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Instructions
This checklist is provided to our clients during tax season to
assist them in collecting their tax data. Click
here for printable version.
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| 1. Personal Information
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| Name: |
___________________________________________ |
| Address: |
___________________________________________ |
| City/State: |
______________ |
Zip code: |
______________ |
| Tel (home): |
______________ |
Tel (bus): |
______________ |
| Fax (home): |
______________ |
Fax (bus): |
______________ |
| Email: |
______________ |
Occupation: |
______________ |
| SSN: |
______________ |
Birth Date: |
______________ |
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| 2. Spouse (including
common-law) |
| Name |
Birth Date |
Net Income |
SSN |
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| 3. Dependents
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| Name |
Relationship |
Birth Date |
Net Income |
SSN |
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| _______________________________________________________ |
| _______________________________________________________ |
| _______________________________________________________ |
| _______________________________________________________ |
| _______________________________________________________ |
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| 4. Employment
Income Information |
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Attached |
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| Employment Income |
| -Employment Income |
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______ |
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______ |
| Pension/retirement income |
| - Pension/annuity income |
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______ |
| - Social Security |
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______ |
| - Pension Plan benefits |
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______ |
| Investment income |
| - Interest & dividends |
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______ |
| - Mutual funds and other trusts |
|
______ |
| Other sources |
| - Partnership income |
|
______ |
| - Unemployment insurance |
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______ |
| - Purchase and sale of securities |
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______ |
| - Tax shelters |
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______ |
| - Other (specify) |
___________________ |
______ |
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| 5. Official Receipts
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Attached |
| Please provide your
official receipts to support these deductions/credits: |
| Charitable donations |
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_________ |
| Political donations |
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_________ |
| Professional dues |
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_________ |
| Tuition fees |
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_________ |
| Education deduction |
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_________ |
| Disability credit |
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_________ |
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| 6. Other Income and
Deductions |
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Attached |
Coming |
N/A |
| Employment |
| Details regarding cash and non-cash benefits of employment. |
______ |
______ |
______ |
Details regarding employer stock options
granted or exercised in the year; |
______ |
______ |
______ |
| Automobile expenses; |
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| Office/workspace in the home expenses; |
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| Other employment-related expenses; |
______ |
______ |
______ |
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| Business: self-employment or partnership |
| Summary of income and expenses from self-employment,
unincorporated business or partnership; |
______ |
______ |
______ |
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| Investments |
| Listing of income and expenses from rental properties,
on a property by property basis (indicate ownership split); |
______ |
______ |
______ |
Particulars relating to tax shelter investments
(including limited partnerships); |
______ |
______ |
______ |
| List of investments owned at the end of 2005 on which interest is required to be reported on an accrual basis. |
______ |
______ |
______ |
| Carrying charges and interest paid to earn income
from investments, safety deposit box fees, accounting fees, investment
counsel fees; |
______ |
______ |
______ |
| Details on the sale of investment assets (e.g. stocks,
bonds, mutual funds, land & buildings) -- provide the original
cost, proceeds, and selling/commission expenses; |
______ |
______ |
______ |
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| Other deductions/tax credits |
Attached |
Coming |
N/A |
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| The amount of alimony or child support paid or received
in the year and the name and address of the payee, if applicable; |
______ |
______ |
______ |
| Details regarding eligible moving expenses; |
______ |
______ |
______ |
| Details regarding child care expenses for any child
who was under 16 at any time in 2005 (include the SSN of any individual
providing care; and include receipts or cancelled checks for all
lessons and extracurricular programs); |
______ |
______ |
______ |
| The amount of non-reimbursed medical expenses (including
premiums for private health insurance) paid during the year for
yourself and your dependents; |
______ |
______ |
______ |
| Property taxes or rent paid in the year; |
______ |
______ |
______ |
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| 7. Other Information |
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Attached |
Coming |
N/A |
| Notices of (re)assessment received during the year. |
______ |
______ |
______ |
| Details regarding installment payments made
during the year. |
______ |
______ |
______ |
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| Tax,
accounting and advisory services for individuals and businesses.
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