____________________________   Did you receive alimony, if so how much?$______________   Did you have any adoption expenses? $ ____________   Did you receive gifts in excess of $14,375 from a foreign person?   Did your college student receive educational benefits under a prepaid tuition program?   Do you wish to designate $3 of your taxes to the Presidential Campaign Fund?   Did you receive an advance child tax credit payment? If yes, how much? $_______________   Have you ever qualified for the Earned Income Tax Credit?   Did you have a casualty of theft loss? If so, attach itemized list (including original cost and the value on date of loss), insurance information regarding coverage, reimbursement and police report.   Did you purchase an alternative fuel motor vehicle?   Did you make qualified energy improvements, such as energy efficient windows, doors, or metal roofs?   Did you purchase alternative energy sources for your personal residence, such as solar water heaters, solar electric equipment, geothermal heat pumps or wind turbines and fuel cell plants?   Did you have a property foreclosed on, have a short sale, or relinquish a property in lieu of foreclosure? Estimated Tax Payments 1st Quarter 2nd Quarter 3rd Quarter 4th Quarter TOTAL Date Paid Amount Date Paid Amount Date Paid Amount Date Paid Amount Federal State City Wage Income Employer’s Name T or S Wages Federal W/H FICA Medicare State W/H City W/H Retirement Benefits Received (Enclose all 1099R Forms) Payer T or S Amount Plan Type Interest Income (Enclose all 1099-INT Forms) Payer T or S Amount Seller Financed Mortgage Early Withdrawal Penalty Tax Exempt (Y or N) Total Municipal Bond Interest Earned in 2011: $________________________ For seller financed mortgage: Buyer’s name, Social Security number and addresses: __________________________________ ___________________________________________________________________________________________________________ Dividend Income (Enclose all 1099-DIV Forms) Payer T or S Total Amount Qualified Dividends Capital Gain Dist. Non-Taxable Do you have funds in a foreign account?  Yes  No Did you have any stock sales in 2011? If yes, submit all 1099B forms.  Yes  No Installment Sale Payments Received: Interest $____________ Principal $ _________________ Buyer’s name: ________________ SS # _________________ Address: ____________________________ Other Benefits/Income Received (Enclose all 1099, SSA-1099, K-1s and other Misc. Forms) Taxpayer Social Security Unemployment Alimony State Refund Other Spouse Capital Assets Sold (Securities, Real Estate, etc.) Attach Forms 1099B and 1099S Description of Property Date Acquired Date Sold Sale Price Depreciation Taken (if applicable) Cost or Basis *To qualify for long term capital gain rates, assets sold must have been held for more than one year. Rental Income (Attach 1099 Forms) Property Description Gross Income Expenses Advertising Auto & Travel Cleaning & Maintenance Commissions Insurance Professional Fees Mortgage Interest Other Interest Repairs Supplies Taxes Utilities Wages/Schedule % Occupancy by Taxpayer Depreciable Asset Additions For Schedule C, E, F, 2106 Description Date Purchased Cost Trade-In (if any) Improvements to Personal Residence Note: If you refinanced your home this year, please bring a copy of your closing statement. For Schedule C, E, F, 2106 Description Date Purchased Cost Business Income (Attach 1099-MISC Forms) Business Name _______________________________ Federal ID No. _______________________________ Principal Business Activity _____________________ Principal Product _____________________________ Method Used to Value Inventory _________________ Accounting Method:  Cash  Accrual Gross Income Amount Gross Income………………………. __________________ Less Returns/Allowances…………….. __________________ Cost of Sales Beginning Inventory………………….. __________________ Purchases……………………………... __________________ Cost of Labor…………………………. __________________ Materials and Supplies……………….. __________________ Freight In…………………………….. __________________ Other________________________.... __________________ ____________________________... __________________ Ending Inventory…………………….. __________________ Deductions Advertising………………………… __________________ Auto-Truck Expense………………. __________________ Bad Debts………………………….. __________________ Collection Expense………………… __________________ Commissions………………………. __________________ Professional Dues & Subscriptions.. __________________ Employee Benefit Program……….. __________________ Freight & Express ……………….. __________________ Utilities…………………………… __________________ Insurance………………………….. __________________ Interest—Mortgage………………… __________________ Interest—Other…………………….. __________________ Janitorial & Cleaning……………….. __________________ Laundry…………………………….. __________________ Legal & Accounting Fees………….. __________________ Office Expense…………………….. __________________ Postage…………………………….. __________________ Rent………………………………... __________________ Repairs…………………………….. __________________ Salaries…………………………….. __________________ Supplies……………………………. __________________ Telephone………………………….. __________________ Travel……………………………… __________________ Total Meals & Entertainment……… __________________ _______________________............ __________________ _______________________............ __________________ Farm Income (Attach 1099 Forms) Farm Name__________________________________ Principal Activity_____________________________ Accounting Method:  Cash  Accrual Income Sales of Items Bought for Resale……. __________________ Cost of Items Bought for Resale…….. __________________ Sales of Livestock & Produce Raised Except for Breeding Stock Feeders & Calves………………….. __________________ Pigs & Sheep ……………………… __________________ Poultry & Eggs ……………………. __________________ Dairy Products…………………….. __________________ Corn, Peas, etc.. ……………………. __________________ Wheat, Oats, Hay & Straw ………… __________________ Fruit ………………………………... __________________ Patronage Dividends ………………. __________________ Agricultural Program Payments……. __________________ Commodity Credit Loans Neglected…. __________________ CCC Loans: Forfeited……………... __________________ Repaid with Certificates………… __________________ Crop Insurance Proceeds…………… __________________ Federal Gasoline Tax Credit……….. __________________ Other___________________.............. __________________ Deductions Breeding Fees……………………. __________________ Chemicals………………………… __________________ Conservation Expenses…………… __________________ Custom Hire (Machine Work)…… __________________ Employee Benefits Programs……… __________________ Feed Purchased……………………. __________________ Fertilizers & Lime ………………… __________________ Freight & Trucking………………... __________________ Gasoline, Fuel, Oil…………………. __________________ Insurance …………………………… __________________ Interest—Mortgage………………… __________________ Interest—Other……………………… __________________ Labor Hired ………………………… __________________ Pension & Profit Sharing Plans……… __________________ Rent of Farm, Pasture……………… __________________ Repairs, Maintenance ……………… __________________ Seeds, Plants Purchased …………… __________________ Storage, Warehousing……………… __________________ Supplies Purchased………………… __________________ Taxes ……………………………… __________________ Utilities …………………………… __________________ Veterinary Fees, Medicine………… __________________ _______________________............ __________________ _______________________............ __________________ Personal Itemized Deductions Medical Amount Prescription Drugs…………………. __________________ Medical Insurance Premiums..…….. __________________ Long Term Care Ins. Premiums…… __________________ Medicare Premiums……………….. __________________ Doctors/Dentists…………………… __________________ Clinic/Lab Tests…………………… __________________ Hospitals…………………………… __________________ Eyeglasses/Hearing Aids………….. __________________ Orthopedic Shoes/Braces………….. __________________ Medical Long Distance Phone……. __________________ Other_______________.................. __________________ ____________________.................. __________________ _____ Miles..................................... __________________ Fares: Taxi, Bus, etc......................... __________________ Do you have a medical savings acct.? __________________ Interest Deductible Home Mortgage Interest Paid to Financial Institutions……………… __________________ Home Equity Interest……………….. __________________ Deductible Home Mortgage Interest Paid to Individuals:* Name Address:*_____________________________ __________________________________________ Social Security No.:*_________________________ *Failure to provide is subject to a $50 penalty. Deductible Points (Include Amortization Points from Prior Years)………… __________________ Investment Interest (list)…………… __________________ ________________________.............. __________________ ________________________.............. __________________ ________________________.............. __________________ Taxes Real Estate…………………...………. __________________ Personal Property……………….…… __________________ State & Local Income Tax…………… __________________ State & Local General Sales Tax......... __________________ ____________________..................... __________________ Charitable Contributions Cash Contributions*___________....... __________________ ___________________________......... __________________ ___________________________......... __________________ ___________________________......... __________________ Other Than Cash Contributions……. __________________ _________________________............ __________________ _________________________............. __________________ ______Miles for Charity …………… __________________ *Contributions of $250 or more require written substantiation from the organizations. Miscellaneous Deductions Subject to 2% AGI Unreimbursed Employee Business Expense_________________ Union & Professional Dues…………… __________________ Safe Deposit Box Rental…………….. __________________ Tax Return Preparation Fee…………. __________________ Business Publications……………… __________________ Business Telephone Calls…………… __________________ Tools, Supplies, Equipment………… __________________ Employment-Related Education…… __________________ Investment Expenses……………… __________________ Other_________________________.... __________________ Miscellaneous Deductions Not Subject to 2% AGI Gambling Losses (limited to winnings).. __________________ ___________________________________________________ ___________________________________________________ Employee Business Expense Travel Expense Amount Air Fares………………………… __________________ Auto Rentals…………………… __________________ Entertainment…………………… __________________ Garage…………………………….. __________________ Hotel/Motel………………………. __________________ Meals……………………………... __________________ Parking…………………………… __________________ Postage……………………………. __________________ Amount Road Tolls…………………… __________________ Taxi, Subway……………………… __________________ Telephone, Telegraph……………… __________________ Tips………………………………… __________________ Other………………………………. __________________ ________________________......... __________________ ________________________......... __________________ ________________________......... __________________ Car 1 Car 2 Actual Automobile Expenses Gas & Oil Insurance Licenses Lubrication Repairs Tires, Tire Repair Wash Other: