W-2

Gross Income

Federal Withholding

FICA

1

$

$

$

2

$

$

$

3

$

$

$

4

$

$

$

5

$

$

$

W-2

Medical

State Withholding

SDI

1

$

$

$

2

$

$

$

3

$

$

$

4

$

$

$

5

$

$

$

W-2

Gross Income

Federal Withholding

FICA

1

$

$

$

2

$

$

$

3

$

$

$

4

$

$

$

5

$

$

$

W-2

Medical

State Withholding

SDI

1

$

$

$

2

$

$

$

3

$

$

$

4

$

$

$

5

$

$

$

Would you like electronic filing?

Yes!

No

Automatic deposit?

Yes
(attached a VOID check)

No

Name

Date of Birth

Social Security Number

Relationship

Months Lived at Home

Name

Date of Birth

Social Security Number

Relationship

Months Lived at Home

Name

Date of Birth

Social Security Number

Relationship

Months Lived at Home

Name

Date of Birth

Social Security Number

Relationship

Months Lived at Home

Name

Date of Birth

Social Security Number

Relationship

Months Lived at Home

Payor

Amount

1

$

2

$

3

$

4

$

Payor

Total

Capital
Gain

Ordinary
Dividend

1

$

$

$

2

$

$

$

3

$

$

$

4

$

$

$

Amount Received

$

Check if you did not itemize in prior years

Description

Date
Acquired

Date
Sold

Sales
Price

Cost or
Basis

1

$

$

2

$

$

3

$

$

4

$

$

Payor

Gross
Distribution

Taxable
Amount

1

$

$

2

$

$

Check box if Federal or State Tax was withheld

Payor

Amount$

Payor's Social Security #

Taxpayer Amount

$

Spouse Amount

$

Taxpayer Amount

$

Spouse Amount

$

Description:

Insurance Premiums (Net)

Doctors, Dentists, etc.

State & Local Income Tax

Real Estate Taxes - Residence

Real Estate Taxes - Other Property

Auto License:

No. of Cars Fees Paid

Personal Property Taxes

Other Taxes

Home Mortgage Interest Paid (1st)

Home Mortgage Interest Paid (2nd)

Contributions by Cash or Check

Contributions by Other than Cash

Un-reimbursed Employee Business Expenses

Union /Professional Dues

Investment Expense

Tax Return Preparation Fees

Safe Deposit Box Rental

Cash basis

Accrual Basis

First Year

Taxpayer

Spouse

Principal Bus./Profession

Business Name

Business Address

City, State, Zip

Other Accounting Method

Gross Receipts or Sales

$

Returns and Allowances

$

Other Income

$

Inventory at Beginning of the Year

$

Inventory at End of the Year

$

Purchases

$

Cost of Items for Personal Use

$

Cost of Labor

$

Materials and Supplies

$

Other Costs

$

Advertising

Car and Truck Expenses*

Commissions

Employee Benefit Programs

Insurance (other than health)

Health Insurance

Premiums for Self*

Mortgage Interest (paid to banks, etc.)

Other Interest

Legal and Professional

Office Expense

Pension and Profit

Sharing Plans

Rent - Vehicles, Machinery, and Equipment

Rent - Other Business Property Repairs

Supplies

Taxes - Real Estate

Taxes - Other

Travel

Total Meals and Entertainment

Utilities

Wages

Did you dispose of any business assets (including real estate)?

Yes

No

Did you have a home office during the year?

Yes

No

Rent

$

Utilities

$

Insurance

$

Janitorial

$

Misc.

$

% of exclusive business use

Cash basis

Accrual Basis

First Year

Taxpayer

Spouse

Principal Bus./Profession

Business Name

Business Address

City, State, Zip

Other Accounting Method

Gross Receipts or Sales

$

Returns and Allowances

$

Other Income

$

Inventory at Beginning of the Year

$

Inventory at End of the Year

$

Purchases

$

Cost of Items for Personal Use

$

Cost of Labor

$

Materials and Supplies

$

Other Costs

$

Advertising

Car and Truck Expenses*

Commissions

Employee Benefit Programs

Insurance (other than health)

Health Insurance

Premiums for Self*

Mortgage Interest (paid to banks, etc.)

Other Interest

Legal and Professional

Office Expense

Pension and Profit

Sharing Plans

Rent - Vehicles, Machinery, and Equipment

Rent - Other Business Property Repairs

Supplies

Taxes - Real Estate

Taxes - Other

Travel

Total Meals and Entertainment

Utilities

Wages

Property Address

1.

2.

3.

Property

1.

2.

3.

Income:
Rents Received

Expense:
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:

Payee

Amount

$

Payee's Social Security #

IRA Deduction

$

Keogh/SEP Deduction

$

Penalty on Early Withdrawal of Savings

$

Federal

Date Paid

Amount Paid

Overpayment -
Prior Year

1st Quarter

2nd Quarter

3rd Quarter

4th Quarter

State

Date Paid

Amount Paid

Overpayment -
Prior Year

1st Quarter

2nd Quarter

3rd Quarter

4th Quarter