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Tax Prep Worksheet For Tax Year

(Note: Values entered will *not* be saved if you save this to disk, but will appear if you print this page after entering them.
This form prints best with landscape orientation. Or click here for an Adobe Acrobat (PDF) version.)

Please tell us about yourself, The Taxpayer

Taxpayer's Full Name: Home Phone:
Taxpayer's Email Address: Work Phone:
Taxpayer's Birthdate: Cell Phone:
Taxpayer's Occupation: Pager:
Spouse's Full Name:
Spouse's Occupation:
Spouse's Birthdate:

Check Here if there are any changes in your dependents and/or filing status, then fill in the details below. Otherwise leave blank.


[Special Credits]

 Energy Credits (Exterior Windows, Doors, Skylights, Insulation, New Roof, Furnace, Central Air and more - bring all receipts)


Please bring these with you (or send to us):

NEW CLIENTS ONLY: A copy of your last year's Tax Return.
ALL W-2 forms, including W-2P (pension), W-2G (gambling winnings) and/or 1099-R forms
ALL Social Security income and railroad retirement forms (SSA-1099, RRB-1099, RRB-1099R)
ALL Unemployment Income and State Tax Refund forms (1099-G)
ALL Interest Income forms (1099-INT)
ALL Dividend Income forms (1099-DIV)
Information on Foreign Bank Account(s), if any.
ALL Other Miscellaneous Income (1099-MISC, etc)
ALL Sales of Stocks & Bonds (Click here to open the Capital Gains and Losses Worksheet)
When Sold and how MUCH you received MANDATORY!
ALL Other Income and ALL expenses incurred with that activity:
¤ Click here to open the Sole Proprietorship Worksheet
¤ Click here to open the Rental Income Worksheet
ALL ROLLOVER Information 401(k), Pension, IRA
ALL 529 Plan Distributions 1099-Q
ALL Alimony Received $ .00
Estimated Income Tax Payments (if any)
  April June September January
Federal $ $ $ $
State $ $ $ $


EXEMPTIONS: Do not include your spouse. -- If you do not have the Social Security Number, you won't be able to claim the dependent!
Returning clients: Bill has this information, you only need to provide changes, if any.

[First, Initial, Last]
Birth Date Social Security Number Relationship
to Taxpayer

School Teachers (K-12) School supplies (up to $250)
$ .00
ALL I.R.A. / Keogh or SEP Contributions (if any)
(H) $ .00 (W) $ .00
Medical or Health Savings Account Contributions
$ .00
Education Credits (modified Hope and Lifetime Learning - 1098-T required)
Tuition and Fees $ .00   Books $ .00   Is Student in years 1 through 4 of College and a full time student?   YN
Name of College: Federal ID:
Student Loan Interest Paid
$ .00
Alimony Paid
$ .00   Recipient's Social Security Number   

RX, prescribed drugs and medicines $
Health Insurance (premiums you paid, Medicare) - includes money withheld from your salary $
Long Term Care Premiums $
Doctor(s) and/or Dentist(s) $
Eyeglasses (contact lenses and/or solution) $
Hospitals, Lab Fees, X-Rays, ANY Medical Cost $
Hearing Aids (batteries, etc.) $
Sick-Room Equipment and/or Supplies $
Canine, TTY/TDD Care, Deaf / Blind Taxpayers $
GRAND TOTAL (actual money paid by you)
Number of Miles Driven for Medical Reasons Miles

Real Estate Property Taxes (home) $
Real Estate Property Taxes (other property) $
Personal Property Taxes (Virginia Taxpayers) $

[Interest You Paid Out]
Home Mortgage (1st & 2nd Trust) $
Other Mortgage (vacation home, etc.) $
Mortgage Insurance Premium (PMI) $
Investment Interest (Margin, Land) $

CASH: (Money / Checks You Gave Away)
Church, Other Religious Organizations, UGF, One-Fund, heart Fund, Boy Scouts, Girls Scouts, Boys' and Girls' Clubs, Easter / Christmas Seals, misc. contributions

GRAND TOTAL (dollar amount actually contributed)

Goodwill, Purple Heart, AmVets, Salvation Army, National Children's Center, etc., any items that you have given away. You only need to bring a list of items whose "Fair Market Value" exceeds $500.00, just provide a total "Fair Market Value" for the rest.
(Click here to open the Valuation Guide for Items Donated)
¤ Include any volunteer mileage driven (School, Church, Boys' & Girls' Club, etc.):   Miles
GRAND TOTAL ("Fair Market Value" of items not counting mileage)

Gambling Losses (Up to the amount reported as income) $

[Child Care]
Provide the amount you paid to have someone watch / care for your child / children, while you were earning a salary. Name, Address, and Social Security Number or Federal Tax ID of the daycare provider are required. Without either number you will not be able to claim the credit! $
Social Security or Federal Taxpayer ID:
Caregiver Name and Address:

    Notes For When We Meet
  • Bring figures only, we do not need receipts, though you DO need to save them.
  • If you sold or refinanced your home and/or bought a new home, bring all settlement papers. There are Points, Taxes, and Interest on these papers that are TAX DEDUCTABLE.
  • A good thing to bring along is last year's check register just in case we ask a question about
    a deduction or tax deductible payment you made last year.
  • If you have any doubt about any other documents or figures, it can't hurt to bring them, and might save us time in the long run.
  • In case Bill needs to reach you, you may want to provide a daytime and/or evening phone number:
    Daytime:  (optional)
    Evening:  (optional)
  • Please Remember: If you have any questions at all, Bill is as close as your phone: (301) 345-0101 or (301) 345-0008(fax) or computer

Fill out this form and print it from your web browser, then bring it along when you come to see Bill.

Please Note: This form does NOT send or save this information in any way electronically, it is just provided as a convenient form you may fill out and print from your computer. All information you enter will be lost when you close down your web browser.

Informal Poll: Check here if you would be interested if we were to provide a free secure way this information could be sent to Bill over the internet in advance of your appointment.

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