STATE DEDUCTIONS FOR AL, AR, CA, HI, MN, NY, PA – MA (transit passes only for MA)
Uniforms/ Work Clothing/Footwear Tools/Supplies/Equipment/Safety Equip
Laundry / Cleaning of Uniforms Print Media or Subscriptions
Postage/Fax/Shipping for business Professional Insurance
Licenses, even if not used this year Professional Memberships
Fingerprints/Verification/Security Union Dues
Job Physicals/Job Medical/Testing Other
REIMBURSEMENTS for any/all above expenses You: Spouse:
Did you change your permanent residence to any of these states during tax year? Yes No ______ ______
Communications Expense: To calculate estimated business use, take total monthly minutes and divide by business minutes. Business minutes are the total of all minutes used to talk to
employers, recruiters, and other conversations related to your temporary housing, relocation, and other employment related agencies.
Estimated business use %Do you have a landline? Y N 1st phone/cell - Total for year: _________________________ ___________________________
Estimated business use %2
nd
phone/cell – Total for year __________________________ ___________________________
Work Related Continuing Education, Conventions, ACLS, BLS, PALS - Not college courses or travel assignments
I confirm that the information given on this page is true, complete, and accurate. (enter initials) Page 5
TravelTax – 46 St. Mark Rd., Taylors, SC 29687 - Fax 877.872.8829 - Office 402.379.7818
Copyright © 2021 TravelTax. Use of this by anyone other than TravelTax and its clients is prohibited.
Check the “ask me” box in addition to your ‘yes/no’ if you need to discuss this with us.
18) Are you and/or your spouse: blind or a tribal member?
19) Did you give back Jury Pay to your employer in exchange for hours worked? Enter amount turned in to employer _______________________________
20) Did you have reported Gambling winnings? Send all W2Gs that you have received. If you have your losses documented, send that along also.
21) Did you receive any royalties from authorship (copyrights/books) or mining (minerals, oil, etc.)? Please send 1099M or K1.
22) Have you experienced any losses related to Presidential Disaster Area?
23) Did you know that in Alabama there is a law that bans driving while blindfolded? (and yes, we are serious tax preparers, but figured you might need some comic relief right about now!
Received?24) Have you paid or received alimony for a divorce settlement made prior to 2019? Amount ____________________ Paid?
and SSN:If paid, please list name of alimony recipient: ____________________________________________________ __________________________
Paid? Received? 25) Have you given or received gifts over $15,000 to / or from any one person? Amount ___________________
26) Did you pay more than $2100 this year to any individual as an in-home caregiver, cleaner, or other domestic help?
Amount paid to this provider SS# or EIN
Phone Address
relationship if relative Name 2
Amount paid to this provider SS# or EIN
Phone Address
relationship if relative
27) Did you have child or dependent care expenses? You will need to provide the info below, or send the documentation that the daycare provider gave you.
Name 1 ______________________________________________________________________ ____________________________
__________________________________________________________________________________ _________________________
_____________________________________ _________________
______________________________________________________________________ ____________________________
___________________________________________________________________________________ _________________________
_____________________________________ _________________
28) Did you install any energy efficient items to your home? (eg. solar/geothermal/insulation/windows) Provide the type and cost (or receipt) of each improvement.
29) Did you foreclose on your home? (Send 1099C and/or 1099A)
30) Did you claim the First Time Homebuyers Credit on your 2008 return? (the $500 that gets partially repaid every year)
31) Did you sell a home this year? Please provide us with a copy of the first 2 pages of your settlement statement
Did you ever rent this home to other individuals or use it for business or home office deduction? Yes No
Purchase price of your old home Date you purchased the home ________________________ ________________________________
Unreimbursed Lodging Unreimbursed Meals
Rental Car (including gas)Mileage if own car
32) Are you a member of the military? Reservist Active Duty
Did you sell your residence in the last 5 years? Yes No
Did you travel more than 100 miles to attend Guard or Reserve meetings? Yes No If yes, then fill out the rest of this section.
Airfare/Transit expenses _____________________ _____________________ ___
_____________________
___________________________ ______________________
Do you own property in your country of origin? Yes
What was your filing status in the US last year? Resident Alien
year before thatyear before Days spent in the US: tax year
34) Are you an alien or a foreign worker? VISA type: _______________________________
__________________ ____________________ ___________________
Nonresident alien NA
Do you have a spouse residing outside of the US? Yes No
Do you maintain a job in your country of origin? Yes No Give last date worked there
________________________
