TAX YEAR 2016
CLIENT TAX ORGANIZER
INSTRUCTIONS
Dear Tax Client: Do not send your tax information until you have completed this organizer and have all of your tax info. to send. We will not accept or store partial information.
Thank you for allowing us to prepare your tax returns for tax year 2016. Please read and follow these instructions carefully. Failure to do this will delay the completion of your tax return and result in an inaccurate result. If you are sending your child’s tax info., they must complete & sign their own organizer. WARNING: No signed organizer, No tax preparation!!!
1. Fill in only the areas that apply to you.
2. Fill in all personal information even if you are a previous client.
3. Include all tax documents that you received for the tax year (W2s, 1099 Misc., 1099 Int., 1099 Div., etc.)
4. For PA Clients Only - Include your local tax return forms that you receive in the mail. We have all federal and state forms in our office.
5. If you moved during the year we need your moving date as well as your old and new addresses.
6. Do not send all your receipts for expenses. Send us a list of your expenses and group them in categories. We need to know that you have receipts for your expenses and may ask to verify them; but we do not keep them on file in our offices.
7. If you have a ministerial housing allowance did you spend it all? If not, how much did you have left over above your housing costs?
8. For auto expenses be sure to include a description of the auto, business miles, commuting miles, personal miles, and purchase date of each vehicle for which you are claiming mileage. Please separate your mileage for each vehicle. Do not send us just one mileage figure for all vehicles!
9. If you have honoraria or other self employed income, list it separately. List your expenses incurred due to this self employment income separately from other employee expenses.
10. List your federal, state, and local estimated tax payments that you made for the tax year along with the dates that you made the payments.
11. Please sign the organizer (both husband & wife) at the signature lines to certify that the information that you are providing us is accurate and that you have receipts or other documentary evidence to support your income and expense information.
12. You must complete the Healthcare Worksheet page as completely as possible or your taxes
will be delayed. We will not prepare your taxes without the info. required on that page.
CERRAN ENTERPRISES Tax Year 2016 CLIENT TAX ORGANIZER
Please complete this Questionnaire before your appointment and bring the following:
· All statements Last year’s tax return (new clients only)
· All statements (W-2s, 1099s, etc.)
1. Personal InformationName (First, Initial, Last) / Soc. Sec. No. / Date of Birth / Occupation / Work Phone
Taxpayer
Spouse
Street Address / City / State / Zip / Home Phone
County / Boro or Township / School District
Taxpayer E-mail Address
Spouse E-mail Address
Taxpayer Spouse Marital Status
Blind ___ Yes ___ No ___ Yes ___ No ___ Married Will file jointly ___ Yes ___ No
Disabled ___ Yes ___ No ___ Yes ___ No ___ Single Date of divorce ______
Pres. Campaign Fund ___ Yes ___ No ___ Yes ___ No ___ Widow(er) Date of Spouse’s Death ______
2. Dependents (Children & Others)Name
( First, Initial, Last) / Relationship / Date of
Birth / Social Security
Number / Months Lived
with You / Disabled / Full Time
Student / Dependent’s Gross Income
1. Did you receive rent from real estate or other property? ______
2. Did you refinance your main home or other property? ______
3. Did you receive any correspondence from the IRS or State Department of Taxation? ______
4. Did you pay interest on a student loan for yourself, your spouse, or your dependent during the year? ______
5. Did you pay expenses for yourself, your spouse, or your dependent to attend classes beyond high school? ______
6. Beginning Jan. 1, 2011 we must efile all tax returns unless you opt out. Do you wish to opt out of efiling? ___ Yes ___ No
If yes, you must complete and ATTACH OPT OUT form.
7. Would you like your refund directly deposited into your bank? ______
Account Type: / Checking ______Savings ______Your Account Number: / Bank Routing Number:
3. Wage, Salary Income
ATTACH W-2s:
Employer Taxpayer Spouse
______
______
______
______
______
______
4. Interest IncomeATTACH 1099-INT & broker statements
Payer’s Name Taxpayer Spouse
______
______
______
______
Tax Exempt
______
______
______
5. Dividend IncomeFrom Mutual Funds & Stocks – ATTACH 1099-DIV
Payer’s Name Taxpayer Spouse
______
______
______
______
7. Partnership, Trust, Estate IncomeList payers of partnership, limited partnership, S-corporation, trust, or estate income – ATTACH K-1
______
______
______
______
8. Property SoldATTACH 1099-S and closing statements
Property / Date Acquired / Cost & Imp.Personal Residence*
Vacation Home
*Provide information on improvements, prior to sales of home, and cost of a new residence
9. I.R.A. (Individual Retirement Acct.)Contributions for tax year income – not listed on W2
Amount X for Date X for Roth IRA
Taxpayer
Spouse
Amounts withdrawn – ATTACH 1099-R & 5498
Plan Trustee Reason for Withdrawal Reinvested?
___ Yes ___ No
___ Yes ___ No
___ Yes ___ No
___ Yes ___ No
10. Pension, Annuity IncomeDid you receive pension funds? ____ Yes ____ No
Did you receive: Taxpayer Spouse
Social Security benefits __ Yes __ No __ Yes __ No
Rail Road Retirement __ Yes __ No __ Yes __ No
ATTACH 1099-R, SSA 1099, RRB 1099
6. Investment SoldStocks, Bonds, Mutual Funds, Gold, Silver, Partnership interest – ATTACH 1099-B & confirmation slips
Investment / Date Acquired/Sold / Cost / Sale Price.
11. Other IncomeList All Other Income (including non-Taxable)
Alimony Received ______
Child Support ______
Scholarship (Grants) ______
Unemployment Compensation (repaid) ______
Prizes, Bonuses, Awards ______
Gambling, Lottery (expenses ______) ______
Unreported Tips and Gratuities ______
Director / Executor’s Fee ______
Commissions ______
Jury Duty Pay ______
Worker’s Compensation ______
Disability Income ______
Veteran’s Pension ______
Payments from Prior Installment Sale ______
State Income Tax Refund ______
Clergy Honoraria ______
Other ______
12. Medical/Dental ExpensesLong-term Care Premium ______
Medical Insurance Premiums (paid by you) ______
Prescription Medications ______
Insulin ______
Eyeglasses, Contact Lenses ______
Hearing Aids, Batteries ______
Braces ______
Medical Equipment, Supplies ______
Nursing Care Services ______
Medical Therapy ______
Hospital and Nursing Homes ______
Doctor, Dentist, and other
Healthcare Professionals ______
Lodging ______
Mileages (no. of miles) ______
13. Taxes PaidReal Property Tax (attach bills) ______
Personal Property Tax ______
Other Taxes ______
14. Charitable ContributionsChurch ______
Other Charities (List name and give amounts)
______
______
______
Non –Cash ______
Volunteer (no. of miles) ______
*Provide detail if over $5000.00 is paid to any one organization.
15. Interest ExpenseMortgage interest paid (ATTACH 1098) ______
Interest paid to individual for your
home (include amortization schedule) ______
Paid to:
Name ______
Address ______
Social Security No . ______
Investment Interest ______
16. Moving InformationDid you move during 2016?
Yes_____ No_____ Move Date ______
If yes, previous address ______
______
Previous County & School District ______
______
Current address ______
______
Current County & School District ______
______
17. Job-Related Moving ExpensesDate of move ______
Move Household Goods ______
Travel to New Home (no. of miles) ______
Lodging During Move ______
18. Employment-Related Expenses That You Paid (Not self-employed)(List and identify Taxpayer & Spouse expenses separately)
Dues – Union, Professional ______
Books, Subscriptions, Supplies ______
Licenses ______
Tools, Equipment, Safety Equipment ______
Uniforms (including cleaning) ______
Sales Expense, Gifts ______
Tuition, Books (work related) ______
Entertainment ______
Office in home:
In a) Total Home ______
Square b) Office ______
Feet c) Storage ______
Rent ______
Insurance ______
Utilities ______
Maintenance ______
19. Child & Other Dependent CareName of Care Provider / Address / Soc Sec No. or
Employer ID / Amount
Paid
Also complete this section if you receive dependent care benefits from your employer.
20. Business Mileage / Actual Cost MethodDo you have written records? ___ Yes ___ No
Did you sell or trade in a car used
for Business? ___ Yes ___ No
Make/Model Year Vehicle ______
Date Purchased ______
Total Miles (personal & business) ______
Business Miles (not to and from work) ______
From First to Second Job ______
Education (one way, work to school) ______
Job Seeking ______
Other Business ______
Round Trip commuting distance ______
Gas, Oil, Lubrication ______
Batteries, Tires, etc. ______
Repairs ______
Wash ______
Insurance ______
Interest ______
Lease Payments ______
Garage Rent ______
21. Investment-Related ExpensesTax Preparation Fee ______
Safe Deposit Box Rental ______
Mutual Fund Fee ______
Investment Counselor ______
Other ______
22. Business TravelIf you are not reimbursed for exact amount, give total
expenses.
Airfare, Train, etc. ______
Lodging ______
Meals (no. of days ______) ______
Taxi, Car Rental ______
Other ______
Reimbursement Received ______
23. Auto Mileage Record / Standard Deduction MethodVEHICLE 1
Description: / VEHICLE 2
Description:
Date placed in service: / Date placed in service:
Total mileage
Business mileage
Commuting mileage
Personal mileage
24. Estimated Tax Payments /not W2 amounts
Date Paid / Federal / State / Local
25. Other Deductions
Alimony Paid to ______
Social Security No. ______$______
Student Loan Interest Paid $______
26. Education ExpensesStudent’s Name Type of Expense Amount
______
______
______
SPECIAL NOTE:
27. For Ministers Only1. Designated Housing Allowance $______
Amount of Housing Allowance Actually
Spent $______
2. If you lived in a Parsonage - Fair Rental Value (FRV)
of the Church Parsonage $______
3. Unreimbursed Professional Expenses (DO NOT SEND
RECEIPTS / just give category totals)
Professional Dues ______
Travel ______
Books ______
Subscriptions ______
Gifts ($25/personal/year limit) ______
Supplies ______
Religious Materials ______
Entertainment ______
Education ______
Other ______
* * * * * * * * * * * * * * * * * * * * * * * * * * *
HEATHCARE INSURANCE COVERAGE
Enter the name, SSN/DOB and health insurance status for each person claimed on your return in the table below regarding the new health insurance reporting requirements beginning in 2014.
(If not all 12 months, indicate which months eachName of covered SSN/DOB Covered All Exchange Exemption person was covered by MEC*)
individual(s) 12 months Policy Received Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec
Use this worksheet to list the names of individuals listed on the income tax return and their health care insurance coverage status. It will help your tax preparer determine who has health insurance coverage, who may have an exemption, and who may be subject to the individual shared responsibility payment.
Beginning in 2014, most individuals are required to have:
n Minimum Essential Coverage (MEC*), or
n An Exemption from the responsibility to have minimum essential coverage, or
n Make a Shared Reponsibility Payment.
Minumum Essential Coverage includes employer-sponsored coverage, health insurance purchased through the Health Insurance marketplace (Exchange), Medicare, medicaid, certain VA coverage, Tricare, etc.
If you purchased a health insurance policy from an exchange (or marketplace, check the Exchange Policy box above. You will receive Form 1095-A from the exchange that issued your policy. Please provide us with this form.
Also if you received a 1095 B or C form, please include it with this organizer.
We cannot begin to process your taxes without this necessary Healthcare information.
* * * * * * * * * * * * * * * * * * * * * * * * * * *
To the best of my knowledge the enclosed information is correct and includes all income, deductions, and other information necessary for the preparation of this year’s income tax returns for which I have adequate records.
Signature______Date ______
Signature______Date ______
Please Note: Your tax return will not be processed without the appropriate signatures
On the lines above. Both persons whose names appear on a joint tax return must sign
On the appropriate line above.
E-FILING IS NOW MANDATORY FOR FIRMS PREPARING 10 OR MORE TAX RETURNS!!! If you wish to opt out of efiling, you must complete an opt out form and send it with your completed organizer.
This form is available on our web site.
ADDITIONAL NOTES AND INFO
Please mail to:
Cerran Enterprises
65 Willow Mill Park Rd
Mechanicsburg, PA 17050
Please include your current email address
on page 1