/ / / / /

Melissa A Schiff, CPA, PC

/ 2597 Old State Road 37 South / ph 765-349-8272
www.MelissaSchiffCPA.com / Martinsville, IN 46151 / fax 765-342-1666

READ ** SIGN ** RETURN

2015 Tax Document Checklist

I have reviewed and marked this checklist for items related to my tax return

______

Signature Date Best Phone number Best Text number

______Preferred contact (circle): Phone Text Email

Email ( We cannot receive text)

Please mark all that apply, make notes as needed and return with tax information

Who might be on the return

q  Married, divorced or separated(living apart) on December 31, 2015 (if living apart, date moved apart)

q  Children: Any changes in children you can claim; births, move outs, custody arrangements

q  Any changes in who you supported, children or adults (parents don’t have to have lived in your home)

q  Any name changes filed with Social Security

Employment & Income Data – please advise if you had income but did not receive the document

q  W-2 forms for this year

q  1095 Proof of Insurance (we will need some form of proof of coverage)

q  1099-G; Unemployment compensation, and/or state and local tax refunds

q  1099-MISC Miscellaneous income - will need to know how earned to best shelter from tax

q  1099-R Pensions, annuities and retirement account distributions - was any directly donated to charity

q  SSA-1099 Social Security benefits

q  W2-G Gambling/lottery winnings - need winnings separate from losses

q  Schedule K-1, basis changes, activity level: S-Corp, LLC, Estate/Trust

q  1099-INT Interest income statements

q  1099-DIV Dividend income statements

q  1099-B Proceeds from broker transactions: Basis and Purchase Date for each asset sold

q  Worthless stock information: Stock, shares, purchase date and costs, date became worthless, reason

q  Sale of home, land, and other property including but not limited to: trees, coins and collectables

q  Other income including prizes

Homeowner/Renter Data

q  Address(es) where you lived this year – note current mailing address, and consider 911 changes

q  County of residence at January 1, 2015

q  Mortgage interest: Form 1098, Seller financed: name and social security number of individual

q  Real estate taxes paid, even if not itemizing

q  Did you refinance or do a mortgage adjustment – need closing statements and use of funds

q  Did you sell, leave a home that you received a Home Buyer Credit

q  Amount of rent paid during tax year, name and address of landlord, addresses where you rented if more than current address

Financial Liabilities

q  Student loan interest paid

q  Early withdrawal penalties on CDs and other time deposits

Automobiles

q  Personal Property Tax information (license plates - excise tax only)

q  Sales tax on major purchase such as boat, car, motor home – need sales invoice

Miscellaneous Tax Documents

q  Federal, state, and local estimated income tax paid for current year – payment detail by date

q  IRA, Roth IRA, Keogh, and other retirement plan contributions

q  HSA Contribution and Distribution, eligible medical expense total

Rental Income Data – Must have data separated by property

q  Number of hours spent during the year, may combine all properties

q  Rental income totals: separate by property and rent vs. insurance proceeds

q  Days rented: total days each property was rented and available to rent

q  Rental-related expenses totaled by type plus detail on asset & major repairs: descriptions & purchase dates

q  Mileage log, auto interest on vehicle with Rental use

q  Home office: Sq footage of home office and total home, utilities, repairs, cost of home

q  Tenant info: is tenant a related company, business affiliate, family member

Self-employment Data - see additional guidance provided on our handouts

q  Number of hours spent during the year

q  Business income totals: Forms 1099-MISC and/or your own records

q  Business-related expenses totaled by type plus detail on asset descriptions & purchase dates

q  Mileage log, auto interest on vehicle with business use

q  Inventory at cost as of 12/31

q  Home office: Sq footage of home office and total home, utilities, repairs, cost of home - simplified calculation is available

q  Retail storage space in home: Sq footage of storage space – does not have to be exclusive use room

q  Partnership SE income: Schedules K-1, basis changes, activity level

Expenses - see additional guidance provided on our handouts

q  Gifts to charity – ALL deductions of any amount must have a receipt. Any individual contribution over $250 must also have an acknowledgement letter from the charity, and the letter must be received by the date we file your return.

q  Miles driven for Charitable Activity: such as to purchase and donate to food banks and giving trees

q  Unreimbursed expenses related to your job (travel expenses, uniforms, union dues, subscriptions, protective clothing, and tools)

q  Education expenses – Job related, seminar, certification, and college (split: tuition, r&b, materials, fees)

q  Investment expenses, safety-deposit box expense

q  Childcare expenses: Name, Address, and Tax ID or Social Security Number of provider, Amount Paid

q  Unreimbursed medical expenses, including total miles driven exclusively for medical care

q  Casualty or theft losses not completely reimbursed by insurance

Miscellaneous Information

q  Banking information for any account you wish to have your refund direct deposited to - you are allowed to split your federal refund

q  Full legal name, date of birth, and Social Security Number for any person not previously on your tax return, new last name if changed at Social Security Office

q  Debt/Loan forgiveness, including bankruptcy

q  Converted IRA or 401K to Roth IRA

q  Purchase of electric or hybrid car, date, cost, year, make, model, and dealer stub

q  Energy improvements: window, heating, insulation, doors, water heater – need receipt

q  Real estate tax refund

q  Use tax liability - Ebay, magazines, out of state purchase

q  Health insurance premiums paid by you

q  Moving expenses (if you relocated due to a change in your employment)

q  Foreign Accounts - If you have an account, retirement account, or business interest with a value over $10,000 in a foreign country, or a foreign business ownership (not through a mutual fund), please let us know as some special rules will apply to you.

Education

q  College-related expenses, split by type, and student status and college location and source of funds for payment

q  529 contribution information, must have account number

q  Scholarships in excess of eligible expenses

q  Private/Home school - # of dependants in home or private school and name of private school

q  Any room & board paid via scholarship

Other Notes:

Any accounting, business or tax advice contained in this communication, including attachments and enclosures, is not intended as a thorough, in-depth analysis of specific issues, nor a substitute for a formal opinion, nor is it sufficient to avoid tax-related penalties. If desired, we would be pleased to perform the requisite research and provide you with a detailed written analysis under a separate engagement.