Name: _________________________       SS#__________________________  Tax Year 200___

If Joint Return:  Spouse's Name: ________________________________Spouse's SS#___________________________  

INCOME
Send me all statements from work, banks, mutual funds, etc.

 RENTAL INCOME
ITEM: AMOUNT:
ISSUED BY: AMOUNT: TOTAL RENT REC’D:  

Total Interest received:

 

Mortgage Interest Pd:

 

Total Dividends received:

 

Real Estate Taxes Pd:

 

Capital Gains Distributions:

 

Fire Insurance:

 

Unemployment Received:

 

Management Fees:

 

Taxable pensions received:

 

Advertising for Tenant:

 

Winnings from Gambling/Lottery:

 

Legal Fees/Commissions:

 

Other Taxable Income received:

 

Repairs:

 

Social Security received:

 

Improvements:

 

TOTAL

 

TOTAL    
ADJUSTMENTS AMOUNT CREDITS AMOUNT

IRA Contribution (not Roth IRA):

 

Day Care/after school care Paid:

 

Student Loan Interest pd:

 

Enter SS or EIN of Provider:

 

Early w/d penalty on interest:

 

   

Alimony pd (SS#_______________)

 

Education: tuition pd:

 

Moving Expenses: Pack & Shipping:

 

for >½ time student in yr 1or 2:

 

Moving Expenses: Travel for family:

 

Other tuition pd (not job req’d):

 

Self-Employed Health Insurance:

 

# of dependents under age 17:

 

Simple/ SEP Pension Contribution:

 

Cost of driver ed class for child:

 

Keogh Contribution:

 

   
TOTAL

 

TOTAL    
ITEMIZED DEDUCTIONS AMOUNT MISC DEDUCTIONS AMOUNT

Real Estate taxes on Home:

 

Union/Professional Dues:

 

Personal Property Taxes pd:

 

Uniforms & uniform cleaning:

 

Interest on mortgage on Home:

 

Safety Equipment for work:

 

Interest on second mortgage:

 

Tools/Vocational supplies:

 

Contributions by Cash or Check:

 

Continuing Ed (Req'd by job):

 

Non-Cash items to Goodwill, etc

 

Safe Deposit Box:

 

Volunteer miles for scouts, etc

 

Tax Prep Fee/software/info:

 

Medical: Drs, dentist, hospital:

 

Mutual Fund maintenance fees:

 

Glasses, prescriptions, hearing aid batteries, med equip needed, etc

 

Total from Employee Business Expense Form:

 

TOTAL

 

TOTAL