Fillable Client Tax Organizer 1. Personal Information

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Client Tax Organizer 1. Personal Information

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Client Tax Organizer
Please complete this Organizer before your appointment. Prior year clients should use the proforma Organizer provided.
1. Personal Information
Work Phone
Name Soc. Sec. No. Date of Birth Occupation
Taxpayer
Spouse
Street Address City State ZIP Home Phone
Email Address
Taxpayer Spouse Marital Status
Blind
Disabled
Pres. Campaign Fund
Yes
Yes
Yes
No
No
No
Yes
Yes
Yes
No
No
No
Married
Single
Widow(er), Date of Spouse's Death
Will file jointly Yes No
2. Dependents (Children & Others)
Name
(First, Last)
Relationship
Date of
Birth
Social
Security
Number
Months
Lived
With
You
Disabled
Full
Time
Student
Dependent's
Gross
Income
ID
Protection
PIN
Please provide for your appointment
-
-
Last year's tax return (new clients only)
Name and address label (from government booklet or card)
- All statements (W-2s, 1098s, 1099s, etc)
Please answer the following questions to determine maximum deductions
9.
1. Are you self-employed or do you
receive hobby income?
Were there any births, deaths,
marriages, divorces or adoptions
in your immediate family?
Yes* No
Yes No
2. Did you receive income from
raising animals or crops?
Yes* No
10. Did you give a gift of more than $15,000
to one or more people?
Yes No
3. Did you receive rent from real
estate or other property?
Yes* No
11. Did you have any debts cancelled, forgiven,
or refinanced?
Yes No
4. Did you receive income from
gravel, timber, minerals, oil, gas,
copyrights, patents?
12. Did you go through bankruptcy
proceedings?
Yes* No
Yes No
5. Did you withdraw or write
checks from a mutual fund?
13. (a) If you paid rent, how much did you pay?
Yes No
6. Do you have a foreign bank
account, trust, or business?
Yes No
(b) Was heat included?
Yes No
14. Did you pay interest on a student loan for
yourself, your spouse, or your dependent
during the year?
7. Do you provide a home for or
help support anyone not listed
in Section 2 above?
Yes No
Yes No
15.
Did you pay expenses for yourself, your
spouse, or your dependent to attend
classes beyond high school?
8. Did you receive any correspondence
from the IRS or State Department
of Taxation?
Yes No
Yes No
CTORG01 12-04-19 * Contact us for further instructions
16. Did you have healthcare coverage (health
insurance) for you, your spouse and
dependents during this tax season? If yes,
include Forms 1095-A, 1095-B, and 1095-C.
19. Did you purchase a new alternative
technology vehicle or electric vehicle?
Yes No
Yes No
20.
Did you install any energy property to your
residence such as solar water heaters,
generators or fuel cells or energy efficient
improvements such as exterior doors or
windows, insulation, heat pumps, furnaces,
central air conditioners or water heaters ?
17. Did you apply for an exemption through the Marketplace
/Exchange? If so, provide the exemption certificate number.
Yes No
18. Did you have any children under the age of
19 or 19 to 23 year old students with
unearned income of more than $1100?
21. Did you own $50,000 or more in foreign
financial assets?
Yes No
Yes No
Have you or your spouse been a victim of identity theft and given
an identity theft protection PIN by the IRS? If yes, enter the six
digit identity protection PIN number.
22.
3. Wage, Salary Income
Attach W-2s:
Taxpayer Spouse
Employer Taxpayer Spouse
7. Property Sold
Attach 1099-S and closing statements
Property Date Acquired Cost & Imp.
Personal Residence*
Vacation Home
Land
Other
* Provide information on improvements, prior sales of home,
and cost of a new residence. Also see Section 17
(Job-Related Moving).
4. Interest Income
Attach 1099-INT, Form 1097-BTC & broker statements
Payer Amount
8. I.R.A. (Individual Retirement Acct.)
Contributions for tax year income
U for
Roth
Amount Date
Tax Exempt
Taxpayer
Spouse
Amounts withdrawn. Attach 1099-R & 5498
Plan
Trustee
Reason for
Withdrawal
5. Dividend Income
Reinvested?
Yes
Yes
Yes
Yes
No
No
No
No
From Mutual Funds & Stocks - Attach 1099-DIV
Capital
Gains
Non-
Taxable
Payer Ordinary
9. Pension, Annuity Income
Attach 1099-R
Payer*
Reason for
Withdrawal
Reinvested?
Yes
Yes
Yes
Yes
No
No
No
No
6. Partnership, Trust, Estate Income
* Provide statements from employer or insurance
company with information on cost of or
contributions to plan.
List payers of partnership, limited partnership, S-corporation, trust,
or estate income - Attach K-1
Taxpayer Spouse
Did you receive:
Social Security Benefits
Railroad Retirement
Yes
Yes
No
No
Yes
Yes
No
No
CTORG02 12-04-19
Attach SSA 1099, RRB 1099
10. Investments Sold
Stocks, Bonds, Mutual Funds, Gold, Silver, Partnership interest - Attach 1099-B & confirmation slips
Investment Date Acquired/Sold Cost Sale Price
/
/
/
/
11. Other Income 14. Interest Expense
Mortgage interest paid (attach 1098)
Interest paid to individual for your
home (include amortization schedule)
List All Other Income (including non-taxable)
Alimony Received
Child Support
Scholarship (Grants)
Paid to:
Name
Address
Social Security No.
Unemployment Compensation (repaid)
Prizes, Bonuses, Awards
Gambling, Lottery (expenses )
Investment Interest
Premiums paid or accrued for qualified
mortgage insurance
Unreported Tips
Director / Executor's Fee
Commissions
Jury Duty
15. Casualty/Theft Loss
Worker's Compensation
Disability Income
Veteran's Pension
For property damaged by storm, water, fire, accident, or stolen.
Location of Property
Description of Property
Payments from Prior Installment Sale
State Income Tax Refund
Other
Other
Other
Federally Declared
Disaster Losses
Other
12. Medical/Dental Expenses
Amount of Damage
Insurance Reimbursement
Repair Costs
Federal Grants Received
Medical Insurance Premiums
(paid by you)
Prescription Drugs
Insulin
Glasses, Contacts
Hearing Aids, Batteries
16. Charitable Contributions
Other
Braces
Medical Equipment, Supplies
Nursing Care
Medical Therapy
Hospital
Church
United Way
Scouts
Telethons
Doctor/Dental/Orthodontist
University, Public TV/Radio
Heart, Lung, Cancer, etc.
Wildlife Fund
Salvation Army, Goodwill
Mileage (no. of miles)
13. Taxes Paid Other
Non-Cash
Real Property Tax (attach bills)
Personal Property Tax
Volunteer (no. of miles) @ .14
Other
CTORG03 12-04-19
$0.00
17. Child & Other Dependent Care Expenses
Name of Care Provider Address
Soc. Sec. No. or
Employer ID
Amount
Paid
Also complete this section if you receive dependent care benefits from your employer.
21. Business Mileage
18. Job-Related Moving Expenses
U
if you are a member of the Armed Forces on active duty
and moving due to a permanent change of station due to
a military order.
Do you have written records? Yes
Yes
No
No
Did you sell or trade in a car used
for business?
Date of move
Move Household Goods If yes, attach a copy of purchase agreement
Lodging During Move
Make/Year Vehicle
Date purchased
Travel to New Home (no. of miles)
Total miles (personal & business)
19. Employment Related Expenses That You Paid
(Not self-employed)
Business miles (not to and from work)
From first to second job
Education (one way, work to school)
U if Armed Forces reservist, a qualified performing artist,
a fee-basis state or local government official, or an individual
with a disability claiming impairment-related work expenses.
Job Seeking
Other Business
Round Trip commuting distance
Gas, Oil, Lubrication
Batteries, Tires, etc.
Dues - Union, Professional
Books, Subscriptions, Supplies
Licenses Repairs
Wash
Insurance
Tools, Equipment, Safety Equipment
Uniforms (include cleaning)
Sales Expense, Gifts
Tuition, Books (work related)
Entertainment
Interest
Lease payments
Garage Rent
Office in home:
In Square a)
b)
c)
Total home
Office
Storage
22. Business Travel
Feet
If you are not reimbursed for exact amount, give total expenses.
Rent
Insurance
Utilities
Maintenance
Airfare, Train, etc.
Lodging
Meals (no. of days )
Taxi, Car Rental
Other
Reimbursement Received
20. Investment-Related Expenses State use only
Tax Preparation Fee
Safe Deposit Box Rental
Mutual Fund Fee
Investment Counselor
Other
CTORG04 12-04-19
23. Estimated Tax Paid 24. Other Deductions
Due Date Date Paid Federal State
Alimony Paid to
Social Security No.
Student Interest Paid
Health Savings Account Contributions
Archer Medical Savings Acct. Contributions
$
$
$
$
26. Questions, Comments, & Other Information
25. Education Expenses
Student's Name Type of Expense Amount
Residence:
Town
Village
City
County
School District
27. Direct Deposit of Refund / or Savings Bond Purchases
Would you like to have your refund(s) directly deposited into your account? Yes No
(The IRS will allow you to deposit your federal tax refund into up to three
different accounts. If so, please provide the following information.)
ACCOUNT 1
Owner of account Taxpayer Spouse Joint
Type of account Checking Traditional Savings Traditional IRA Roth IRA
Treasury Direct Archer MSA Savings Coverdell Education Savings HSA Savings SEP IRA
Name of financial institution
Financial Institution Routing Transit Number (if known)
Your account number
ACCOUNT 2
Owner of account Taxpayer Spouse Joint
Type of account Checking Traditional Savings Traditional IRA Roth IRA
Treasury Direct Archer MSA Savings Coverdell Education Savings HSA Savings SEP IRA
Name of financial institution
Financial Institution Routing Transit Number (if known)
Your account number
CTORG05 12-04-19
ACCOUNT 3
Owner of account Taxpayer Spouse Joint
Type of account Checking Traditional Savings Traditional IRA Roth IRA
Treasury Direct Archer MSA Savings Coverdell Education Savings HSA Savings SEP IRA
Name of financial institution
Financial Institution Routing Transit Number (if known)
Your account number
Would you like to purchase Series I Savings bonds with a portion of your refund? If so, please answer the following:
Amount used for bond purchases for yourself (and spouse if filing jointly).
Amount used to buy bonds for someone else (or yourself only or spouse only if filing jointly).
Owner's name Co-owner or Beneficiary's
name if applicable
X if name is for
a beneficiary
Bond purchase Amount
To the best of my knowledge the information enclosed in this client tax organizer is correct and includes all
income, deductions, and other information necessary for the preparation of this year's income tax returns for
which I have adequate records.
Taxpayer Date Spouse Date
CTORG06 12-04-19
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Client Tax Organizer 1. Personal Information

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Completed 12 January 2021

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