2005 Personal Tax Checklist
Instructions This checklist is provided to our clients during tax season to assist them in collecting their tax data. You may simply print this form from your browser. |
|||
| 1. Personal Information | |||
| Name: | _____________________________________________________________________ | ||
| Address 1: | _____________________________________________________________________ | ||
| Address 2: | _____________________________________________________________________ | ||
| City/State: | _________________________ | Zip code: | _________________________ |
| Tel (home): | _________________________ | Tel (bus): | _________________________ |
| Fax (home): | _________________________ | Fax (bus): | _________________________ |
| Email: | _________________________ | Occupation: | _________________________ |
| SSN: | _________________________ | Birth Date: | _________________________ |
| 2. Spouse (including common-law) | |||
| Name | Birth Date | Net Income | SSN |
| ________________________________________________________________________________ | |||
| 3. Dependents | ||||
| Name | Relationship | Birth Date | Net Income | SSN |
| ___________________________________________________________________________________ | ||||
| ___________________________________________________________________________________ | ||||
| ___________________________________________________________________________________ | ||||
| ___________________________________________________________________________________ | ||||
| ___________________________________________________________________________________ | ||||
| 4. Employment Income Information | ||
| Attached | ||
 |
||
| Employment Income | ||
| -Employment Income | ________________ | |
| ________________ | ||
| Pension/retirement income | ||
| - Pension/annuity income | ________________ | |
| - Social Security | ________________ | |
| - Pension Plan benefits | ________________ | |
| Investment income | ||
| - Interest & dividends | ________________ | |
| - Mutual funds and other trusts | ________________ | |
| Other sources | ||
| - Partnership income | ________________ | |
| - Unemployment insurance | ________________ | |
| - Purchase and sale of securities | ________________ | |
| - Tax shelters | ________________ | |
| - Other (specify) | ______________________________ | ________________ |
| 5. Official Receipts | ||
| Attached | ||
| Please provide your official
receipts to support these deductions/credits: |
||
| Charitable donations | _________ | |
| Political donations | _________ | |
| Professional dues | _________ | |
| Tuition fees | _________ | |
| Education deduction | _________ | |
| Disability credit | _________ | |
| 6. Other Income and Deductions | |||
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; | |||
| Office/workspace in the home expenses; | |||
| Other employment-related expenses; | ______ | ______ | ______ |
| Business: self-employment or partnership | |||
| Summary of income and expenses from self-employment, unincorporated business or partnership; | ______ | ______ | ______ |
| 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; | ______ | ______ | ______ |
| Other deductions/tax credits | Attached | Coming | N/A |
| 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; | ______ | ______ | ______ |
| 7. Other Information | |||
| Attached | Coming | N/A | |
| Notices of (re)assessment received during the year. | ______ | ______ | ______ |
| Details regarding installment payments made during the year. | ______ | ______ | ______ |
Tax, accounting and
advisory services for individuals and businesses.
Los Angeles, CA © Mark J. Lowen |