Lena N.

Crowley, CPA Client Tax Organizer

Before your appointment, please fill out the following organizer and provide the following: - Last year's tax return (new clients only) - All statements received (W-2's, 1098's, 1099's, etc) Please be advised that although this tax organizer will accommodate most taxpayers' needs, you may have a special circumstance that is not covered in this questionaire. Please write your concerns on the last page. Personal Information Name Taxpayer Spouse Soc. Sec. No Taxpayer Spouse Martial Status Married Will File Jointly Yes Single Widow(er), Date of Spouse's Death ________________________ Taxpayer Blind Disabled Pres. Campaign Fund Yes Yes Yes No No No Yes Yes Yes Spouse No No No No Date of Birth Occupation Cell/Home Phone Work Phone Email Address

Dependents (Children & Others) Name (First & Last) Relationship Date of Birth Social Security Number Months Lived W/ You Disabled Full Time Student Dependents Gross Income

Please answer the following questions : 1 Are you self employed or receive hobby income? 2 Did you receive rent from real estate or other property? 3 Do you have a foreign bank account, trust, or business? 4 Did you have any debts cancelled forgiven or refinanced? 5 Did you pay student loan interest for yourself, your spouse, or your dependent during the year? 6 Did you install any energy efficient improvements to your home?

Yes Yes Yes Yes

No No No No

Yes Yes

No No

7 Did you pay for higher education for yourself, your spouse, or your dependent during the year? Yes 8 Did you refinance your mortgage this year? Yes If Yes, please provide closing statement. 9 Do you have children under the age of 19 or 23 and a student with unearned income of more then $950? Yes 10 Did you purchase a new alternative technology/electric Yes vehicle?

No No

No No

Lena N. Crowley, CPA Client Tax Organizer

Wage & Salary Income Attach Your W-2's Employer Amount Taxpayer Spouse

Interest Income Attach Your 1099-INT - Note: Always use payer name listed on 1099 even if not original source; the IRS computer matches payer and amount. Payer Amount Taxpayer Spouse

Tax Exempt - Indicate if tax exempt at the federal level or if tax exempt at the federal and state level

Dividend Income Attach Your 1099-DIV - Note: Always use payer name listed on 1099 even if not original source; the IRS computer matches payer and amount. Payer Ordinary Qualified Capital Gains Non-Taxable

S-Corporations, Partnerships, Trusts or Estate Income Attach your K-1's Payer

Property Sold and/or Purchased Attach closing statements and 1099-S Property Date Acquired Cost & Improv.

IRA Contributions Amount Taxpayer Spouse Date Roth- Y/N? Basis To calculate the basis in your Roth IRA, calculate the total amount of post-tax contributions made since inception.

Lena N. Crowley, CPA Client Tax Organizer

IRA/401(k) Distributions Attach 1099-R & 5498 Payer Reason Reinvested? Yes No Yes No Yes No Yes No Pension, Annuity Income Attach 1099-R Payer Reason Reinvested? Yes No Yes No Yes No Yes No

Social Security/Railroad Retirement Attach SSA 1099, RRB 1099 Please check if you have received: Taxpayer Social Security Yes No Railroad Retirement Yes No

Spouse Yes Yes

No No

Investments Sold Attach 1099-B - All transactions must be reported. The IRS computer matches gross proceeds from sales using the 1099B. The IRS only receives the sales price, but not the cost. Investment Date Acquired/Sold Cost Sales Price

Other Income Please list the totals of all other income (including non-taxable) you have received: Alimony Prizes, Awards Child Support Gambling, Lottery Scholarships (Grants) Jury Duty Unemployment Worker's Compensation State Income Tax Refund Disability Income Other - Description Other - Totals If you had gambling winnings, please list your gambling losses Estimated Taxes Paid Amounts applied from prior year return Due Date Date Paid Federal State Other Deductions Alimony Paid Social Security No. Student Interest Paid Health Savings Acct Contr. Coverdell Education Savings Account Contributions

Federal

State

Lena N. Crowley, CPA Client Tax Organizer

Medical & Dental Expenses Only the amount above 7.5% of your Adjust Gross Income is deductible. Medical Ins. Premiums (you paid) Long Term Care Ins. for Taxpayer Long Term Care Ins. For Spouse Medicare Insurance Premiums Lab Fees & X-Rays Doctor, Dentist/Orthodontist Prescriptions Glasses, Contacts Hearing Aids, Batteries Braces Medical Equipment, Supplies Nursing Care Medical Therapy Hospital Number of Medical Miles 1/1-6/30 7/1-12/31 Taxes Paid Property Tax on Primary Home Property Tax on Secondary Home Attach property tax statements if not on 1098 Personal Property Tax (example - car license fees) City, county, local taxes Sales Tax Paid on New Vehicle Balance due on P/Y state return Taxes Paid to Another State Interest Expense Mortgage Interest (attach 1098) Interest paid to an individual for your home (include amortization schedule) Paid to: Name: Address: Social Security Number:

Cash Contributions: Church Salvation Army, Goodwill University, Public, TV/Radio Heart, Lung, Cancer, etc. Wildlife Fund United Way Other Other Other Employment Related Expenses Paid Dues - Union/Professional Uniforms (include cleaning) Uniform accessories (boots/gloves) Small Tools Equipment/ Safety Equipment Books, Subscriptions, Supplies Licenses, Fees, Credentials, etc. Sales Expense Gifts/Promotional Items Job related educational expense Entertainment Telephone Usage (Business Calls) Office in Home: (In Square Feet) Total Home Office Rent Insurance Utilities Maintenance

Charitable Contributions Non-Cash Contributions Item Donated

Date

Amount

Number of Volunteer Miles: Job-Related Moving Expenses Mileage from old residence to new job must be 50+ miles from old residence to old job. Date of Move Cost to Move Household Goods Cost of Lodging During Move Miles to Travel to New Home: 1/1-6/30 7/1-12/31 Casualty/Theft Losses For property damaged by storm fire, accident, or stolen Location Description Insurance Reimbursements Repair Costs Federal Grants Received Was this a federally declared disaster loss? Y/N?

Lena N. Crowley, CPA Client Tax Organizer

Business Mileage & Auto Expenses Do not use this section if you use your vehicle just for commuting to and from work or pleasure. Year, make and model of vehicle Date you originally purchased the vehicle Business miles (not to and from work) 1/1-6/30 7/1-12/31 From First to Second Job 1/1-6/30 7/1-12/31 Job Seeking Other Business Gas, Oil, Lubrication Car Maintenance (batteries, tires, etc.) Repairs Insurance Garage Rent Do you have supporting documentation? Yes No Away-From-Home-Business Expenses Airfare, Train, etc. Lodging Meals Tax, Car Rental Other Reimbursements Received Investment Related Expenses Tax Preparation Fee Safe Deposit Box Rental Mutual Fund Fee Investment Counselor Other

Child & Other Dependent Care Expenses Care must enable you to work, attend school full-time or look for a job. Must be for a child under 13 or an individual incapable of self care. Name of Care Provider Address Soc. Sec. No or Tax ID

Amount Paid

Education Expenses Please attach 1098-T Student's Name Name of College Amount Paid Year in College

For New York State Residents County Town Taxpayer Full Time Resident of NYC Part Time Resident of NYC Full Time Resident of Yonkers Part Time Resident of Yonkers Maintain Living Quarters in NYC Yes Yes Yes Yes Yes No No No No No School District Spouse Yes Yes Yes Yes Yes No No No No No

Lena N. Crowley, CPA Client Tax Organizer

Direct Deposit/Refund Would you like to have your refund directly deposited into your account? Owner of Account Type of Account Name of Financial Institution Routing Number Account Number Checking Savings Yes No

Would you like to apply your refund (partial or full) to next year's taxes? Questions, Comments & Other Information

Yes

No

To the best of my knowledge the information enclosed in this organizer is correct and for which I have adequate records.

Taxpayer

Date

Spouse

Date