FOR TAX YEAR 2020 New Add On Printed/Ack

FOR TAX YEAR 2020

Name:

SS#:

DOB Occupation

Email: Phone:

In order of preference, how should we contact you? (1stt, 2nd, 3rd) Email_______ Phone______ Text______

Spouse Information – Required, even if filing separate

Name: FIRST: MIDDLE: LAST:

SS#:

DOB Occupation

Email: Phone:

WHOSE NAME WAS FIRST ON LAST YEAR’S TAX RETURN?

Filing Status: Single (not married, no dependents) Head of Household (have dependents) Widow(er) as of _____________ (mm/yy)

Filing Joint return with spouse (If married Dec 31, married entire year) 😊 Filing separately from my spouse

Common Law My marital status changed this year _________________________________________

IN ORDER TO ALLOW FOR APPROPRIATE APPOINTMENT TIMES AND PREPARER SCHEDULING, PLEASE CHECK YES OR NO:

Yes No

Are you a new client? (if you did not file with us last year, you are considered a new client.)

Are you a professional athlete?

Does your main income come from your own business/self-employment/1099?

Do you work internationally (including religious workers)? OR have income from outside of the US?

Are you a Healthcare Traveler? (nurse/PT/OT/etc.) OR perform any kind of temporary contract work away from home?

Are you enclosing any correspondence from the IRS or State Agency with your return? (something other than PIN information for filing)

Do you own rental property? ___ First year? Help! I need teaching! ___ 2+ years. Y’all have been doing my stuff for years, we’re on cruise control!

Do you have a need to discuss a plan of action with your tax preparer over significant capital gains (or losses) this year (or next year)?

Did you participate in the payroll tax deferral that was offered the last part of 2020?

Do you live/reside outside of the US? Country? _______________________________

Are you (or spouse) a beneficiary/trustee of an estate or trust?

Do you (or spouse) own more than $25,000 in non-US mutual fund shares?

Do you (or spouse) hold more than a collective total of $10,000 outside of the US?

Do you (or spouse) own or have a partial ownership of a company, partnership, or corporation?

Do you (or spouse) have any US or foreign virtual currency accounts (including Bitcoin or cryptocurrency)?

Do you (or spouse) have signatory authority, or are a beneficiary, or hold any interest in any Foreign Account? Serious penalties apply for non-disclosure.

Do you want to complete your tax return via email instead of over the phone? (MOST but not all RETURNING clients qualify for the email return option.)

Permanent Mailing Address

School District at permanent address (if applicable):

County:

Did you move your permanent address during the tax year?

Date: ________________________ Provide old address:

I confirm that the information given on this page is true, complete, and accurate. (enter initials)

TravelTax – 46 St. Mark Rd., Taylors, SC 29687 - Fax 877.872.8829 - Office 402.379.7818 Copyright © 2021 TravelTax. Use of this by anyone other than TravelTax and its clients is prohibited.

DO NOT FILL THIS OUT ON THE BROWSER OR IN APPLE PREVIEW MODE (IF USING A MAC) OR IT WILL PRINT OUT BLANK! Download and save it on your computer, THEN open it from your computer and let those fingers fly!

FIRST: MIDDLE: LAST:

TravelTax Use Only:

New Add On

Printed/Ack___________________

_

Required Certification and Signature:

Based on the information you furnish us; we will prepare your Income Tax Returns. The law requires taxpayers to maintain records supporting their return, including receipts, canceled checks, card statements, etc. for all deductible expenditures. You will be responsible for maintaining these records, for the accuracy, and for the completeness of the information submitted to us in connection with the preparation of your return. By signing this document, you are representing that you have fully disclosed your income and relevant information to the best of your knowledge. We do not and cannot audit this information for its accuracy.

When we obtain confidential financial information from you, it will not be shared with any person or corporation other than the employees of our firm who have a need to know in order to complete the task(s) for which we have been engaged. Neither will we sell or disclose your personal financial information to third parties without your prior consent. Only a government agency, following due process of law, can obtain your information without consent.

We offer free defense for any return that we prepare and will pay the penalties and interest arising from error on our part. These guarantees are contingent on timely communication of any letters or notices received by the client and full disclosure of any data pertinent to the issue at hand. Regarding a tax home, per diem, or other defense of a healthcare traveler's contractual issue, our guarantee is contingent on us receiving copies of all traveler's contracts for the year in question. OUR FEES:

• Our fee schedule/pricing can be found on our website. (Fees for Corporate Returns, International Returns, or special circumstances will be provided upon request or discussed upfront.)

• Additional charges may be incurred if your return requires additional research, staff time to produce records from third parties, or communication to other entities on your behalf.

• An invoice will be sent to your email after your documents have been uploaded for your review.

• We do not take payment out of your refund. (The bank fees for this can be upwards of $50 for the convenience and we strive to keep your costs low. We trust you to pay us after our work is completed!)

• Please Note: We bill for our completed work. If you decide not to file the return we prepare, it does not invalidate our invoice. If you cancel after your file has gone through our scheduling and data entry process, there is a $150 cancellation charge to cover the time invested. If you go through the tax consult, the full fee will be invoiced. A $35 late fee will be added for invoices not paid within 30 days. If there is a financial difficulty, please call us so we can design a payment plan for you. If we do not hear from you nor receive payment due, then your account will go to collections after 6 months.

“I (We) have reviewed the above engagement letter and privacy statement and agree to the terms and conditions set forth. Any information that I (we) have submitted for the sole purpose of preparing my (our) tax return(s) can be substantiated by receipts, canceled checks or other documents. I (We) have reported all my (our) taxable income. This information is true, correct and complete to the best of my (our) knowledge.” I (We) hereby give permission for TravelTax to prepare my (our) tax return.

Taxpayer’s Signature______________________________________________ Date _______________________

Spouse’s Signature________________________________________________ Date _______________________ (If using the PDF FILL, a digital signature is acceptable, others will need to print the workbook after completion out and sign and initial each page.)

TravelTax - 46 St. Mark Rd., Taylors, SC 29687 - Fax 877.872.8829 - Office 402.379.7818

Copyright © 2021 TravelTax. Use by this by anyone other than TravelTax and its clients is prohibited.

Document Checklist – You may fax, email, upload to portal or mail your documents to us (but please DO NOT mail originals)!

(also, please send this checklist in with your documents)

Yes No Will

send later

New clients only: Send a copy of previous year’s tax return (federal, state, municipal or other nation). Do not send old W-2s or supplemental summaries. If

it is paper format and 50+ pages, send only the main federal forms (first 5 pages) and then the first 4 pages on every state return.

Copy of Driver’s License (and Spouse’s if applicable) – NY Driver’s License holders must send front and back copies

Copies of your travel contracts – we need the pages which involve dates and pay rates, not supplemental info.

Copy of voided check if you want direct deposit or withdraw. Alternative = something with your account & routing number

I am a returning client, and my account has not changed, please use previous year’s info. _____________(please initial)

Any current notices from the IRS, states, municipal or other income tax jurisdictions

W2(s) ___________ # of different employers

___________ total # of all W2 individual pages being sent

1099-A or 1099-C Debt Cancellation, and/or Foreclosure and Abandonment Statements

1099-B Brokerage, prizes or barter exchanges - -

1099-DIV Dividend statements - - - - - - - - -

1099-INT Interest statements - - - - - - - - -

1099-G State Refund Statements / Unemployment / State Payments / Other

1099K Merchant Card and Third-Party Network Payments

1099-MISC Miscellaneous income

1099-NEC Independent contracting income

1099-R IRA, pension, or retirement distributions

1099-SSA Social Security income

1098 Mortgage interest statements

1098-E Student loan interest

1098-T Tuition and Education Payments

1095-A Health insurance information - obtained through the Healthcare Marketplace (www.healthcare.gov)

1095-B Health insurance information – obtained from health insurance company (for self-employed individual)

1095-C Health insurance information – obtained from employer (corporate)

1099-HC Massachusetts Healthcare Form (If MA resident)

1099-SA Health savings accounts

W2G Gambling or lottery winnings

Real Estate Tax Statements if not reported already on mortgage interest/bank statement

If you bought or sold a house during the tax year, the two pages of your settlement statement.

Vehicle Tax and Personal Property Tax Statements (ad valorem, based on value of vehicle)

Charitable donation receipts if NON-Cash (clothing, household goods, etc.) contributions total above $500

Foreign Income with employer name and address

Disability Income Statements

Electric vehicle purchases

K1 Reports

Your favorite recipe (optional)

Other:

Please do not send individual receipts except for charitable non-cash donations. (clothing/household items/cars/etc.)

You can enter all other receipt totals in the correct spots in the workbook. We trust you!

One last note: The numbers entered in this workbook need to be accurate, based on records or receipts, not vague estimates. It amazes us how often deductions wind up being even like $25, $50, $100… The probability of every deduction landing on a $5 or $10 note must be

similar to hitting the Powerball Jackpot. 😯😉



Sometimes these 3 are all combined into one-year end summary called a 1099-Composite. Just send all the pages! Even if it says, ‘this page intentionally left blank.’


TravelTax – 46 St. Mark Rd., Taylors, SC 29687 - Fax 877.872.8829 - Office 402.379.7818

Copyright © 2021 TravelTax. Use of this by anyone other than TravelTax and its clients is prohibited.

DEPENDENTS First name Last (if different) Social Security # Relationship Birth date (if away for school, still considered living at home)

# months in home for the year: ____________ if in college, full time at least 5 months? Y ___ N ___




Any custody or support arrangements? Yes No Do you need tax advice on adoptions? Yes No

Yes No Ask me QUESTIONS - Check the “ask me” box in addition to your yes ‘yes/no’ if you need to discuss this with us.

1) COLLEGE EXPENSES - If you, or family members, are taking post grad courses, or any other college classes, just send the 1098T from the school. (for many schools this can be downloaded from their website under your billing, etc.) List any other expenses like books, etc. _______________________________________________________________________________________________________

New clients: Have you been claiming the American Opportunity Credit? How many times has it been already taken? ___________________________________________

2) Did you have any IRA or SEP Contributions NOT listed on your W2s (deductible)? Total for self $_________________ total for spouse $____________________

3) Did you make any Roth IRA Contributions (non-deductible)? Total for self $________________________ total for spouse $________________________

4) Did you make any Contributions to Health Savings Accounts (HSAs) for High Deductible Plans out of pocket?

(out of pocket expenses only, paycheck deductions do not get listed- you already got that tax break!)

total for self $_______________________ total for spouse $___________________________ total in a joint account $___________________________

5) Did you receive Interest NOT reported on 1099INT? (supply name, address, SS# or EIN# or recipient) _________________________________________________

____________________________________________________________________________________________________________________________________

6) Did you make any estimated payments made for this year’s tax return? (lump mailed/online to each jurisdiction - NOT amounts withheld from paychecks)

1st Quarter / Date paid 2nd Quarter / Date paid 3rd Quarter / Date paid 4th Quarter / Date paid

Federal

State _____________

Local _____________

7) Were you audited in the past 3 years? Or did you receive any letters form the IRS or state revenue offices?

8) Did you back file or amend any state, local or federal returns last year?

9) Did you receive stimulus check(s) last year? 1st time: You $______ Spouse $______ Child $______ 2nd time: You $______ Spouse $______ Child $______

9) Did you pay an additional amount when you filed last year’s returns? Amount $_________________________ State ________ Returning clients can leave blank

ITEMIZING

DEDUCTIONS:

Many of our clients no longer itemize. If you know without a shadow of a doubt that you will not itemize, you can skip to page 6. However, some states allow you to itemize

and it may be worth it for you to spend some time to gather and answer questions 10-17.

10) MEDICAL AND DENTAL expenses are limited by 7.5% of your gross income for 2020. So only the expenses over that 7.5% are deductible to you. Some states, including AZ, OH, ND, and NM, allow you to deduct expenses regardless on the state return. Health Insurance Premiums paid out of pocket (NOT amounts deducted from your paycheck) ________________________________________________________ Long term Care Premiums______________________________________________________________________________________________________________

Miles driven for medical purposes: ________________________________________________________________________________________________________

Prescriptions / Co-Pays / Hearing aids / Glasses / Dental / Other ________________________________________________________________________________

Ambulance transport/hotel lodging ________________________________________________________________________________________________________

11) Did you have any Sales Taxes on Major Purchases like a car, boat, etc.? Total amount ___________________________ 12) Did you have any Charitable Donations by cash, check, or credit? Do not send receipts. Enter total amount $______________________________________

13) Did you have any Charitable Donations Other than cash/check/credit? (Clothing, furniture, etc.) Total valued amount $_______________________

(If annual donation total equal or over $500, we need copies of all receipts per IRS reporting regulations.)

14) Did you take any overnight trips for charitable organizations or mission trips? Some of these expenses are deductible; we will go over this with you.

15) Did you have any miles driven for Charity? Total miles ____________________

16) Did you pay any Investment Interest expenses? (not personal home mortgage or rental home)? Enter total amount $____________________________________

17) Did you have any impairment related work expenses?

STATE DEDUCTIONS FOR AL, AR, CA, HI, MN, NY, PA – MA (transit passes only for MA)You Spouse You Spouse

Uniforms/ Work Clothing/Footwear Tools/Supplies/Equipment/Safety Equip

Laundry / Cleaning of Uniforms Print Media or Subscriptions

Postage/Fax/Shipping for business Professional Insurance

Licenses, even if not used this year Professional Memberships

Fingerprints/Verification/Security Union Dues

Job Physicals/Job Medical/Testing Other

REIMBURSEMENTS for any/all above expenses You: Spouse:

Did you change your permanent residence to any of these states during tax year? Yes No ______ ______

Communications Expense: To calculate estimated business use, take total monthly minutes and divide by business minutes. Business minutes are the total of all minutes used to talk to employers, recruiters, and other conversations related to your temporary housing, relocation, and other employment related agencies.

Estimated business use %Do you have a landline? Y N 1st phone/cell - Total for year: _________________________ ___________________________

Estimated business use %2nd phone/cell – Total for year __________________________ ___________________________

Work Related Continuing Education, Conventions, ACLS, BLS, PALS - Not college courses or travel assignments

Event Destination Cost Airfare Miles driven Rental Car Rental Gas Hotel Other Reimbursement given



EVEN MORE QUESTIONS - Check the “ask me” box in addition to your ‘yes/no’ if you need to discuss this with us. Yes No Ask Me

18) Are you and/or your spouse: blind or a tribal member?

19) Did you give back Jury Pay to your employer in exchange for hours worked? Enter amount turned in to employer _______________________________

20) Did you have reported Gambling winnings? Send all W2Gs that you have received. If you have your losses documented, send that along also. 21) Did you receive any royalties from authorship (copyrights/books) or mining (minerals, oil, etc.)? Please send 1099M or K1.

22) Have you experienced any losses related to Presidential Disaster Area?

23) Did you know that in Alabama there is a law that bans driving while blindfolded? (and yes, we are serious tax preparers, but figured you might need some comic relief right about now! 😊😊)

Received?24) Have you paid or received alimony for a divorce settlement made prior to 2019? Amount ____________________ Paid?

and SSN:If paid, please list name of alimony recipient: ____________________________________________________ __________________________

Paid? Received? 25) Have you given or received gifts over $15,000 to / or from any one person? Amount ___________________

26) Did you pay more than $2100 this year to any individual as an in-home caregiver, cleaner, or other domestic help?

Amount paid to this provider SS# or EIN

Phone Address

relationship if relative Name 2

Amount paid to this provider SS# or EIN

Phone Address

relationship if relative

27) Did you have child or dependent care expenses? You will need to provide the info below, or send the documentation that the daycare provider gave you.

Name 1 ______________________________________________________________________ ____________________________

__________________________________________________________________________________ _________________________

_____________________________________ _________________

______________________________________________________________________ ____________________________

___________________________________________________________________________________ _________________________

_____________________________________ _________________

28) Did you install any energy efficient items to your home? (eg. solar/geothermal/insulation/windows) Provide the type and cost (or receipt) of each improvement.

29) Did you foreclose on your home? (Send 1099C and/or 1099A)

30) Did you claim the First Time Homebuyers Credit on your 2008 return? (the $500 that gets partially repaid every year) 31) Did you sell a home this year? Please provide us with a copy of the first 2 pages of your settlement statement

Did you ever rent this home to other individuals or use it for business or home office deduction? Yes No

Purchase price of your old home Date you purchased the home ________________________ ________________________________

Unreimbursed Lodging Unreimbursed Meals

Rental Car (including gas)Mileage if own car

32) Are you a member of the military? Reservist Active Duty

Did you sell your residence in the last 5 years? Yes No

Did you travel more than 100 miles to attend Guard or Reserve meetings? Yes No If yes, then fill out the rest of this section.

Airfare/Transit expenses _____________________ _____________________ ________________________

___________________________ ______________________

Do you own property in your country of origin? Yes

What was your filing status in the US last year? Resident Alien

year before thatyear before Days spent in the US: tax year

34) Are you an alien or a foreign worker? VISA type: _______________________________

__________________ ____________________ ___________________

Nonresident alien NA

Do you have a spouse residing outside of the US? Yes No

Do you maintain a job in your country of origin? Yes No Give last date worked there________________________

No



State Specific Tax Laws Answer only for the state below that is your permanent residence. If we missed something, write us a note on page 8.

529 College Savings/ABLE Accounts/QTP Contributions ____________________ State ___________ Non-qualified withdrawals ______________ State ________

Major out of state purchases that were free of state sales taxes ____________________________ Did you donate any biological organs? (y/n) _____________

AR Political Contributions amount $___________________________________ given to (name of recipient): __________________________________________________

AZ Contributions to private school / Tuition organizations. AZ has numerous small credits. If you know one that applies to you, send us the documentation.

GA Are you a rural physician qualifying for the tax credit? Yes /No? ________ Ask me _________

IA Federal refund from previous tax year (unless sending copies of that return) $_______________________ Impairment related expenses $________________________

Expenses for disabled relative $___________________________________ Volunteer for EMS or Fire? Yes/No _______

ID Donations to Educational Institutions, Youth/Rehab Facilities, or other community charities _______________________________________________________________

List any Energy Efficiency upgrades (type & cost): ________________________________________________________________________________________________

IL Educational tuition and/or fees for K-12 education ________________________________________________________________________________________________

Property/Parcel Number for tax credit if you are aware of it: (top of bill or from online county assessor records) ________________________________________________

IN Was your child(ren) homeschooled or in private school? Yes/No? _________ Insulation/caulking/weatherstripping expenses __________________________

Name/address of landlord if qualifying for rent deduction: __________________________________________________________________________

_________________________________________________________________________________ Rent paid for year $________________________

Property/Parcel Number for tax credit if you are aware of it: (top of bill or from online county assessor records) ______________________________________________

KS Armed Forces Recruitment bonuses __________________________________

LA Property Insurance Surcharge ________________ Property address _________________________________________________________________

Insurance Company _____________________________________________________________ Account # __________________________________

Private school tuition or homeschooling expenses K-12 _________________________________________________________________________________

MD Volunteer as an EMT or Fire Personnel? Yes/No? _________________

Higher Education Credits are available, send us the documents. https://mhec.maryland.gov/preparing/Pages/StudentLoanDebtReliefTaxCredit.aspx

MA Rent paid $____________________ Tolls and Transit passes $__________________ send health insurance forms

Did you move your permanent residence to MA during tax year? Yes/No? _____

MN K-12 educational expenses (breakdown by category) _______________________________________________________________________________________________

Renters’ credit (send copy of CRP certificate from landlord) Long term care insurance _____________________________

MO Contributions to an IMA (Missouri Individual Medical Account) $___________________ Home Energy Audit $___________________________________

Healthcare Sharing Ministry Premiums (MediShare) $________________________________________________________________________________________________

MT First Time Homebuyers Savings Accounts Contributions $__________________________________ Ineligible withdraws $_________________________

Are you a rural physician qualifying for the tax credit? Yes/No? ________ Ask me _________

NJ Rent Paid for Year $ ________________________ Name/Address of Landlord: __________________________________________________________________________

Block & Lot Number for tax credit. Google: "new jersey property tax list search" to find NJ state webpage ______________________________________________________

Did you move your permanent residence to NJ during tax year? Yes/No? _______

NY Amount of rent paid OR property tax paid on residence if not on mortgage statement? $_____________________ (NY208)

OH Political Contributions amount $___________________________________ given to (name of recipient): __________________________________________________

OR Political Contributions amount $___________________________________ given to (name of recipient): __________________________________________________

SC Volunteer as an EMT, or Fire personnel? Yes/No? __________

UT Does one parent stay at home to care for a child? Yes/No? ____________ If yes who? ______________________________________________________

VA Political Contributions amount $___________________________________ given to (name of recipient): __________________________________________________

VT Rent paid for the year $____________________________ Name and address of landlord _______________________________________________________________

Is your home in VT used solely for personal use and not rented, or a vacation home? Yes/No? _____

WV EZ Pass expenses $_______________________________________________________________________________________________________________________

WI Rent paid during the year $__________________________________ Heating costs for the year if not included in rent $_________________________________________

Have questions or additional information for your preparer? Please add here:

_____________________________________________________________________________________

______________________________________________________________________________________

__

__________________________________________________________________________________________________________________________________________________________________________

_____________________________________________________________________________________

____________________________________________________________________________________

________________________________________________________________________________________________________________________________________________________________________

_____________________________________________________________________________________

_____________________________________________________________________________________

__________________________________________________________________________________________________________________________________________________________________________

___________________________________________________________________________________

__

You are almost done! �� Please verify the following:

N Are you a Traveler/work temporary contracts away from home? - - - Please fill out Appendix A Y___ ___

N Are you self-employed/independent contractor/own a business? - - - Please fill out Appendix B Y___ ___

N Do you own rental property?- - - - - - - - - - - - - - - - - - -Y - - - - - - - - - - Please fill out Appendix C ___ ___

N Did you know in Arizona it is illegal for a donkey to sleep in a bathtub? 😊😊 Google it! Y___ ___

Everyone else: You may stop here and don’t have to send in any other pages!



INSURANCE REPORTING The 1095A (Healthcare Marketplace Insurance) are the only ones that we must have prior to filing your return.

1095-B and 1095-C are necessary for residents of VT, MA, NJ, DC, CA & RI Check here if you, and your entire household, had coverage for all year if you are a resident of the states above. If you could not place a check, please fill out the spreadsheet below for each family member. Only mark months that you did not have ANY coverage. Even one day of coverage exempts you from the penalty for that month.

FIRST NAME NOV year before

DEC 1-31

JAN 1-31

FEB 1-28/29

MAR 1-31

APR 1-30

MAY 1-31

JUNE 1-30

JULY 1-31

AUG 1-31

SEP 1-30

OCT 1-31

NOV 1-30

DEC 1-31

This page MUST be filled out yearly for us to complete your return. It is not a pass/fail test! No worries! 😊😊 Our goal is to identify any potential danger areas and help you fix them. There are no wrong answers, and it will probably generate several questions. Answer what you can. We will go over this page with you when we complete your return. Yes No I am a returning client and have already discussed my situation last year and know that I DO NOT have a tax home. If “yes” then you can skip the rest of the questions and the assignment sheets, but you need to send us copies of your contracts. Yes No I have already participated in a paid Tax Home consult with TravelTax (separate appointment).

Estimated number of days spent at home duri1- __________________ ng the tax year.

2- Yes No Have you spent more than 12 months (including breaks) working temporarily in one metropolitan area? (E.g.: 3 hospitals in Dallas)

3- Yes No Have you returned to a metropolitan area/travel assignment (NOT your tax home) where you worked the previous year?

Enter total number of months spent in that area over the last 24 months. Example: Feb-Sept then Dec-July = 16 out of 24 months _______________________________________________________________________________________________________

Where have you claimed a tax home? TAX HOME = A METRO AREA (OR REGION) WHERE YOU HAVE ECONOMIC TIES OR EARNED INCOME. 4- ____________________

Where do you claim a permanent residence? AN ADDRESS YOU USE FOR LEGAL DOCUMENTS OR REGISTRATIONS 5- ____________________

When did you begin traveling? (month & year) 6- ____________________

When do you plan to stop traveling? 7- ____________________

When was the last time you had income at your tax home?8- ____________________

9- Yes No Do you earn significant income in any one metro area annually? Approximate income earned there last year: ____________________

10- Yes No Do you use this job to maintain your tax home?

11- Yes No Do you expect to return to your claimed tax home when you have stopped?

12- Yes No Did you live and work at your tax home immediately before you began temporary assignments?

Where are you registered to vote? 13- ___________________

In what state are you licensed to drive?

In what state did you file your resident tax return last year?

15-

14- ___________________

___________________

In what state is your car registered? 16- ___________________

17- Yes No Do you have your personal items (i.e.) furniture, clothing, business records, etc., at your permanent residence?

18- Yes No Is your claimed residence available to you at all times?

19- Yes No Do you have a family, financial, social ties, or memberships at the permanent residence?

20- Yes No Do you own your home and are responsible for maintenance and upkeep?

21- Yes No Do you rent out any or part of your home while you are away?

If your permanent residence is not owned by you or spouse:

22- Yes No Do you pay a monthly amount throughout the entire year?

23- Yes No Enter amount paid every month, or list other regular expenses. _______________________________________________________

Is this amount based on: Fair Market Rent? or Shared Expenses?

24- Yes No Do you have receipts and/or contracts to support these expenses in case of an audit?

If you RENTED from a relative or friend: (different from “sharing expenses,” where you are paying your equal portion of household costs.)

25- Yes No Is that individual aware that rental income may be taxable?

26- Yes No Do you have a written contract?

Comments: _________________________________________________________________________________________________________

___________________________________________________________________________________________________________________

___________________________________________________________________________________________________________________

I confirm that the information given on this page is true, complete, and accurate. (initial box) Page A-1


Appendix A – For all Healthcare Travelers and Mobile Professionals

(city/state)


Appendix A continued – Itinerary for Tax Year

Assignment 1 Start Date mm/dd/yy

End Date mm/dd/yy

City, State

Company

Notes:

Travel to assignment Miles driven to assignment

Hotel cost while traveling to/from location

Airfares/rental/shipping/other

Travel Reimbursement

During assignment – see page 15 for trips home Total commuting miles on your car during entire contract. (to/from worksite) A googled/logged one way trip: ___________ Or entire contract ________________ Car rental/parking/tolls/fares ______________________________________

Did you receive a car allowance during contract? Y N

Return home at the end of contract (If directly to next assignment skip this section and go to next column) Miles driven home




If you answer ‘yes’ to any of the questions below, fill out Section B. Assignment worked as an independent contractor? (not W2 employee) Was this assignment worked in: AL, AR, CA, HI, MA, MN, NY, PA, AND YOU ARE NOT a resident of that state?

SECTION B - Enter only expenses related to this contract.

Contracted state license:

Fingerprints/verification/physicals/testing:

Uniforms/footwear/protect equipment:

Supplies and equipment:

Laundry:

Other:

If a 1099 independent contractor, list housing expenses at assignment:


End Date mm/dd/yy

City, State

Company

Notes:

















Laundry:

Other:


I confirm that the information given on this page is true, complete, and accurate. (Initial box) Page A-2

TravelTax - 46 St. Mark Rd., Taylors SC 29687 - Fax 877.872.8829 - Office 402.379.7818 Copyright © 2021 TravelTax. Use of this by anyone other than TravelTax and its clients is prohibited.



End Date mm/dd/yy

City, State

Company

Notes:

















Laundry:

Other:



End Date mm/dd/yy

City, State

Company

Notes:

















Laundry:

Other:






End Date mm/dd/yy

City, State

Company

Notes:

















Laundry:

Other:



End Date mm/dd/yy

City, State

Company

Notes:

















Laundry:

Other:



I confirm that the information given on this page is true, complete, and accurate. (enter initials) Page A-5


Appendix A continued – Almost done!

RECORD OF TRIPS HOME WHILE ON ASSIGNMENT (NOT AT BEGINNING OR END OF ASSIGNMENT)

This doubles as documentation for days spent at home. 😊😊

Trip # Date Departed Date Returned Roundtrip Miles Driven or Transportation Costs (Train/Bus/Uber/Air fare)

Trip # Date Departed Date Returned Roundtrip Miles Driven or Transportation Costs (Train/Bus/Uber/Air fare)

1

26

2

27

3

28

4

29

5

30

6

31

7

32

8

33

9

34

10

35

11

36

12

37

13

38

14

39

15

40

16

41

17

42

18

43

19

44

20

45

21

46

22

47

23

48

24

49

25

50

I confirm that the information given on this page is true, complete, and accurate. (enter Initials) Page B



APPENDIX B - BUSINESS OWNERS AND SELF-EMPLOYED (You may send us a QuickBooks or Quicken file instead.)

Business Name FEIN (if any)

Type of Business or Profession When did you acquire or start the business?

INCOME

If all income has been reported on 1099 form, no need to enter here Gross Receipts/Sales/Income: $__________________________________________

Explanation:Other Income: ______________________ ________________________________________________________________________________________

EXPENSES – If you are working as an independent contract traveler, this page is for annual expenses NOT attributed to one contract, performed in one state.

Vehicle Info: Annual Miles = miles driven for every purpose during the tax year (not just work). An accurate estimate can be obtained by looking at oil change/repair receipts near the beginning or end of the year (they have your odometer readings on them).

Annual Miles on Vehicle 1 ________________

Total Business miles if not listed in contract sections (back appendix): ____________________________________________

Do you have a travel log that records your travel expenses and mileage? This would be required by the IRS in an audit. Y N Work Related Continuing Education, Conventions, ACLS, BLS, PALS - Not college courses or travel assignments

Date Left Date Returned Destination Cost Airfare Miles Driven Rental Car Gas for Rental Lodging Other

Communications Expense: To caclulate estimated business use, take total monthly minutes and divide by business minutes. Business minutes are the total of all minutes used to talk to employers, recruiters, and other conversations related to your temporary housing, relocation, and other employment related agencies.

Estimated business use % Do you have a landline? Y N 1st phone/cell - Total for year: _________________________ ___________________________

Estimated business use %2nd phone/cell – Total for year: __________________________ ___________________________

Estimated business use % Internet: Business use is more of a good faith estimate. Includes researching next contract, new companies, areas for temporary residences, time spent on CEUs and business-related forums.: __________________________________ ________________________ Home/Office/Building Deductions:

Sq Ft of area used exclusively for business:Sq Ft of entire building: ________________________ ____________________

If using actual expenses and NOT the standard sq. ft. deduction, please also send statements or give actual amounts below:

Insurance:Utilities: Taxes:Mortgage/Rent: _______________ ____________________ ____________________ ____________________

Repairs:Landscaping/Maintenance: ____________________ _____________________________

% Business Use Cost: _This tax year computer purchase: Purchase date: ________________________ _______________________ _______________________

Use section below for items NOT listed elsewhere:

Professional Insurance (not health) Union dues:

Books/Journals/Magazines/Online CEUS Supplies:

Legal and Professional Services Tools:

Office Expense Protective Equipment/Uniforms/footwear

Postage/Fax: Cost of sub-contract labor:

Misc. Taxes and Licenses Car and Truck Expenses (if not using mileage)

Fingerprints/Verif./Physicals/Testing Rent or Leases (vehicles, machinery and equipment)

Advertising Repairs and Maintenance (vehicles, machinery/equip)

Commissions and Fees Do you have employees other than self?

# nights spent away from home for business:Airfare:ADDITIONAL Travel Expenses not recorded elsewhere: Hotel stays: ________________ _________________ ___________

Assets purchased or sold, or other expenses:

APPENDIX C – RENTAL PROPERTY

Please provide us with last year’s depreciation schedule if you were not a TravelTax client last year If not US $, please indicate currency here: ____________________________

Did you spend over 250 hours managing your property(ies)? Yes No Property # 1 2

Type of Property and Location

Actively Participated in Management? Yes No Yes No

Are you the sole investor in this property? Yes No Yes No

Did you sell this property, or a portion of it, this year? Yes No Yes No

Portion of home rented if not 100%

Number of months rented

Gross Rents

EXPENSES

Advertising

Auto and Travel

Cleaning and Maintenance

Commissions

Insurance

Legal and Professional

Management fees

Mortgage Interest

Other Interest

Small Repairs (list significant work done in bottom section)

Supplies

Taxes

Utilities

HOA fees

Other

Other

Days away from home overnight to tend to rental

Mileage associated with rental

How many days did you occupy the dwelling?

Purchased assets, extensive repairs & improvements. List item, costs and date:

I confirm that the information given on this page is true, complete, and accurate. (enter initials) Page C


FAX COVERSHEET

(only fill out this page if you are sending a fax)

To: TravelTax Fax #: 1-877-872-8829

Available 24/7. Number is valid in US, Canada and all territories. Our fax never runs out of paper.

Phone #: 402-379-7818 Our office hours are Monday-Thursday 8:30 am- 4:30 pm & Fridays 8:30 – 12 pm Eastern time.

Email: [email protected]

Email us in case you haven’t heard from us acknowledging we’ve received your fax. Documents are processed within 24-72 hours EXCEPT ANY DOCUMENTS SENT AFTER 2 PM Eastern time on Fridays or on the weekend. Weekend docs will be processed Monday or Tuesday at the latest.

From: __________________________________________________________________ Email: __________________________________________________________________ Phone # (with time zone): __________________________________________________ Total # of pages including cover sheet: _______________________________________ Please number your individual pages

Note: When faxing a large amount of pages, please number each page about ½ inch from the margin to avoid cut off. If pages are missing, we can just notify you which pages need to be resent. Trust us; it will be a lot less frustrating for you this way!



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FOR TAX YEAR 2020 New Add On Printed/Ack

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