Fillable Tax Organizer Taxpayer Information 1/6 Date of Bir (Waxenberg Wayntraub, PLLC)

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Tax Organizer Taxpayer Information 1/6 Date of Bir (Waxenberg Wayntraub, PLLC)

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Tax Organizer
Taxpayer Information
1/6
First Name: Initial: Last Name:
Date of Bir
th: SSN#: Occupation:
Address:
City:
State:
Zip:
Home Tel: Work Tel:
Email
Filing Status
Single:
Married: Married filing separately: Head of household: Qualified widow(er):
Spouse Information
First Name: Initial: Last Name:
Date of Birth: SSN#: Occupation:
Dependents
Name:
DOB:
SSN#:
Relationship:
Months at home:
Wage, Salary Income (Provide W-2s)
Employer Name: Gross Wages: Fed Withholdings: State Withholdings: Local Withholdings:
Other Income
Interest (Provide 1099INT Forms)
Payer:
Amount:
Payer:
Amount:
$
$
$
Tax Organizer 2/6
Other Income (Cont.)
Dividends (Provide 1099DIV Forms)
Payer: Total:
Capital Gains: Ordinary Dividend:
$
$ $
$
$ $
$
$ $
$
$ $
Capital Gains (Provide 1099B and 1099S Forms)
Description: Date Acquired: Date Sold: Cost: Sale Price:
$
$
$
$
$
$
$
$
Pension / IRA Distributions (Provide 1099R Forms)
Payer:
Gross Distribution: Taxable Amount: Roth Conversion:
$
$ $
$
$ $
$
$ $
$
$ $
Check if federal
or state tax was
withheld.
State tax refund (Provide 1099G Forms)
Amount Received: $
Alimony Received (Not including child support)
Payer:
Payer SSN: Amount: $
Unemployment Received (Provide 1099G Forms)
Tax Payer Amount: $ Spouse Amount: $
Social Security Received (Provide SSA-1099 Forms)
Tax Payer Amount: $ Spouse Amount: $
Income from rental property (Please fill out rental income section of this form) $
Miscellaneous Income
Tips and gratuities (not on W-2) $
Recovery of bad debts previously deducted
Gambling / Lottery winnings $
Veteran's Pension $
Scholarships / Grants
$
Other (Description and amount)
$
Bonuses and prizes $
Jury duty pay
$
Disability Income $
Child Support $
Tax Organizer 3/6
Deductions
Medical and dental expenses
Insurance Premiums: $ Doctors, Dentists, etc (net): $
Taxes Paid
State and local income tax: $ Real est
ate taxes (residence): $
Real estate taxes (other property, not rental): $ Auto registration & licensing: $
Other personal property tax: $ Foreign income tax (not taken as credit): $
Others $ Others
$
Interest Paid (
A
t
t
ac
h
10
98
F
or
m
s
)
H
om
e
m
or
t
ga
ge
i
nt
er
e
st paid (1st): $ Home mortgage interest paid (2nd): $
Home mortgage (equity line): $ Student loan interest: $
Others $ Others
$
Contributions (Attach details)
Cash or check: $
Other than cash: $
Miscellaneous Deductions
Unreimbursed employee business expense
s: $ Tax return preparation fees: $
Investment council and advisory fees: $
Safe deposit box rental: $
Others
$
Others
$
Child and other dependent care expenses
Vehicle used for business
Business miles driven: Actual expens
es: $
Education expenses
Interest paid on qualified student loans:
$
Tuition fees
Student (first, last name):
SSN:
Expenses:
$
$
$
Name of care
Address:
SSN or employee ID:
Name of care
Address:
SSN or employee ID:
Other professional fees: $
Educator expenses: $
Tax Organizer 4/6
Business Income
Cash basis: Accrual basis: First year: Tax payer: Spouse:
Principal business / Profession Business name:
Business Address:
City:
State:
Zip:
Other accounting method:
Income
Gross receipts or sales $
Returns and
allowances: $
Other income $
Cost of Goods Sold (If Applicable)
Inventory at beginning of year: $ Inventory at end of year: $
Purchases: $
Cost of items for personal use: $
Cost of labor: $
Materials and supplies: $
Other costs: $
Expenses
Advertising: $ *Car & truck expenses: $
Commissions: $
Employee benefit programs: $ Insurance other than health: $
*Health insurance premiums for self: $ Mortgage interest (paid to banks, etc): $
Other interest: $ Legal & professional: $ Office expense: $
Pension and profit sharing plans: $ Rent - vehicles machinery & equipment: $
Rent - other business property: $ Repairs: $
Supplies: $
Taxes - real estate: $ Taxes - other: $ Travel: $
*Other: $ Total meals & entertainment: $ Utilities: $
Wages: $ *Attach detailed schedule
Check if you acquired or disposed of any business assets (including real estate) during the year.
If yes, provide detailed schedule
Check if you had a home office during the year.
Rent: $ Utilities: $
Janitorial: $ Miscellaneous: $
Insurance: $
% of exclusive
business use: $
Rental Income
Check if any property was purchased/converted to rental last year:
Property Address (include city and state)
1.
2.
3.
Percentage
ownership
%
%
%
Tax Organizer 5/6
Rental Income
(Cont.)
Property
Rents received:Income $ $ $
1. 2. 3.
Expenses
$ $ $
Advertising:
$ $ $
Association dues:
$ $ $
Auto and travel:
$ $ $
Cleaning/Maintenance:
$ $ $
Commissions:
$ $ $
Gardening:
$ $ $
Insurance:
$ $ $
Labor:
$ $ $
Professional fees:
$ $ $
Miscellaneous:
$ $ $
Mortgage interest:
$ $ $
Other Interest:
$ $ $
Repairs and Maintenance:
$ $ $
Supplies:
$ $ $
Taxes:
$ $ $
Telephone:
$ $ $
Utilities:
$ $ $
Improvements:
$ $ $
Other:
Adjustments to Income
Traditional IRA Contributions:
Roth IRA Contributions:
Spouse
Self Employed KEOGH, SEP & SIMPLE Contributions:
Tax Payer
Alimony paid SSN of Payee Amount
1. $ 2. $
SSN of Payee Amount
Estimated Tax Payments
Federal
1st Quarter Date
$
Overpayment - Prior Year
$
2nd Quarter Date
$
3rd Quarter Date
$
4th Quarter Date
$
State
1st Quarter Date
$
Overpayment - Prior Year
$
2nd Quarter Date
$
3rd Quarter Date
$
4th Quarter Date
$
$
$
$
$
$
$
Amount Amount
Health Care Information
Did you have qualifying health care coverage, such as employer-sponsored coverage or government-
sponsored coverage (i.e. Medicare/Medicaid) for every month of the year for your family?
Yes No
Were you covered for part of the year? From: To:
Did anyone in your family qualify for an exemption from the health care coverage mandate?
Yes
No
Did you enroll for lower cost Marketplace Coverage through healthcare.gov under the Affordable Care Act? (If
yes, please provide any Form(s) 1095-A you received.)
Yes
No
Tax Organizer 6/6
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Tax Organizer Taxpayer Information 16 Date of Bir (Waxenberg Wayntraub, PLLC)

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Completed 16 May 2021

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