TAX ORGANIZER

This tax organizer will assist you in gathering information necessary for the preparation of your 2004 tax return.

CLIENT INFORMATION
Filing Status 
__ Single
__ Married filing joint
__ Married filing separate
__ Head of household
__ Qualifying widow(er)
Taxpayer 
Full Name ____________________________________
Social Security No. __________________________
Occupation ___________________________________
Age or Date of Birth__________________________
Spouse 
Full Name ____________________________________
Social Security No. __________________________
Occupation ___________________________________
Age or Date of Birth__________________________
Address 
Street Address _______________________________
Apartment No. ________________________________
City _________________________________________
State ________________________________________
Zip Code _____________________________________
Telephone 
Home Phone ___________________________________
Work Phone ___________________________________
Work Extension _______________________________
Fax Number ___________________________________
E-Mail Address _______________________________

DEPENDENTS
TYPE OF DEPENDENT: 1=Child at home; 2=Child not at home; 3=Dependent other than child; 4=HH only, not a dependent; 5=EIC only, not a dependent

EARNED INCOME CREDIT: 1=When applicable; 2=Student age 19 to 23; 3=Disabled age 19 or older; 4=Force; 5=Supress

Dependent 1 
Full Name ____________________________________
Age or Date of Birth _________________________
Social Security No. __________________________
Relationship _________________________________
Months Lived at Home _________________________
Type of Dependent ____________________________
Earned Income Credit _________________________
Claimed By: __ Taxpayer   __ Spouse
Dependent 2 
Full Name ____________________________________
Age or Date of Birth _________________________
Social Security No. __________________________
Relationship _________________________________
Months Lived at Home _________________________
Type of Dependent ____________________________
Earned Income Credit _________________________
Claimed By: __ Taxpayer   __ Spouse
Dependent 3 
Full Name ____________________________________
Age or Date of Birth _________________________
Social Security No. __________________________
Relationship _________________________________
Months Lived at Home _________________________
Type of Dependent ____________________________
Earned Income Credit _________________________
Claimed By: __ Taxpayer   __ Spouse

MISCELLANEOUS QUESTIONS
If any of the following items pertain to you or your spouse for the year 2004, please check the appropriate box and include all pertinent details. Attach additional schedules if necessary.

Yes No PERSONAL INFORMATION:
___ ___ Did your marital status change during the year?
___ ___ Did your address change during the year?
___ ___ Could you be claimed as a dependent on another person's tax return for 2004?
DEPENDENTS:
___ ___ Were there any changes in dependents?
___ ___ Were any of your unmarried children who might be claimed as dependents 19 years of age or older at the end of 2004?
___ ___ Did you have any children under age 14 on January 1, 2004 with interest and dividend income in excess of $700, or total investment income in excess of $1400?
INCOME:
___ ___ Did you receive unreported tip income of $20 or more in any month?
___ ___ Did you cash any Series EE U.S. savings bonds issued after 1989?
___ ___ Did you receive any distribution from a profit-sharing plan, retirement plan, or individual retirement arrangement?
___ ___ Did you receive any disability income?
___ ___ Did you have any foreign income or pay any foreign taxes?
PURCHASES, SALES AND DEBT:
___ ___ Did you start a business or farm, purchase rental or royalty property, or acquire an interest in a partnership, S corporation, trust, or REMIC?
___ ___ Did you purchase or dispose of any business asset (furniture, equipment, vehicles, real estate, etc.), or convert any personal assets to business use?
___ ___ Did you buy or sell any stocks, bonds or other investment property? Specify the sale of any collectibles (e.g. artworks, gems, stamps, coins) and any qualified small business stock.
___ ___ Did you purchase, sell or refinance your principal home or second home, or did you make a home equity loan?
___ ___ Did you have any debts cancelled or forgiven?
___ ___ Did anyone owe you money which had become uncollectible?
ITEMIZED DEDUCTIONS:
___ ___ Did you incur a loss because of damaged or stolen property?
___ ___ Did you work out of town for part of the year?
___ ___ Did you use your car on the job (other than to and from work)?
MISCELLANEOUS:
___ ___ Do you want to allocate $3 to the Presidential Election Campaign Fund?
___ ___ Does your spouse want to allocate $3 to the Presidential Election Campaign Fund?
___ ___ Did you have an interest in or signature or other authority over a financial account in a foreign country, such as a back account, securities account, or other financial account?
___ ___ Did you receive a distribution from, or were you the grantor or, or transferor to, a foreign trust?
___ ___ Was your home rented out or used for business?
___ ___ Did you pay interest on a higher education loan or pay tuition and related expenses for any post-secondary education?
___ ___ Did you have a medical savings accounting (MSA) or acquire an interest in an MSA because of the death of the account holder? Or, were you a policyholder who received payments under a long-term care (LTC) insurance contract or received any accelerated death benefits from a life insurance policy?
___ ___ Did you incur moving expenses due to a change of employment?
___ ___ Did you engage the services of any household employees?
___ ___ Were you notified or audited by either the Internal Revenue Service of the State taxing agency?

WAGES & PENSIONS
Please enter all pertinent 2004 amounts & attach all W-2, W-2G and 1099-R forms.

WAGES, SALARIES, TIPS
Tax Withheld
Name of Employer Wages, Tips, Other Compen-
sation		 Federal Social Security Medicare State Local
             
             
             
             

PENSIONS, IRA DISTRIBUTIONS
Tax Withheld
Name of Payer Gross
Distribution		 Taxable
Amount		 Federal State Local
           
           
           
           

INTEREST INCOME
Interest Income Tax-Exempt Interest
Name of Payer Banks, S&Ls, C/Us, etc. Seller-
Financed Mortg.		 U.S. Bonds, T-Bills Total Munic. Bonds In-State Munic. Bonds Early With-
drawal Penalty
             
             
             

DIVIDEND INCOME
Dividend Income Tax-Exempt Interest
Name of Payer Ordinary Dividends Capital Gain Distributions 28% Rate Gain U.S. Bonds (% or amt.) Total Munic. Bonds In-state Muni-
bonds (% or amt.)
             
             
             

MISCELLANEOUS INCOME
Please enter all pertinent 2004 amounts and attache all 1099-G, 1099-MISC, SSA-1099, and RRB-1099 forms.

Taxpayer Spouse
State tax refund if you itemized last year    
Social Security Benefits (SSA-1099, Box 5)    
Medicare Premiums Paid (SSA-1099)    
Tier 1 RR Retirement Bene. (RRB-1099, Box 5)    
Lump-Sum Election for SS Benefits    
Alimony Received    
Unemployment Compensation Received    
Unemployment Compensation Repaid    
Taxable Scholarships and Fellowships    
Household Employee Income Not on W-2    
Income Subject to S/E Tax:
__________________________________
__________________________________
__________________________________
__________________________________		    
Other Income:
__________________________________
__________________________________
__________________________________
__________________________________		    

TAX WITHHELD
Taxpayer Spouse
Federal Income Tax Withheld    
State Income Tax Withheld    


ITEMIZED DEDUCTIONS
Please enter all pertinent 2004 amounts and attach all 1098 forms.

MEDICAL AND DENTAL EXPENSES
2004 Amount
Prescription Medicines and Drugs  
Doctors, Dentists and Nurses  
Hospitals and Nursing Homes  
Insurance Premiums (excluding long-term care)  
Long-Term Care Premiums  
Insurance Reimbursement (enter as a positive number)  
Trasnportation and Lodging (.10/mile)  
Other Medical and Dental Expenses:
__________________________________
__________________________________
__________________________________
__________________________________		  

TAXES PAID (State & local withholding and 2004 estimates are automatic)
2004 Amount
State & Local Income Taxes - 1/00 payment on 2004 st. estimate  
State & Local Income Taxes - Paid with 2004 state extension  
State & Local Income Taxes - Paid with 1999 state return  
State & Local Income Taxes - Paid for prior yrs. and/or to other state  
Real Estate Taxes - Principal Residence  
Real Estate Taxes - Property Held for Investment  
Personal Property Taxes (including automobile fees)  
Foreign Income Taxes  
Other Taxes:
__________________________________
__________________________________		  

INTEREST PAID
2004 Amount
Home mortgage interest and points reported on Form 1098:
__________________________________
__________________________________
__________________________________		  
Home mortgage interest not reported on Form 1098 (if paid to the home seller, enter the seller's name, SSN or EIN, and address):
__________________________________
__________________________________
__________________________________		  
Points not reported on Form 1098:
__________________________________
__________________________________
__________________________________		  
Investment Interest:
__________________________________
__________________________________
__________________________________		  
Passive Interest  
Certain home mortgage interest included above (6251)  

CONTRIBUTIONS
2004 Amount
Volunteer Expenses and Travel (.14/mile)  
Contributions by Cash or Check:
__________________________________
__________________________________
__________________________________
__________________________________
__________________________________		  
Contributions Other Than Cash or Check (Use Sheet 25 if over $500):
__________________________________
__________________________________
__________________________________
__________________________________
__________________________________		  
Contributions entered above limited to 30% of AGI  
Contributions entered above limited to 20% of AGI  

MISCELLANEOUS DEDUCTIONS
(subject to 2% AGI limit)

2004 Amount
Union and Professional Dues  
Other Unreimbursed Employee Expenses:
__________________________________
__________________________________
__________________________________
__________________________________		  
Investment Expense:
__________________________________
__________________________________
__________________________________		  
Tax Return Preparation Fee  
Union and Professional Dues  
Miscellaneous Deductions (2% AGI):
__________________________________
__________________________________
__________________________________		  

OTHER MISCELLANEOUS DEDUCTIONS
2004 Amount
Gambling Losses to extent of winnings  
Estate tax, Section 691(C)  
Other Miscellaneous Deductions:
__________________________________
__________________________________
__________________________________