Oshima Company CPA · [email protected] Oshima Company CPA A Limited Liability Company January...
Transcript of Oshima Company CPA · [email protected] Oshima Company CPA A Limited Liability Company January...
Davies Pacific Center 841 Bishop Street Suite 208 Honolulu, HI 96813-3908 Tel (808) 521-6481 US Toll Free (888) 441-8665 Fax (808) 521-8844
Oshima Company CPA
A Limited Liability Company
January 2012
Aloha, Friends: We wish you warm Holiday greetings and best wishes for the New Year. Thank you for being a part of our family of friends and for allowing us to provide you with our professional services. We look forward to working with you in 2012 and we will make every effort to justify the confidence you have placed in us. Enclosed you will find our usual tax organizer for your 2011 income tax preparation. Please use it as a guide to gather the information needed to prepare your returns. It is important that you include copies of the original documents for our reference if they contain relevant information. We will return the documents you provide to us after making copies of any that we need to keep in our files. If you have additional information that doesn’t seem to fit in the organizer, just make notes anywhere or on a separate page. We’ll examine all information carefully to ensure that it is dealt with correctly. After you have gathered all the information, just mail in or drop off the organizer with your documentation; or you can call us to schedule a tax interview appointment with one of our interviewers. If you chose to scan the documents and e-mail them to us, please be sure to put a protective password on the documents to insure your privacy. If the information is self-explanatory, you may want to skip the appointment. We will call you or e-mail you with any questions that arise during the tax preparation. Electronic Filing – Please see our attached notice on electronic filing. Tax Return Engagement Letter – Our separate engagement letter is enclosed as part of our Tax Organizer. We need for you to sign and return it to us before we begin your tax preparation so we can confirm our assignment. By completing and returning the engagement letter and organizer to us with your tax information (you should, at a minimum, complete the initial pages up to the PERSONAL INFORMATION section), you are authorizing us to prepare your return and you are confirming the accuracy of the information provided to us. Because we are required to e-file your returns, more detailed information is required from your W-2s and Form 1099s; therefore we must have copies of the original documents, not just a listing of the dollar amounts. Please also review the accompanying E-Filing Notice for additional information. Privacy Policy – Please review the accompanying Privacy Policy to understand how we protect your information.
Davies Pacific Center 841 Bishop Street Suite 208 Honolulu, HI 96813-3908 Tel (808) 521-6481 US Toll Free (888) 441-8665 Fax (808) 521-8844
Document Retention & Copy Policy – We generally keep copies of your tax returns and supporting documents for up to 3 years after preparation. In some cases we may keep them longer. For our business clients, payroll records are generally kept up to 4 years. In order to keep our overhead costs down, we will destroy old records without further notice to you. All documents you give us for the preparation of your tax returns are returned to you upon completion of your returns. If you are missing any documents upon completion of your returns, please notify us as soon as you can. We also provide you with one set of copies of all returns prepared for your
records. If additional copies of tax returns are requested, we will charge a fee for each additional tax return provided. Please refer to the following websites to learn more about records retention guidelines: http://www.irs.gov/businesses/small/article/0,,id=98513,00.html; http://www.smead.com/hot-topics/records-retention-guidelines-1394.asp; http://www.hhcpa.com/accounting-tax-audit-resources/accounting-record-retention-guidelines.php http://www.skocpa.com/document_retention_recommendation.htm#Corporate or just go to GOOGLE and search "records retention guidelines" Office Calendar – Enclosed for your information is our office calendar. Please call us to make an appointment to come in for a consultation whenever you have tax, financial or accounting issues you would like to discuss. Extension to File – For those of you who submit your complete tax information after April 1, 2012, we will make every effort to complete your returns by the April 17th, Tuesday, deadline. However, due to our large volume of work at this time of year, we may not be able to complete your returns by then; and an extension of time to file may be required. Also, if your information will not be available by April 17th, please let us know as soon as possible, along with the best estimates possible of your tax situation, so we can prepare an extension request for you. Please note the extension of time to file will not extend the time to pay your tax liability. Consequently, we may suggest that you make a payment with your extension to avoid unnecessary interest and late payment penalty charges. Tax Return Pick-Up – We will contact you when your returns are completed and ready to be filed. Our office will be closed promptly at 5:00 p.m. on Tuesday, April 17, 2012. Be sure to pick up your tax returns early or make prior arrangements with us to file an extension. Remember also that the post office will be extremely crowded on the 17th. Although we will make every effort to contact you, you are ultimately responsible for your tax returns left in our office on April 17th, after 5:00 p.m. Thank you, again, for the opportunity to serve you.
Sincerely,
Dick Oshima Enclosures
Oshima Company CPAA Limited Liability Company
NOTICE TO ALL CLIENTS CONCERNING ELECTRONIC-FILING
Please Note - This affects all federal tax filers: This filing period, the IRS has mandated electronic filing for preparers who prepare and file for their clients at least 11 returns. Oshima Company CPA will be subject to this requirement.
What this means for you:
1. You may opt out of electronic filing and file your return manually as you may have for previous years. If so, please let us know at the time of submission of your tax information that you prefer this option. You will be asked to sign a form, which will be attached to your return, indicating your choice.
2. You may take this opportunity to file electronically. Electronic filing is a very efficient process and provides taxpayers a convenient way to expedite their tax filing and be certain that no problems occur due to IRS processing errors. Refunds are accelerated by a minimum of one week. Payments may still be handled by check or any alternatives available under manual filing. Electronic filing is also available for filing most state tax returns. (Last year Oshima Company CPA offered electronic filing to any client requesting it and no significant problems were experienced.)
Unless you indicate to us your decision to file manually, we are required to prepare your return for electronic filing of your federal return and any state returns your tax situation requires.
How electronic filing will affect your interactions with Oshima Company CPA:
1. Tax information that you provide to us will need to include copies of all W-2, 1099-R and 1098 forms that you receive. We have always encouraged clients to provide these documents, along with copies of other tax documents such as 1099-INT and 1099-DIV forms. This insures that we have the correct and complete information for your return. However, in the past, some clients have preferred to copy information into our organizers and have us prepare returns from that information. In the future, with electronic filing, this will not be possible.
2. When the return is complete, you will be asked to review your return and sign a Form 8879, IRS e-file Signature Authorization, indicating your approval of the electronic filing of your return. This process can be handled in person or by fax or e-mail. Discuss this with our staff when you submit your information so we can handle your tax preparation as conveniently for you as possible.
How electronic filing will affect your dealing with the IRS & state tax departments:
1. Accuracy will be enhanced – most discrepancies that could have occurred in the past will be caught early in process and eliminated before filing and acceptance.
2. Speed of processing – any problems which do arise will be identified immediately and can be addressed at the same time as the initial preparation and filing. Refunds will be processed more quickly.
3. Postage costs will be minimized.
Please contact us immediately with any questions or concerns about electronic filing.
Oshima Company CPA A Limited Liability Company
TAX ENGAGEMENT LETTER
January 2012 Dear Friends:
We look forward to assisting you in meeting your tax filing requirements and also advising you on any tax matters that you specifically request. To ensure a complete understanding, we ask that you put your request in writing and sign it. This letter also includes a review of our mutual responsibilities. Because this mutual understanding is important, we ask that you review and sign this letter prior to our preparation of your tax returns. If you have any questions please discuss this with us prior to signing this letter. We will be happy to discuss any issue about the process before beginning, since we believe this will allow us to deliver better services and will insure greater satisfaction to you. This engagement letter indicates the extent of the professional services we will render on your behalf. We will not perform any services not specifically requested. Please indicate all the services you wish us to perform. By accepting this document, we are indicating our acceptance of your assignment. Please complete the checklist on page 2, review the attached information and sign & date in the space provided to indicate that you agree with the terms of this engagement. If you submit your tax information without signing your agreement to our engagement terms, we will deem your submission as your acceptance of our engagement terms. You may return the checklist to our office when you submit your tax information or beforehand if you wish. We would like to express our sincere appreciation for this opportunity to work with you as your tax preparer and advisor. Sincerely,
Oshima Company CPA To Oshima Company CPA We / I agree and accept the terms of this engagement and fee arrangement as detailed on the following pages: ______________________________________________ _____________________ Print Name Date Signature (if joint filing, either signature is sufficient)
Please prepare the following returns (please check all that apply): _____ Form 1040, 1040NR or other federal individual income tax return for the year(s) _________________ If married, prepare as: ____ separate ____ joint or ____ best option (this will require additional time) _____ Form N-11 or other Hawaii individual income tax returns for the year(s) ____________ _____ Form G-45, G-49 Hawaii General Excise Tax monthly or related annual returns for the years required _____ Other State income tax returns. Indicate State(s): _____ Other returns for the years indicated: Please indicate any other requests: _____ I am interested in Gift & Estate planning. _____ Other services: Please note any special timing required or other circumstances about this engagement: Fee arrangement: You will be billed at our standard rates for the time it takes for completing the work including time for explanations, correspondence and gathering information. We reserve the right to increase or decrease our fees based on our determination of the value of the services rendered. (See details on next page.) _______________________________________________________________________________________
ADDITIONAL INFORMATION
Tax Engagement Letter
YOUR RESPONSIBILITIES AS A TAXPAYER:
For engagements requiring the preparation of tax returns, you are responsible for providing the information necessary for the preparation of complete and accurate returns; to confirm the reasonable accuracy of the data included in your return and to confirm that you have the required documentation to substantiate all deductions claimed. You should retain all the documents, cancelled checks and other data that substantiate your income and deductions. These may be necessary to prove the accuracy and completeness of the returns to a taxing authority, if requested. You have the final responsibility for your income tax returns, and therefore, should review them carefully prior to signing and filing them. In order to claim the certain items on your tax returns, you will need to provide the actual amounts to be used. Please do not ask or depend upon us to estimate these on your behalf. These items have stringent record keeping and documentation requirements. To claim these deductions you need to be familiar with the current tax rules and have the required records and documentation. We will be glad to discuss these requirements with you if you are not aware of them or need further explanation.
* Meals, travel, and entertainment expenses * Dependent child under 14 with income * Business vehicle use expenses * Home office expense * Cellular phone expense * Club dues * Below-market interest loans * Cash or Non-cash charitable contributions * Dependent care credit information OUR ASSIGNMENT: We will prepare your federal and State income tax returns from information that you furnish to us. We will not audit or verify the data you submit, although we may ask you for clarification of certain items. To assist you in gathering the information necessary for the preparation of your returns, we will provide you with a tax organizer; the tax organizer will help you gather your information in an orderly and efficient manner. Based on our past experience, a properly completed tax organizer will minimize our time and thus the fees for our services. LIMITATIONS OF OUR SERVICE: Our work in connection with the preparation of your income tax returns does not include any procedures designed to discover defalcations or other irregularities, which may exist. We will render such accounting and bookkeeping assistance as determined to be necessary for the preparation of your returns and we will provide additional assistance as you specifically request to resolve non-income tax related issues that may arise during the preparation of your tax returns. Our fee will include these additional costs. TECHNICAL ISSUES: We will use professional judgment in resolving tax matters where the tax law is unclear or where there may be conflicts between the taxing authorities' interpretations of the law and other supportable positions. Unless otherwise instructed by you, we will resolve such questions in your favor whenever possible. POSSIBLE REVIEW BY TAXING AUTHORITIES: All returns are subject to potential review by taxing authorities. Should the taxing authorities have questions about your tax returns, or select the returns for examination we will be pleased to respond to the request and assist you in the agent's review. Any proposed adjustments by an examining agent are subject to certain rights of appeal. In the event of such government tax examination, at your request, we will be pleased to represent you. Our fee for the preparation of your 2011 or other returns does not include the cost of subsequent responses to tax agency inquiries or examinations. Our fees for such services will be charged in accordance with our fee schedule at the time the services are rendered. OUR FEE ARRANGEMENTS: The fee for our services will be based upon the amount of time required using our standard hourly billing rates or what we believe to be reasonable for such services. You will also reimburse us for expenses that may be incurred for your account such as travel, postage, typing, computer, and reproduction charges.
Our regular billing rates are as follows: Hourly Rate
Professional Staff $ 135.00 - $ 300.00 Clerical & Bookkeeping Staff $ 65.00 - $ 135.00
All charges are subject to 4.712% Hawaii general excise tax.
OUR CREDIT TERMS FOR TAX ENGAGEMENTS:
1. We will commence the assignment upon your acceptance of the arrangements. If we request a retainer, the amount so paid will be applied to your bill upon completion of your tax returns. All billings sent to you will be deemed to be proper and conclusive unless notice to the contrary is given in writing within 15 days from the date of such billing.
2. Payment for services rendered will be due and payable immediately upon completion of the requested assignment and presentation of the bill. Any billing or portion thereof rendered during a particular month and not paid in full within 30 days of the invoice date will be increased by a finance charge equal to 1.50% of the unpaid balance, for each month the billing or any portion thereof is outstanding.
3. We may send those accounts that are 90 days or more delinquent to a collection service bureau. If your account is sent to a collection service bureau for collection, in addition to any finance charges as stated above, they may assess a rebilling charge of $5.00 to $10.00 for each statement that they send and they may send you statements as often as every 10 days. Also, if your account continues to be delinquent, the collection service bureau or we may exercise our right to take further legal action to collect it. Any legal fees and costs assessed to us up to 25% of the amount owed will be added to your delinquent account. You will also be charged for the professional time expended in the collection of your account utilizing our rate schedule as set forth above.
4. All disputes arising under this agreement shall be submitted to mediation. Each party shall designate an executive officer empowered to attempt to resolve the dispute. Should the designated representatives be unable to agree on a resolution, a competent and impartial third party acceptable to both parties shall be appointed to mediate the dispute. Each disputing party shall pay an equal percentage of the mediator's fees and expenses. No suit or arbitration proceeding shall be commenced under this agreement until at least 60 days after the mediator's first meeting with the involved parties. In the event that the dispute is required to be litigated, the court shall be authorized to assess litigation costs against any party found not to have participated in the mediation process in good faith.
5. In the event of a dispute concerning any aspect of this engagement which is not resolved prior to or at mediation, including a dispute concerning payment of fees for our services, it is agreed that, not-withstanding any statute or law to the contrary, the prevailing party shall be awarded all expenses incurred after commencement of litigation in court through final judgment or other final determination, including reasonable attorney fees. The prevailing party will be the party whose final settlement position at mediation is determined by the court to be closest to the final judgment in the litigation. If we are unable to agree on what were the terms of our final settlement positions, the mediator's evidence on that issue shall be entitled to the greatest weight. However, a party that has refused to participate in mediation shall not be considered the prevailing party under any circumstances.
6. Reserving the right to withdraw: We both recognize the importance of performing our obligations under this agreement in a timely way and fully cooperating with the other. In the event that either of us fails to timely perform or fully cooperate, the other party may, in its sole discretion, elect to suspend performance or terminate the agreement regardless of the prejudice to the other person. We agree that we will give ten days written notice of an intent to suspend or terminate, specifying the grounds for our decision, and will give the other an opportunity to cure the circumstances which are cited as grounds for that decision. In the event of suspension or termination, all fees and costs are immediately due on billing.
Davies Pacific Center 841 Bishop Street Suite 208 Honolulu, HI 96813-3908 Tel (808) 521-6481 US Toll Free (888) 441-8665 Fax (808) 521-8844
Oshima Company CPA
A Limited Liability Company PRIVACY POLICY CPAs, like all providers of personal financial services, are required by law to inform their clients of their policies regarding privacy of client information. CPAs have been and continue to be bound by professional standards of confidentiality that are even more stringent than those required by law. Therefore, we have always protected your right to privacy. TYPES OF NONPUBLIC PERSONAL INFORMATION WE COLLECT We collect nonpublic personal information about you that is either provided to us by you or obtained by us with your authorization. PARTIES TO WHOM WE DISCLOSE INFORMATION For current and former clients, we do not disclose any nonpublic personal information obtained in the course of our practice except as required or permitted by law. Permitted disclosures include, for instance, providing information to our employees and, in limited situations, to unrelated third parties who need to know that information to assist us in providing services to you or who may need information we have to process a loan request from you. In all such situations, we stress the confidential nature of information being shared. PROTECTING THE CONFIDENTIALITY AND SECURITY OF CURRENT AND FORMER CLIENTS’ INFORMATION We retain records relating to professional services that we provide so that we are better able to assist you with your professional needs and, in some cases, to comply with professional guidelines. In order to guard your nonpublic personal information, we maintain physical, electronic, and procedural safeguards that comply with our professional standards.
>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> Please call if you have any questions, because your privacy, our professional ethics, and the ability to provide you with quality financial services are very important to us.
Oshima Company CPAA Limited Liability Company
2012 HOLIDAY SCHEDULE
New Year’s Day ................................................................... Monday, January 2, 2012
End of Tax Season Holiday ................................................... Monday, April 23, 2012
Memorial Day ....................................................................... Monday, May 28, 2012
Kamehameha Day ............................................................... Monday, June 11, 2012
Independence Day ............................................................... Wednesday, July 4, 2012
Admission Day ..................................................................... Friday, August 17, 2012
Labor Day ........................................................................... Monday, September 3, 2012
Columbus Day ..................................................................... Monday, October 8, 2012
Veterans' Day ...................................................................... Monday, November 12, 2012
Thanksgiving Day ............................................................... Thursday, November 22, 2012
Day After Thanksgiving ........................................................ Friday, November 23, 2012
Day Before Christmas ......................................................... Monday, December 24, 2012
Christmas Day ..................................................................... Tuesday, December 25, 2012
Mail/Presentation Sheet - to preparer100106 07-14-11
Taxpayer Signature Date
Spouse Signature Date
FROM
TO
I (We) have submitted this information for the sole purpose of preparing my (our) tax return(s).Each item can be substantiated by receipts, canceled checks or other documents. Thisinformation is true, correct and complete to the best of my (our) knowledge.
2011 TAX ORGANIZER
100111 10-10-11
Form Form
Throughout the tax organizer, you will find columns with the heading "TSJ".TSJ Codes - Enter "T" for taxpayer, "S" for spouse or "J" for joint.
~~~~~~~~~~~~~~~~~~~~Gambling Winnings 21~~~~~~~~~~~~~~~~~Alimony Paid or Received
Annuity Payments Received
Application of Refund
13
9, 13
20
~~~~~~~~~~~~~~~~~~~~~~~~~Gifts
Health Savings Accounts
34, 35
13A
~~~~~~~~~~~~~~~
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Household Employment Taxes
Installment Sale Receipts
Interest Income
Interest Paid
Investment Interest Expense
IRA Contributions
IRA Distributions
19
7
5A
14A
14A
9
9, 13
~~~~~~~~~~~~~~~~~~~~~~~~~~~~Business Income and Expenses
Business Use of Home:
6, 6A
~~~~~~~~~~~~~~~~~
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~Business
Employee Business Expenses
Farm
Itemized Deductions
Passthrough
Rental
6D
17A
12D
16A
11B
10D
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
~~~~~~~~~~~~~~~~~Keogh Plan Contributions
Medical and Dental Expenses
Ministerial Income
Miscellaneous Income and Adjustments
Miscellaneous Itemized Deductions
Mortgage Interest Paid
Moving Expenses
Partnership Income
Pension Income
9
14
13B
13
16
14A
8
11
9, 13
~~~~~~~~~~~~~~~~~~~~~~~~~
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~Calendar
Casualty or Theft Losses
Child and Dependent Care Expenses
33
16
18
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~Consolidated Brokerage Statements:
~~~~~~~~~~~~~~~~~~~~~~~~~~~~ 5E
5F
5G
Interest Income & Foreign Information
Dividend Income & Foreign Information
Sales of Stocks, Securities, Capital Assets & Misc. Income
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
~~~~~~~~~~~~~~~~~~~~
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~Contributions
Dependent Information
Depreciable Property and Equipment:
15
3A3
13
11
10
9
11
Personal Information
Railroad Retirement Benefits
Real Estate Mortgage Investment Conduit Income (REMIC)
Rental and Royalty Income and Expenses
Roth IRA Contributions/Conversions
S Corporation Income
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
~~~~~~~~~~~~~~~~~~~~~~~~~Business
Employee Business Expenses
Farm
Rental and Royalty
6A~~~~~~~~~~~~~~~~~~~~~~ 17
12A
10A
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
~~~~~Sale of Stock, Securities and Other Capital Assets
Sale of Your Home
Savings Bond Purchases
SEP/SIMPLE Plan Contributions
Social Security Benefits
State and Local Tax Refunds
Student Loan Interest
Taxes Paid
Trust Income
Unemployment Compensation
7
8
4B
9
13
13
13
14
11
13
~~~~~~~~~~~~~~~~~Direct Deposit Information
Dividend Income
Education Expenses
Educator (Teacher) Expenses
Electronic Filing
Employee Business Expenses
Estate Income
Farm Income and Expenses
Federal, State and City Estimated Taxes
Foreign Assets
Foreign Employment Information
4A
5B
18
13A
4
17
11
12, 12A
20, 20A
5C, 5D
30, 30A, 30B
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Vehicle/Other Listed Property Information:~~~~~~~~
~~~~~~~~~~~~~~~~~~~~~~ 6B, 6C
17
12B, 12C
10B, 10C
11A
Business
Employee Business Expenses
Farm
Rental and Royalty
Partnership/S Corporation
~~~~~~~~~~~~~~~~~Foreign Housing Expenses
Foreign Taxes
Foreign Travel and Workdays
30C
32
30D
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
~~~~~~~~~~~~~~~~~~~~~~~~Foreign Wages and Other Income 31, 31A, 31B
~~~~~~~~~~~~~~
~~~~~~~~~~~~~~~~~~~~Wages and Salaries 3A
Tax Organizer Legend:
Topic Index 1
100121 09-28-11
For any question answered Yes, please attach supporting detail or documents.
Yes No
Did your marital status change during 2011?
If married, do you and your spouse want to file separate returns?
]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]
]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]
Did your address change during 2011?
Can you or your spouse be claimed as a dependent by another taxpayer?
]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]
]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]
Were there any changes in dependents from the prior year? ]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]
Note: Include non-child dependents for whom you provided more than half the support
Did you pay for child care while you worked or looked for work? ]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]
Do you have any children under age 18 with unearned income more than $950? ]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]
Do you have any children age 18 or student children, aged 19 to 23, who did not provide more than half of their cost of supportwith earned income and that have unearned income of more than $950? ]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]
Did you adopt a child or begin adoption proceedings during 2011? ]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]
Did you have any debts canceled, forgiven or refinanced during 2011? ]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]
Did you start a new business, purchase a new rental property, farm or acquire any new interest in any partnership or S corporation during 2011? ]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]
Did you sell an existing business, rental property, farm or any existing interest in a partnership or S corporation during 2011? ]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]
Did you sell, exchange or purchase any real estate in 2011? If so, please attach closing statements. ]]]]]]]]]]]]]]]]]]
Did you withdraw any amounts from your Individual Retirement Account (IRA) or Roth IRA to acquire a principal residence? ]]]]
Did you receive grants of stock options from your employer, exercise any stock options granted to you or dispose of any stock acquired under a qualified employee stock purchase plan? ]]]]]]]]]]]]]]]]]]]]]]]]]]]
Did you pay any student loan interest in 2011? ]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]
Are your total mortgages on your first and/or second residence greater than $1,000,000? If so, please provide
the principal balance and interest rate at the beginning and the end of the year. ]]]]]]]]]]]]]]]]]]]]]]]]]]]]
Did you have an outstanding home equity loan at the end of 2011? If so, please provide the principal balance
and interest rate at the beginning and end of the year. ]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]
Did you take out a home equity loan in 2011? ]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]
Are you claiming a deduction for mortgage interest paid to a financial institution and someone else received the Form 1098? ]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]
]]]]]]]]]]]]Did you or your mortgagee receive any mortgage assistance payments? If Yes, enclose and Forms 1098-MA.
Personal Information:
Dependents:
Purchases, Sales and Debt:
Questions (Page 1 of 4) 2
100122 09-28-11
Yes No
Months
Did you engage in any put or call transactions? If Yes, please provide details. ]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]
Did you close any open short sales during 2011? ]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]
Did you sell any securities not reported on your Form 1099-B? ]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]
Did you contribute property (other than cash) with a fair market value of more than $5,000 to a charitable organization? ]]]]]]]
Did you incur any casualty or theft losses during the year? ]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]
Did you make any large purchases, such as motor vehicles and boats? ]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]
Did you incur any casualty or loss attributable to a federally declared disaster? ]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]
Did you or your spouse have any transactions pertaining to a medical savings account (MSA) during 2011? ]]]]]]]]]]]]]]If you received a distribution from an MSA, please include Form 1099-SA.
Did you or your spouse have any transactions pertaining to a health savings account (HSA) during 2011? ]]]]]]]]]]]]]]If you received a distribution from an HSA, please include Form 1099-SA.
Did you or your spouse contribute to a Roth IRA or convert an existing IRA into a Roth IRA? ]]]]]]]]]]]]]]]]]]]]]]]
Did you or your spouse roll into a Roth IRA any distributions from a retirement plan, an annuity plan, tax shelter annuity or deferred compensation plan? ]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]
In 2010 did you or your spouse convert an IRA into a Roth IRA and not elect to include the taxable amountin your 2010 taxable income? ]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]
Did you rollover any amounts from a qualified retirement plan to a Roth IRA or Designated Roth Account and not electto include the taxable distribution in your 2010 taxable income? ]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]
Did you withdraw any amounts from your IRA to pay for higher education expenses incurred by you, your spouse, your children or grandchildren? ]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]
Did you withdraw amounts from a Coverdell Education Savings Account or Qualified Education Program (Section 529 plan)? If Yes, include Form 1099-Q. ]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]
Did you or your dependents incur any post-secondary education expenses, such as tuition? ]]]]]]]]]]]]]]]]]]]]]]]
If you or your spouse are self-employed, are you or your spouse eligible to be coveredunder an employer's health plan at another job? If Yes, how many months were you covered? ]]]]]]]]]]]]
Did you move to a different home because of a change in the location of your job? ]]]]]]]]]]]]]]]]]]]]]]]]]]]]
Did you pay in excess of $1,000 in any quarter, or $1,700 during the year for domestic services performed in or around your home to individuals who could be considered household employees? ]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]
Did you receive unreported tip income of $20 or more in any month of 2011? ]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]
Did you or your spouse receive distributions from long-term care insurance contracts? If Yes, please include Form 1099-LTC. ]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]
Were you or your spouse a grantor or transferor for a foreign trust, have an interest in or a signature or other authority over a bank account, securities account or other financial account in a foreign country? ]]]]]]]]]]]]]]
Did you or your spouse own any foreign financial assets? ]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]
Did you create or transfer money or property to a foreign trust? ]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]
]]]]]Did you purchase a new alternative technology vehicle, including a qualified plug-in electric drive motor vehicle in 2011?
Purchases, Sales and Debt (continued):
Itemized Deductions:
Miscellaneous:
Questions (Page 2 of 4) 2B
100125 09-28-11
Yes No
Date
Did you use gasoline or special fuels for business or farm purposes (other than for a highway vehicle) during the year? ]]]]]]]
Have you received a punitive damage award or an award for damages other than for physical injuries or illness? ]]]]]]]]]]]
Were you notified by the IRS or other taxing authority of any changes in prior year returns? ]]]]]]]]]]]]]]]]]]]]]]]
Did you lose your job during 2011 because of foreign competition and pay for your own health insurance? ]]]]]]]]]]]]]]
Did you install any alternative energy equipment in your residence such as solar water heaters, solar electricity
equipment (photovoltaic) or fuel cells? ]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]
Did you install any energy efficiency improvements, or energy property in your residence such as exterior doors
or windows, insulation, heat pumps, furnaces, central air conditioners or water heaters? ]]]]]]]]]]]]]]]]]]]]]]]
Have you been an identity theft victim and have you contacted the IRS? ]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]
If Yes, please furnish the 6-digit identity protection PIN issued to you by the IRS ]]]]]]]]]]]]]
Did you engage in any bartering transactions? ]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]
Did you make gifts of more than $13,000 to any individual? ]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]
Did you have any foreign income or pay any foreign taxes during 2011? ]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]
Did you retire or change jobs in 2011? ]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]
Did you receive deferred, retirement or severance compensation? ]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]
If Yes, enter the date received (Mo/Da/Yr).
Did you or your spouse turn 70 1/2 during the year and have money in an IRA or other retirement account while not
taking a distribution? ]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]
Miscellaneous: (continued)
Severance/Retirement:
Questions (Page 3 of 4) 2C
100124 05-23-11
Name of Designated BeneficiarySocial Security
NumberState
Sponsoring Plan Account Number2011 AmountContributed
Did you sell your home in 2011? ]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]
If Yes, did you own and occupy the home as your principal residence for at least two years of the five-year period prior to the sale? ]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]
Did you ever rent out this property?
Did you ever use any portion of the home for business purposes?
]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]
]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]
Have you or your spouse sold a principal residence within the last two years? ]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]
At the time of the sale, the residence was owned by the: Taxpayer Spouse Both
For any trust you created or that you are trustee, have any beneficiaries died during 2011? ]]]]]]]]]]]]]]]]]]]]]]]
Did you or your spouse make any contributions to Qualified State Tuition Plans (Section 529 plans) during 2011? ]]]]]]]]]]
If Yes, enter the following:
Sale of Your Home:
Additional Information:
Questions (Page 4 of 4) 2D
First Name and Initial Last Name Social Security Number
Occupation Date of Birth (Mo/Da/Yr) Date of Death (Mo/Da/Yr)
First Name and Initial Last Name Social Security Number
Occupation Date of Birth (Mo/Da/Yr) Date of Death (Mo/Da/Yr)
Street Address Apartment Number
City State ZIP or Postal Code
Province or County
Foreign Country
Taxpayer Daytime/Work Phone Spouse Daytime/Work Phone
Taxpayer Evening/Home Phone Spouse Evening/Home Phone
Taxpayer Cell Phone Spouse Cell Phone
Taxpayer Fax Number Spouse Fax Number
Taxpayer Email Address
Spouse Email Address
Preferred Method of Contact
100131 07-21-11
Taxpayer:
Spouse:
Contact Information:
Yes No
Taxpayer Spouse
Yes No Yes No
Forms 1 and 2
Worksheets: Basic Data > General and Return Options > Processing Options
May the IRS or other taxing authority discuss the return with the preparer? ]]]]]]]]]]]]]]]]]]]]]]]]
Is the taxpayer claimed as a dependent on someone else's tax return? ]]]]]]]]]]]]]]]]]]]]]]]]]]
Are you considered legally blind per IRS regulations?
Do you want to contribute to the Presidential Election Campaign Fund?
]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]
]]]]]]]]]]]]]]]]]]]]]]]]]]
Personal Information 3
100133 09-28-11
Did dependent have income over $3,700?
First Name and Initial Last NameSocial Security
NumberDate of Birth(Mo/Da/Yr)
Relationship toTaxpayer
MonthsLived in
YourHome
X ifDisabled
YesorNo
TS Employer's Name Taxable WagesTax Withheld
Federal FICA/TIER1 Medicare State Local
Forms 1, IRS-W2 and S-37
Worksheets: Basic Data > Dependents, Wages, Salaries and Tips and Other > Rel/Rev of Claim to Exemption for Child (Form 8332)
Please provide the name of any person living with you who is claimed as a dependent
on someone else's tax return
Please list the years that a release of claim to exemption is given for a dependent child not living with you ]]]]]]]
Dependent Information:
Wages and Salaries: Please enclose all copies of your current year Forms W-2
3ADependents and Wages
L
100531 07-14-11
The IRS requires the use of a 5-digit self-selected Personal Identification Number (PIN) in lieu of mailing a signature document when
electronically filing.
Yes No
Form EF-1 and EF-3
Worksheet: Electronic Filing > Form 8948 - Preparer Explanation for Not Filing Electronically and Paperless Efile
Electronic filing is the means by which your return is transmitted directly to the IRS. The IRS has implemented an electronic filing mandaterequiring certain preparers to file all returns that they prepare electronically. Some states also require certain preparers to electronically filestate returns prepared. The IRS and some states allow taxpayers to elect not to file their returns electronically.
Do not electronically file the federal return ]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]
Do not electronically file the state return(s) ]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]
Would you like to use a randomly generated PIN?
Taxpayer ]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]
Spouse ]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]
If No, please enter a 5-digit self-selected PIN:
Taxpayer PIN
Spouse PIN
]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]
]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]
Please enclose all copies of your current year Forms W-2Electronic Filing:
Electronic Filing 4
100147 09-09-11
(To properly file your return, please attach a voided check or a copy of a monthly statement for your account.)
Yes No
Yes No
Form BNK-1
Worksheet: Basic Data > Direct Deposit / Electronic Funds Withdrawal
The IRS and certain states allow refunds to be deposited directly into your financial institution account, regardless of the means used to file the return.For balance due returns to be filed electronically, the IRS and many states allow the entire amount due to be paid using electronic withdrawal. If youwould like to have your refund deposited directly into your account or pay a balance due by using an electronic withdrawal, please complete thefollowing information.
Owner of account ]]]]]]]]]]]]]]]]]]]]]]]]]]] Taxpayer Spouse Joint
Select type of account ]]]]]]] Checking Trad. Savings IRA Savings HSA Savings
Archer MSA Savings Coverdell Ed.Savings
Name of financial institution ]]]]]]]]]]]]]]]]]]]]]
Financial Institution Routing Transit Number (if known)
(Use the routing number from a check, NOT a deposit slip. They can be different.
The Routing Transit Number must begin with 01 through 12 or 21 through 32.)
]]]]]
Your account number ]]]]]]]]]]]]]]]]]]]]]]]]
Is this a business account? ]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]
Do you want your refund deposited directly into your financial institution account? ]]]]]]]]]]]]]]]]]]]]]
If you are filing a balance due return electronically, do you want to pay the amount due using an electronic withdrawal?
What amount do you want withdrawn if not the entire balance due?
What date do you want the withdrawal done?
]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]
]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]] (Mo/Da/Yr)
Owner of account ]]]]]]]]]]]]]]]]]]]]]]]]]]] Taxpayer Spouse Joint
Select type of account ]]]]]]] Checking Trad. Savings IRA Savings HSA Savings
Archer MSA Savings Coverdell Ed.Savings
Name of financial institution ]]]]]]]]]]]]]]]]]]]]]
Financial Institution Routing Transit Number (if known)
(Use the routing number from a check, NOT a deposit slip. They can be different.
The Routing Transit Number must begin with 01 through 12 or 21 through 32.)
]]]]]
Your account number ]]]]]]]]]]]]]]]]]]]]]]]]
Is this a business account? ]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]
Do you want your refund deposited directly into your financial institution account? ]]]]]]]]]]]]]]]]]]]]]
If you are filing a balance due return electronically, do you want to pay the amount due using an electronic withdrawal?
What amount do you want withdrawn if not the entire balance due?
What date do you want the withdrawal done?
]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]
]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]] (Mo/Da/Yr)
Direct Deposit and Electronic Withdrawal Account Information:
Direct Deposit and Withdrawal 4A
!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!
100341 05-01-11
TS Payer Name Prior Year AmountInformationIncluded (X
or )
Wages
U
100151 05-09-11
TSJ Name of PayerSavings & Loans,Bank and Other
U.S. Bonds andObligations
CodeTax-Exempt
Interest2010 Interest
Amount
Total
Name of Individual to WhomMortgage Interest Was Paid
IdentificationNumber of Individual
2011 InterestAmount
2010 InterestAmount
Address of Individual to Whom Mortgage Interest Was Paid
Form IRS-1099INT
Worksheet: Interest
1 - 1099-INT 2 - Private Activity Bond 3 - BothTax-Exempt Interest Code:
Interest Information:
Please enclose copies of all Forms 1099-INT or other documents for interest received
Seller-Financed Mortgage Interest Information:
Enter Any Additional Information:
Note: Please list all items sold during the year on Form 7.
Interest Income 5A
L
100152 05-09-11
TSJ Name of PayerBox 1a
Total OrdinaryDividends
Box 1bQualifiedDividends
Box 2aTotal Capital
Gain Distribution
U.S. Bond InterestAmount or
Percent in Box 1a
2010 GrossDividends Amount
Total
Form IRS-1099DIV
Worksheet: Dividends
Dividend Information:
Please enclose copies of all Forms 1099-DIV or other documents for dividends received
Enter Any Additional Information:
Note: Please list all items sold during the year on Form 7.
Dividend Income 5B
100153 09-16-11
Note:
Yes No
AccountType
If Other Account Type, DescribeMaximumAccount Value
Account NumberFinancial
Institution Name
Street Address City State ZIP/Postal Code Country
Last Name or Organization Name First NameMiddleInitial
Taxpayer IDNumber
# ofJoint
Owners
Street Address City State ZIP/Postal Code CountryOwner-
shipCode
Type Foreign Currency Exchange Rate Source of Exchange AcctOpen
AcctClosed Joint
No TaxItems
Reported
Yes No
Form BNK-2
Worksheet: 90-22.1 and 8938 - Foreign Assets
If the aggregate value of the accounts does not exceed $10,000, then you do not need to provide details.
TSJ
Title of filer
]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]
]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]
Enter all countries where you have foreign bank accounts ]]]]]]]]]]]]]]]]]]]]]]]]]]]
Passport
If not passport, enter description
Number
Country of issue
]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]
]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]
]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]
]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]
1 - Bank Account 2 - Securities Account 3 - Other
A
B
A
B
If you have no financial interest in the account or account is jointly owned, please complete the account owner information below.
A
B
1 - No financial interest 2A - Joint ownership - spouse is joint owner 2B - Joint ownership - other joint owner
A
B
1 - Deposit 2 - Custodial
A
B
At any time during 2011, did you have an interest in or a signature or other authority over a financial account in a foreign country, such as a bank account, securities account or other financial account? ]]]]]]]]]]]]]]]]]]]]
If Yes, enter name of foreign country ]]]]]]]]]]]]]]]]]]]]
Were you the grantor of, or transferor to, a foreign trust that existed during 2011, whether or not you had any beneficial interest in it? ]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]
General Information:
Foreign Identification:
Information on Foreign Financial Accounts:
Foreign Bank Accounts and Trusts:
Foreign Assets 5C
<
<
<
100595 09-19-11
Date Acquired(Mo/Da/Yr)
Date Sold(Mo/Da/Yr)
Description Identifying NumberJointlyOwned
No TaxItems
Reported
Value Foreign Currency Exchange Rate Source of Exchange Rate
Name of Foreign EntityType ofForeignEntity
X ifPFIC Mailing Address of Foreign Entity
City or Town of Foreign Entity Province, County or State of Foreign EntityCountry of
Foreign EntityPostal Code ofForeign Entity
Name of IssuerIssuerCode
Type ofIssuer
Residenceof Issuer
Mailing Address of Issuer City or Town of Issuer
Province, County or State of IssuerCountryof Issuer
Postal Codeof Issuer
Form BNK-3
Worksheet: 90-22.1 and 8938 - Foreign Assets
A
B
A
B
1 - Partnership 2 - Corporation 3 - Trust 4 - Estate
A
B
A
B
1 - U.S. person2 - Foreign person
1 - Issuer 2 - Counterparty
A
B
1 - Individual 2 - Partnership 3 - Corporation 4 - Trust 5 - Estate
A
B
A
B
Asset Information:
If Asset is Stock of a Foreign Entity or an Interest in a Foreign Entity
If Asset is NOT Stock of a Foreign Entity or an Interest in a Foreign Entity
Foreign Assets 5D
<
< <
;
100591 05-09-11
TSJ Payer Name Account No.InformationIncluded (X
or )
Savings & Loans,Bank and Other
U.S. Bonds andObligations
Tax-ExemptInterest
Box 1aTotal Ordinary
Dividends
Box 1bQualifiedDividends
Box 2aTotal Capital
Gain Distribution
U.S. Bond InterestAmount or
Percent in Box 1a
Form CN-1
Worksheet: Consolidated 1099
A
B
C
D
E
F
G
H
I
J
K
L
M
N
O
P
Q
R
S
T
A
B
C
D
E
F
G
H
I
J
K
L
M
N
O
P
Q
R
S
T
Note: For other amounts not listed, please attach a copy of your brokerage statement.
5DABrokerage Statement Details
U
100161 10-31-11
Yes No
2011 Amount 2010 Amount
2011 Amount 2010 Amount
2011 Amount 2010 Amount
Description 2011 Amount 2010 Amount
Description 2011 Amount 2010 Amount
Forms C-1, C-2 and C-3
Worksheet: Business > General, Income and Cost of Goods Sold
]]]]]]]]]]]]]]
]]]
TSJ ]]]]]]]]]]]]]]]]]]]]]]]]]
Employer ID number
Street address
City, state and ZIP code
Method of inventory
Method of accounting
]]]]]]]]]]]]]]]
]]]]]]]]]]]]]]]]]]
]]]]]]]]]]]]]
]]]]]]]]]]]]]]]
]]]]]]]]]]]]]]
Did you dispose of this business? ]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]
]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]If Yes, what was the disposition date? (Mo/Da/Yr)
Was there a change in determining quantities, costs or valuations between opening and closing inventory? ]]]]]]]]]]]]]]
Were you involved in the operations of this business on a regular, continuous and substantial basis?
Have you prepared or will you prepare all required Forms 1099?
]]]]]]]]]]]]]]]]]
]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]
Health insurance premiums paid for yourself and your dependents ]]]]]]]]]]]]]]]]]]
Other gross receipts or sales
Less returns and allowances
]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]
]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]
Beginning inventory ]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]
Purchases less cost of items withdrawn for personal use
Cost of labor (do not include amounts paid to yourself)
Materials and supplies
]]]]]]]]]]]]]]]]]]]]]]]]
]]]]]]]]]]]]]]]]]]]]]]]]
]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]
Other Costs of Cost of Goods Sold:
Ending inventory ]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]
Name of Business:
Principal Business or Profession:
Business Questions for 2011:
Income:
Cost of Goods Sold:
Other Income:
Business Income and Cost of Goods Sold 6
100163 06-28-11
Yes No
If you are an employer who provides vehicles for use by employees:Yes No
Vehicle 1 Vehicle 2
2011 Miles 2010 Miles 2011 Miles 2010 MilesMileage:
2011 Amount 2010 Amount 2011 Amount 2010 AmountActual Expenses:
Forms C-4 and C-5
Worksheet: Business > Auto Information, Depreciation and Listed Property Questions
]]]]]]]]]]]]]]
]]]
Do you have evidence to support your deduction? ]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]
If Yes, is the evidence written? ]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]
Do you have evidence to support the business use percentage claimed on listed property? ]]]]]]]]]]]]]]]]]]]]]]]
If Yes, is the evidence written? ]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]
Do you maintain a written policy statement that prohibits all personal use of vehicles, including commuting, by your employees?
Do you maintain a written policy statement that prohibits personal use of vehicles, except commuting, by your employees? ]]
Do you treat all use of vehicles by employees as personal use?
Do you provide more than five vehicles to your employees, obtain information from your employees about the use of the
]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]
vehicles and retain the information received? ]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]
Do you meet the requirements for qualified demonstration use by maintaining a written policy statement that prohibits
vehicle use by individuals other than full-time vehicle salespersons, use for personal vacation trips, storage of
personal possessions in the vehicle and limits the total mileage outside the salesperson's normal working hours? ]]]]]]
Description of vehicle
Date placed in service
Do you (or your spouse) have another
vehicle available for your personal use?
Was your vehicle available for use during
off-duty hours?
]]]]]]]]]]
]]]]](Mo/Da/Yr)
Yes
Yes
No
No
Yes
Yes
No
No]]]]]]]]]]]]]
Total miles
Total business miles
Total business miles after June 30
Total commuting miles for the year
]]]]]]]]]]]]]]]]
]]]]]]]]]]
]]]
]]
Gasoline, oil, repairs, insurance, etc
Interest
Taxes
Fair market value of leased vehicle
Vehicle rentals/leases
]]
]]]]]]]]]]]]]]]]]
]]]]]]]]]]]]]]]]]]]
]]
]]]]]]]]]
Name of Business:
Principal Business or Profession:
Listed Property Questions for 2011:
Vehicle:
Business Expenses - Vehicle andOther Listed Property
6B
100164 08-05-11
2011 Amount 2010 Amount
Description 2011 Amount 2010 Amount
2011 Amount 2010 Amount
2011 2010
Description 2011 Amount 2010 Amount
Forms A-10 and DP-1
Worksheet: Employee Business Expense
]]]]]]]]]]]]]]
]]]
If these expenses are to be divided between two or more businesses, please enter the percentage to apply to this business ]]] %
Parking fees and tolls
Local transportation
Travel expenses
Meals and entertainment
]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]
]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]
]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]
]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]
Other Business Expenses:
Amount received for other expenses
Amount received for meals and entertainment
If you are a statutory employee, does your employer's reimbursement plan for meals
]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]
]]]]]]]]]]]]]]]]]]]]]]]]]]]]]
and entertainment allow for offset of other reimbursements? ]]]]]]]]]]]]]]]]]] Yes No
If these vehicle expenses are to be divided between two or more businesses, please enter
the percentage to apply to this business ]]]]]]]]]]]]]]]]]]]]]]]]]]]]]] %
Description of vehicle
Date vehicle was placed in service
]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]
(Mo/Da/Yr)]]]]]]]]]]]]]]]]]]]]]]]]]]]
]]]]]]]]] Yes NoDo you (or your spouse) have another vehicle available for personal purposes?
Was your vehicle available for personal use during off-duty hours? ]]]]]]]]]]]]]]]]] Yes No
Total miles
Total business miles
Total business miles after June 30
]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]
]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]
]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]
]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]Average daily commuting miles
Total commuting miles for the year ]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]
Gasoline and oil
Repairs
Insurance
Interest
Taxes
]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]
]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]
]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]
]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]
]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]
Value of employer provided vehicle
Temporary vehicle rentals
Fair market value of leased vehicle
Vehicle leases
]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]
]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]
]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]
]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]
Other Vehicle Expenses:
Name of Business:Principal Business or Profession:
Enter all expenses at 100 percentBusiness Expenses:
Reimbursements: Please list only reimbursements NOT reported inBox 1 of your Form W-2
Vehicle:
Business Expenses 6C
100166 05-09-11
2011 2010
Yes No
Direct Expenses Indirect Expenses
2011 Amount 2010 Amount 2011 Amount 2010 Amount
DescriptionDirect Expenses Indirect Expenses
2011 Amount 2010 Amount 2011 Amount 2010 Amount
Name of Individual to WhomMortgage Interest Was Paid
IdentificationNumber of Individual
Address of Individual to Whom Mortgage Interest Was Paid
Form M-15
Worksheet: Business > Business Use of Home
]]]]]]]]]]]]]]
]]]
Square footage of home used exclusively for business
Total square footage of home
Total hours home was used for day care during the year
]]]]]]]]]]]]]]]]]]]]]]]
]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]
]]]]]]]]]]]]]]]]]]]]]]
Was your home used for day care purposes for the entire year?
Were improvements made to the home and/or home office since the time you began using the home for business?
]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]
]]]]]]]]
Direct expenses benefit the business part of your home.Example: Cost of painting or repairs made to the specific area or room used for business.
Indirect expenses are required for keeping up and running your entire home.Example: Real estate taxes.
Casualty losses
Deductible mortgage interest paid to:
]]]]]]]]]]]]]]]]]]
Financial institutions
Individuals
]]]]]]]]]]]]]
]]]]]]]]]]]]]]]]]]]
Real estate taxes
Insurance
Qualified mortgage insurance premiums
]]]]]]]]]]]]]]]]]]
]]]]]]]]]]]]]]]]]]]]]]
]]]]
Repairs and maintenance
Utilities
Rent
]]]]]]]]]]]]]
]]]]]]]]]]]]]]]]]]]]]]]
]]]]]]]]]]]]]]]]]]]]]]]]]
Name of Business:
Principal Business or Profession:
Partial Use of Your Home for Business:
Expenses: Enter all expenses at 100 percent
Other Expenses:
Seller-Financed Mortgage Interest Information:
Business Use of Home 6D
100171 08-04-11
Yes No
TSJ Kind of Property and DescriptionGross SalesPrice (Less
Commissions)
Cost orOther Basis
DateAcquired
(Mo/Da/Yr)
Date Sold(Mo/Da/Yr)
Federal TaxWithheld
TSJ Property Description Date Sold(Mo/Da/Yr)
2011Principal Received
2010Principal Received
Forms D-1, D-5, D-6, D-7 and D-11
Worksheets: Gains and Losses > Stocks, Securities and Other Non-Passive Transactions and Installment Sales > General
and Schedule of Receipts / Collections
Did you have any of the following during the year?
Mutual fund transactions ]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]
Exchange of any securities or investments for something other than cash
Sales of inherited property
]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]
]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]
Sales of any stock or stock options at a loss and purchases of the same or substantially similar stock or options 30 days
before or 30 days after the sale ]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]
Commodity sales, short sales or straddles ]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]
Reinvestment of the proceeds of the sale of a publicly traded security into an SSBIC interest ]]]]]]]]]]]]]]]]]]]]]]
Reinvestment of the proceeds of the sale of qualified small business stock in other qualified small business stock ]]]]]]]]]]
Debts that became uncollectible ]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]
Securities that became worthless ]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]
Sale of any property where you will receive payments in future years ]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]
Gains or Losses from Sales of Stocks, Securities and Other Capital Assets:
Please enclose all Forms 1099-A, 1099-B, 1099-S and copies of mutual fund statements for the year
Installment Sales: Do not include interest received in principal amount
Sales of Stocks, Securities,Capital Assets & Installment Sales 7
100191 05-09-11
Rollover?
Yes NoIRA Questions for 2011:
IRA Values, Rollovers, and Distributions:
Contributions:
TSJ Name of Payer2011 Gross
DistributionsTaxableAmount
Federal TaxWithheld
State TaxWithheld
Is this a 2010 GrossDistributionsIRA?
Taxpayer Spouse
Yes No Yes No
2011 Amount 2011 AmountContributions to:
Forms M-5, M-6, M-22, M-23, IRS-1099Q and IRS-1099R
Worksheets: IRAs, Pensions and Annuities and Keogh, SEP and Simple Plans
TS
Name of payer
]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]
]]]]]]]]]]]]]]]]]]]]]]]]]]]
Are you covered by an employer's retirement plan? ]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]
If no, is your spouse covered by an employer's retirement plan? ]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]
Do you want to limit your IRA contribution to the maximum amount deductible on your tax return? ]]]]]]]]]]]]]]]]
If no, do you want to contribute the maximum allowable amount to your IRA even though you may not qualify
for an IRA deduction? ]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]
]]]]]]]]]]]]]]]Did you receive distributions in 2011 from a traditional IRA, Roth IRA or Qualified Education Account?
Did you convert a traditional IRA to a Roth IRA in 2011? ]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]
Did you use your IRA as security for a loan this year? ]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]
]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]Did you have any transactions with your IRA during the year?
If Yes, please explain.
Total value of all traditional IRAs on December 31, 2011
Outstanding rollovers on December 31, 2011
IRA distributions received during 2011
]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]
]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]
]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]
Total distributions converted to Roth IRAs
Total retirement plans converted to Roth IRAs
]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]
]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]
IRA:
Contributions in 2011 for the 2011 tax return
Contributions in 2012 for the 2011 tax return
Amount for 2011 you choose to be treated as nondeductible
]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]
]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]
]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]
Roth IRA:
Contributions made for the 2011 tax year ]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]
Have you established a self-employed retirement or SIMPLE plan with
]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]deductible contributions?
]]]]]]]]]]]]]]]]]]]Do you want to contribute the maximum amount allowed?
Simplified employee pension plan
Defined benefit plan
Defined contribution plan
SIMPLE plan
]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]
]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]
]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]
]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]
Individual Retirement Account (IRA):
Please enclose copies of all Forms 1099-R
Please enclose copies of all Forms 5498
Pensions and Annuities: Please enclose all Forms 1099-R and any nontaxable distribution details
Self-Employed Retirement Plan: Please enclose copies of all Forms 1099-R
IRA, Pension, Annuity and Retirement Plan Information 9
100201 10-31-11
Yes No
2011 2010
2011 Amount 2010 Amount
Description 2011 Amount 2010 Amount
2011 Amount 2010 Amount
Description 2011 Amount 2010 Amount
Forms E-1, E-2, E-3, E-4, D-2, DP-1 and DP-2
Worksheet: Rent and Royalty > General, Income and Expenses
TSJ
Type of property
]]]]]]]]]]]
]]]
Have you prepared or will you prepare all required Forms 1099? ]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]
Ownership percentage if not 100%
How many days was this property rented at fair market value?
How many days was this property used personally (including use by family members)?
]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]] %
]]]]]]]]]]]]]]]]]]]
]]]]]
Rents received
Royalties received
]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]
]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]
Other Income:
Advertising
Auto and travel
Cleaning and maintenance
]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]
]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]
]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]
]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]Commissions
Insurance
Legal and other professional fees
Management fees
]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]
]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]
]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]
]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]Mortgage interest paid to banks, etc.
Mortgage interest paid to individuals
Other interest
Repairs
]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]
]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]
]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]
]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]Supplies
Taxes
Utilities
Dependent care benefits
]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]
]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]
]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]
Employee benefits ]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]
Other Expenses:
Location of Property:
Income:
Expenses:
Rental and Royalty Income and Expenses 10
100202 05-09-11
X ifnot new Description Date Acquired
(Mo/Da/Yr) Cost
Description Date Acquired(Mo/Da/Yr) Cost Date Sold
(Mo/Da/Yr) Selling Price
Production TypeRoyalty Income
2011 Amount 2010 Amount
Forms E-1, E-2, E-3, E-4, D-2, DP-1 and DP-2
Worksheets: Rent and Royalty > Depreciation and Amortization (Form 4562) and Depletion and Gains and Losses > Business Property,
Casualties and Thefts
Location of Property:
Property and Equipment: Please attach a list if more space is needed
Acquisitions:
Dispositions:
Percentage Depletion Information:
Rental and RoyaltyProperty and Equipment & Depletion
10A
100203 06-28-11
Yes No
If you are an employer who provides vehicles for use by employees:Yes No
Vehicle 1 Vehicle 2
2011 Miles 2010 Miles 2011 Miles 2010 MilesMileage:
2011 Amount 2010 Amount 2011 Amount 2010 AmountActual Expenses:
Forms E-4 and E-5
Worksheet: Rent and Royalty > Auto Information, Depreciation and Listed Property Questions
Do you have evidence to support your deduction? ]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]
If Yes, is the evidence written? ]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]
Do you have evidence to support the business use percentage claimed on listed property? ]]]]]]]]]]]]]]]]]]]]]]]]
If Yes, is the evidence written? ]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]
Do you maintain a written policy statement that prohibits all personal use of vehicles, including commuting, by your employees?
Do you maintain a written policy statement that prohibits personal use of vehicles, except commuting, by your employees? ]]
Do you treat all use of vehicles by employees as personal use?
Do you provide more than five vehicles to your employees, obtain information from your employees about the use of the
]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]
vehicles and retain the information received? ]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]
Do you meet the requirements for qualified demonstration use by maintaining a written policy statement that prohibits vehicle
use by individuals other than full-time vehicle salespersons, use for personal vacation trips, storage of personal
possessions in the vehicle and limits the total mileage outside the salesperson's normal working hours? ]]]]]]]]]]]
Description of vehicle
Date placed in service
]]]]]]]]]]]
(Mo/Da/Yr)]]]
Do you (or your spouse) have another
vehicle available for your personal
use? ]]]]]]]]]]]]]]]]]]] Yes
Yes
No
No
Yes
Yes
No
No
Was your vehicle available for use during
off-duty hours? ]]]]]]]]]]]]]
Total miles
Total business miles
Total business miles after June 30
Total commuting miles for the year
]]]]]]]]]]]]]]]]
]]]]]]]]]]
]]]
]]
Gasoline, oil, repairs, insurance, etc
Interest
Taxes
Fair market value of leased vehicle
Vehicle rentals/leases
]]
]]]]]]]]]]]]]]]]]]
]]]]]]]]]]]]]]]]]]]
]]
]]]]]]]]]
Location of Property:
Listed Property Questions for 2011:
Vehicle:
Rental and Royalty Vehicleand Other Listed Property
10B
100204 08-05-11
2011 Amount 2010 Amount
Description 2011 Amount 2010 Amount
2011 Amount 2010 Amount
2011 2010
Description 2011 Amount 2010 Amount
Forms A-10 and DP-1
Worksheet: Employee Business Expense
If these expenses are to be divided between two or more businesses, please enter the percentage to apply to this business ]]] %
Parking fees and tolls
Local transportation
Travel expenses
Meals and entertainment
]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]
]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]
]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]
]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]
Other Business Expenses:
Amount received for other expenses
Amount received for meals and entertainment
]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]
]]]]]]]]]]]]]]]]]]]]]]]]]]]]]
If these vehicle expenses are to be divided between two or more businesses, please enter
the percentage to apply to this business ]]]]]]]]]]]]]]]]]]]]]]]]]]]]]] %
Description of vehicle
Date vehicle was placed in service
]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]
(Mo/Da/Yr)]]]]]]]]]]]]]]]]]]]]]]]]]]]
]]]]]]]]]] Yes
Yes
No
No
Do you (or your spouse) have another vehicle available for personal purposes?
Was your vehicle available for personal use during off-duty hours? ]]]]]]]]]]]]]]]]]
Total miles
Total business miles
Total business miles after June 30
]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]
]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]
]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]
Average daily commuting miles
Total commuting miles for the year
]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]
]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]
Gasoline and oil
Repairs
Insurance
Interest
Taxes
]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]
]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]
]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]
]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]
]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]
Value of employer provided vehicle
Temporary vehicle rentals
Fair market value of leased vehicle
Vehicle leases
]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]
]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]
]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]
]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]
Other Vehicle Expenses:
Location of Property:
Enter all expenses at 100 percentBusiness Expenses:
Reimbursements: Please list only reimbursements NOT reported inBox 1 of your Form W-2
Vehicle:
Rental and Royalty Business Expenses 10C
100206 05-09-11
2011
Direct Expenses Indirect Expenses
2011 Amount 2010 Amount 2011 Amount 2010 Amount
DescriptionDirect Expenses Indirect Expenses
2011 Amount 2010 Amount 2011 Amount 2010 Amount
Name of Individual to WhomMortgage Interest Was Paid
IdentificationNumber of Individual
Address of Individual to Whom Mortgage Interest Was Paid
Form M-15
Worksheet: Employee Business Expense > Business Use of Home
Square footage of home used exclusively for business
Total square footage of home
]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]
]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]
Were improvements made to the home and/or home office since the time you began using the home for business? ]] Yes No
Direct expenses benefit the business part of your home.
Example: Cost of painting or repairs made to the specific area or room used for business.
Indirect expenses are required for keeping up and running your entire home.
Example: Real estate taxes.
Casualty losses
Deductible mortgage interest paid to:
]]]]]]]]]]]]]]]]]]]
Financial institutions
Individuals
]]]]]]]]]]]]]]
]]]]]]]]]]]]]]]]]]]]
Real estate taxes
Insurance
Qualified mortgage insurance premiums
]]]]]]]]]]]]]]]]]]
]]]]]]]]]]]]]]]]]]]]]]
]]]]
Repairs and maintenance
Utilities
Rent
]]]]]]]]]]]]]
]]]]]]]]]]]]]]]]]]]]]]]]
]]]]]]]]]]]]]]]]]]]]]]]]]]
Location of Property:
Partial Use of Your Home for Business:
Expenses: Enter all expenses at 100 percent
Other Expenses:
Seller-Financed Mortgage Interest Information:
Rental - Business Use of Home 10D
100211 05-09-11
TSJ Entity Name Employer IDNumber
Health InsurancePaid by Entity
TSJ Entity Name Employer IDNumber
Health InsurancePaid by Entity
TSJ Entity Name Employer IDNumber
TSJ Entity Name Employer IDNumber
Forms K-1 through K-12, IRS-K1 1065, IRS-K1 1120S and IRS-K1 1041
Worksheets: Fiduciary Passthrough, Fiduciary Passthrough (A), Partnership Passthrough, Large Partnership Passthrough,
S Corporation Passthrough and Other Passthrough
Please enclose all Schedules K-1Partnership Income:
S Corporation Income: Please enclose all Schedules K-1
Estate and Trust Income: Please enclose all Schedules K-1
Real Estate Mortgage Investment Conduit (REMIC) Income: Please enclose all Schedules Q
Partnership, S Corporation, Estate, Trustand REMIC Income
11
100212 06-28-11
2011 Amount 2010 Amount
Description 2011 Amount 2010 Amount
2011 Amount 2010 Amount
2011 2010
Description 2011 Amount 2010 Amount
Forms A-10 and DP-1
Worksheet: Employee Business Expense
]]]]
If these expenses are to be divided between two or more businesses, please enter the percentage to apply to this business ]]] %
Parking fees and tolls
Local transportation
Travel expenses
Meals and entertainment
]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]
]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]
]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]
]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]
Other Business Expenses:
Amount received for other expenses
Amount received for meals and entertainment
]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]
]]]]]]]]]]]]]]]]]]]]]]]]]]]]]
If these vehicle expenses are to be divided between two or more businesses, please enter
the percentage to apply to this business ]]]]]]]]]]]]]]]]]]]]]]]]]]]]]] %
Description of vehicle
Date vehicle was placed in service
]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]
]]]]]]]]]]]]]]]]]]]]]]]]]]] (Mo/Da/Yr)
Do you (or your spouse) have another vehicle available for personal purposes?
Was your vehicle available for personal use during off-duty hours?
]]]]]]]]]] Yes
Yes
No
No]]]]]]]]]]]]]]]]]
Total miles
Total business miles
Total business miles after June 30
]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]
]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]
]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]
Average daily commuting miles
Total commuting miles for the year
]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]
]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]
Gasoline and oil
Repairs
Insurance
Interest
Taxes
]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]
]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]
]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]
]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]
]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]
Value of employer provided vehicle
Temporary vehicle rentals
Fair market value of leased vehicle
Vehicle leases
]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]
]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]
]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]
]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]
Other Vehicle Expenses:
Activity Name:
Enter all expenses at 100 percentBusiness Expenses:
Reimbursements: Please list only reimbursements NOT reportedin Box 1 of your Form W-2
Vehicle:
Partnership and S Corporation Business Expenses 11A
100213 05-09-11
2011
Direct Expenses Indirect Expenses
2011 Amount 2010 Amount 2011 Amount 2010 Amount
Direct Expenses Indirect Expenses
Description 2011 Amount 2010 Amount 2011 Amount 2010 Amount
Name of Individual to WhomMortgage Interest Was Paid
IdentificationNumber of Individual
Address of Individual to Whom Mortgage Interest Was Paid
Form M-15
Worksheets: Fiduciary Passthrough > Business Use of Home, Fiduciary Passthrough (A) > Business Use of Home, Partnership Passthrough >
Business Use of Home, Large Partnership Passthrough > Business Use of Home and S Corporation Passthrough > Business Use of Home
]]]]
Square footage of home used exclusively for business
Total square footage of home
]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]
]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]
Were improvements made to the home and/or home office since the time you began using the home for business? ]]] Yes No
Direct expenses benefit the business part of your home.
Example: Cost of painting or repairs made to the specific area or room used for business.
Indirect expenses are required for keeping up and running your entire home.
Example: Real estate taxes.
Casualty losses
Deductible mortgage interest paid to:
]]]]]]]]]]]]]]]]]]]
Financial institutions
Individuals
]]]]]]]]]]]]]]
]]]]]]]]]]]]]]]]]]]]
Real estate taxes
Insurance
Qualified mortgage insurance premiums
]]]]]]]]]]]]]]]]]]
]]]]]]]]]]]]]]]]]]]]]]
]]]]]
Repairs and maintenance
Utilities
Rent
]]]]]]]]]]]]]
]]]]]]]]]]]]]]]]]]]]]]]]
]]]]]]]]]]]]]]]]]]]]]]]]]]
Activity Name:
Partial Use of Your Home for Business:
Expenses: Enter all expenses at 100 percent
Other Expenses:
Seller-Financed Mortgage Interest Information:
Passthrough Business Use of Home 11B
100231 05-09-11
TSJ TSJ
2011 Amount 2010 Amount 2011 Amount 2010 Amount
TSJ State CityTaxYear
Income Tax Refund
State Local
TSJ Nature and Source 2011 Amount 2010 Amount
TSJ Recipient's Name Recipient'sSocial Security No.
AlimonyReceived? 2011 Amount 2010 Amount
Forms M-1, M-2, M-3, IRS-1099G, IRS-1099MISC and IRS-SSA 1099
Worksheets: Other Income > Miscellaneous Income, Social Security Benefit Statement, Certain Government Payments, Miscellaneous,
Refunds of State and Local Income Taxes and Alimony Received and Other Adjustments > Alimony Paid
Taxable pensions and annuities received
Nontaxable pensions and annuities received
]]]]]]]
]]]]]
Federal withholding on pensions and annuities
State withholding on pensions and annuities
]]]]
]]]]]
Unemployment compensation received
Unemployment compensation repaid in 2011
]]]]]]]]
]]]]]
Social security benefits received
Social security benefits repaid in 2011
]]]]]]]]]]]]
]]]]]]]]]
Medicare premiums withheld
Tier 1 railroad retirement benefits received
Tier 1 railroad retirement benefits repaid in 2011
]]]]]]]]]]]]]]
]]]]]]
]]]
Taxable IRA distributions
Nontaxable IRA distributions
Total lump sum social security received
]]]]]]]]]]]]]]]]
]]]]]]]]]]]]]]
]]]]]]]]
Lump sum taxable social security
Other federal withholding
Other state withholding
]]]]]]]]]]]
]]]]]]]]]]]]]]]]
]]]]]]]]]]]]]]]]]
Please enclose Forms: W-2G, 1099-MISC, 1099-RRB, 1099-SSA, 1099-SA, 1099-LTC, 1099-G and 1098-E
Miscellaneous Income and Adjustments:
State and Local Income Tax Refunds:
Other Income:
Alimony Paid or Received:
Miscellaneous Income, Adjustments and Alimony 13
100232 05-09-11
TS 2011 Amount 2010 Amount
TS Description 2011 Amount 2010 Amount
Yes No
TSJ Nature and Source 2011 Amount 2010 Amount
Forms M-1, M-19, and P-16
Worksheet: Health Savings Accounts and Other Adjustments > Educator Expenses, Other Adjustments and Student Loan Interest
Contributions made for 2011
Distributions received from all HSAs in 2011
Were all distributions from your HSA for unreimbursed medical expenses? ]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]
Did you or your spouse enroll in Medicare? ]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]
If yes, what month did you enroll?
What month did your spouse enroll?
]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]
]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]
Educator Expenses: Deduction for amounts paid by educators of kindergarten through Grade 12
Health Savings Accounts (HSAs)
Other Adjustments to Income: Please enclose all Forms 1098-E for Student Loan Interest Paid
Miscellaneous Adjustments 13A
100241 05-09-11
TSJ 2011 Amount 2010 Amount
2011 Amount 2010 Amount
TSJ Description 2011 Amount 2010 Amount
TSJ 2011 Amount 2010 Amount
TSJ Real Estate Taxes 2011 Amount 2010 Amount
TSJ Description 2011 Amount 2010 Amount
Form A-1 and A-2
Worksheet: Itemized Deductions > Medical and Dental Expenses, Other Medical Expenses, Taxes Paid and Other Taxes Paid
Prescription medicines and drugs
Total medical insurance premiums paid (Do not include medicare premiums paid)
]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]
]]]]
Long-term care expenses
Total insurance reimbursement
]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]
]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]
Number of miles traveled for medical care
Number of miles traveled for medical care after June 30
]]]]]]]]]]]]]]]]]]]]]]]]]]]
]]]]]]]]]]]]]]]]]]]]
Lodging
Doctors, dentists, etc.
Hospitals
Lab fees
Eyeglasses and contacts
]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]
]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]
]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]
]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]
]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]
Cobra assistance premiums in 2011 ]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]
Taxpayer long-term care insurance premiums paid
Spouse long-term care insurance premiums paid
]]]]]]]]]]]]]]]]]]]]]]]]]
]]]]]]]]]]]]]]]]]]]]]]]]]]
Personal property taxes paid (include vehicle taxes)
General sales taxes paid on specified items
]]]]]]]]]]]]]]]]]]]]]
]]]]]]]]]]]]]]]]]]]]]]]]]]
Itemize real estate taxes by state.
If you purchased or sold your home in 2011, did you include any taxes from your closing statement in the amounts above? Yes No
Medical and Dental Expenses:
Other Medical Expenses:
Taxes Paid: Please include copies of your tax bills
Other Taxes Paid:
Itemized Deductions - Medical and Taxes 14
100242 05-09-11
Yes No
TSJ Paid To
Did You ReceiveForm 1098?
2011 Amount 2010 AmountYes No
TSJPaid To
ID Number 2011 Amount 2010 AmountName Address
TSJ Paid To
Did You ReceiveForm 1098?
2011 Amount 2010 AmountYes No
TSJ 2011 Amount 2010 Amount
TSJ Paid To 2011 Amount 2010 Amount
Form A-3, A-4 and 1098MIS
Worksheet: Itemized Deductions > Home Mortgage Interest Paid to a Financial Institution and Deductible Points, Other Home Mortgage
Interest Paid, Investment Interest Expense Deduction and Mortgage Insurance Premiums
If you purchased or sold your home, did you include any mortgage interest from your closing statement in the amount below? ]]]
Did you refinance your home? (If Yes, please enclose the closing statement.) ]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]
If Yes, how many years is your new mortgage loan? ]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]
Did you purchase a new home or sell your former home during the year? ]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]
If Yes, please enclose the closing statements from the purchase and sale of your new and former homes.
If Yes, also, did you (or your spouse, if married) have an ownership interest in a principal residence in the US
during the 3 year period prior to the purchase of this home? ]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]
If Yes, did you (and your spouse, if married at the time of purchase) own and use the same home as a principal residence
in the U.S. for any 5 consecutive year period during the 8 year period ending on the purchase date of the new home? ]]]]
Premiums paid or accrued for qualified mortgage insurance.
Interest paid on money you borrowed that is allocable to property held for investment.
Mortgage Questions for 2011:
Home Mortgage Interest Paid To Financial Institutions:
Other Home Mortgage Interest Paid:
Deductible Points:
Mortgage Insurance Premiums:
Investment Interest Expense:
Itemized Deductions - Mortgage Interest and Points 14A
100251 05-09-11
TSJ Organization or Description of Contribution 2011 Amount 2010 Amount
TSJ Conservation Real Property 2011 Amount 2010 Amount
TSJ Description 2011 Miles 2010 Miles
TSJ Description of Donated Property 2011 Amount 2010 Amount
Forms A-5, A-6 and A-8
Worksheet: Itemized Deductions > Contributions
You cannot deduct a cash contribution, regardless of the amount, unless you keep as a record of the contribution a bank record (such as acanceled check, a bank copy of a canceled check, or a bank statement containing the name of the charity, the date, and the amount) or a writtencommunication from the charity. The written communication must include the name of the charity, date of the contribution, and amount of thecontribution. Clothes and household items donated must be in good, used condition or better in order to be deductible unless the item donated isworth more than $500 and you have the item's value appraised. Attach a copy of the appraisal. Include any vehicles donated to charity. AttachForms 1098-C received from the charity.
100% limit
50% limit
Number of miles traveled performing volunteer work for qualified charitable organizations
TSJ ]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]
Description of the donated property
Donee organization name
Donee organization address
]]]]]]]]]]]]]]]]
]]]]]]]]]]]]]]]]]]]]]]
]]]]]]]]]]]]]]]]]]]]]
]]Date the property was acquired by the taxpayer (Mo/Da/Yr)
]]]]]]]]]]]] (Mo/Da/Yr)Date the property was donated
]]]]]]]]]]]]]]]Cost or basis of the donated property
Fair market value of the donated property ]]]]]]]]]]]]]
Which of the following methods was used to determine the fair market value? CAUTION: Generally, contributions in excess of $5,000 of similar
property will require an appraisal (does not apply to marketable securities)
Appraisal Thrift shop value Catalog Comparable sale
Other - please explain ]]]]]]]]]]]]]]]]]]]]]]
Which of the following describes how this donated property was acquired?
Purchase Gift Inheritance Exchange
Cash Contributions:
Noncash Contributions Totaling Less Than or Equal to $500:
Noncash Contributions Totaling More Than $500:
Itemized Deductions - Contributions 15
100261 09-28-11
TSJ 2011 Amount 2010 Amount
Examples:
TSJ Description 2011 Amount 2010 Amount
Forms A-4 and D-2
Worksheets: Itemized Deductions > Miscellaneous Deductions and Gains and Losses > Business Property, Casualties and Thefts
Union and professional dues
Tax preparation fee
Professional subscriptions
Hobby expense (To extent of income)
Safe deposit box
Uniforms and protective clothing
Work tools
Gambling losses
Estate taxes
]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]
]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]
]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]
]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]
]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]
]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]
]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]
]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]
]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]
¥ Certain legal and accounting fees
¥ Investment expenses
¥ Custodial fees
¥ Employment agency fees
¥ Certain educational expenses
TSJ
Property description
Which of the following describes the type of property that sustained the casualty or theft loss?
]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]
]]]]]]]]]]]]]]]]]]]]]]]]]
Personal use due toHurricane KatrinaPersonal use Business use Income producing Employee Use
Personal use attributable to afederally declared disasterdeclared prior to 2010
Personal use attributable toMidwestern disaster area
Personal use attributableto Kansas disaster area
Personal use attributable toinsolvent or bankrupt financialinstitution losses on deposits
Date acquired
Date damaged or lost
]]]]]]]]]]]]]]]]]]]] (Mo/Da/Yr)
(Mo/Da/Yr)]]]]]]]]]]]]]]]
Original cost or other basis ]]]]]]]]]]]]]]]]]]]]]
Fair market value before casualty
Fair market value after casualty
Cost of replacement
Insurance reimbursement
]]]]]]]]]]]]]]]]]]
]]]]]]]]]]]]]]]]]]]
]]]]]]]]]]]]]]]]]]]]]]]]]
]]]]]]]]]]]]]]]]]]]]]]
Miscellaneous Itemized Deductions:
Other Itemized Deductions:
Casualty or Theft Loss:
Itemized Deductions - Miscellaneous 16
100301 05-09-11
Amount DueDate Paid
if Not Date Due(Mo/Da/Yr)
Amount Paid
Yes No
If you answered Yes to any of the above questions, please provide details.
Forms T-1 and T-2
Worksheet: Estimates and Application of Overpayment > Estimate Options
Payments > Federal Estimated Tax Payments
If you have an overpayment of 2011 taxes, do you want the excess:
Refunded ]]]]]]]]]]]]]]]]]] Yes
Yes
No
NoApplied to your 2012 estimated tax liability
2011 1st Quarter Estimate
2011 2nd Quarter Estimate
2011 3rd Quarter Estimate
2011 4th Quarter Estimate
]]]]]]]]]]]]]]]]]] (Due 04-18-2011)
(Due 06-15-2011)
(Due 09-15-2011)
(Due 01-17-2012)
]]]]]]]]]]]]]]]]]]
]]]]]]]]]]]]]]]]]]
]]]]]]]]]]]]]]]]]]
2010 overpayment applied to 2011 estimate ]]]]]]]]]]]]]]
Do you expect any of the following to occur in 2012?
A change in your marital status
A change in the number of your dependents
A substantial change in your income
A substantial change in your withholding
A substantial change in deductions
]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]
]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]
]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]
]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]
]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]
Refund Application:
Federal Estimated Tax Payments:
Tax Planning Information for Tax Year 2012:
Federal Tax Payments 20
100305 05-09-11
TSJ
State/City
Amount DueDate Paid
if Not Date Due(Mo/Da/Yr)
Amount Paid
TSJ
State/City
Amount DueDate Paid
if Not Date Due(Mo/Da/Yr)
Amount Paid
TSJ
State/City
Amount DueDate Paid
if Not Date Due(Mo/Da/Yr)
Amount Paid
State & City Interview Forms
Worksheet: Payments > State Estimated Tax Payments
2011 1st Quarter Estimate
2011 2nd Quarter Estimate
2011 3rd Quarter Estimate
2011 4th Quarter Estimate
]]]]]]]]]]]]]]]]]]]]]]]]]]]]]
]]]]]]]]]]]]]]]]]]]]]]]]]]]]]
]]]]]]]]]]]]]]]]]]]]]]]]]]]]]
]]]]]]]]]]]]]]]]]]]]]]]]]]]]]
2010 overpayment applied to 2011 estimate ]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]
Balance of prior year(s)' tax paid in 2011 plus
amount paid with 2010 extensions ]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]
Estimated tax payments for 2010 paid in 2011 ]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]
2011 1st Quarter Estimate
2011 2nd Quarter Estimate
2011 3rd Quarter Estimate
2011 4th Quarter Estimate
]]]]]]]]]]]]]]]]]]]]]]]]]]]]]
]]]]]]]]]]]]]]]]]]]]]]]]]]]]]
]]]]]]]]]]]]]]]]]]]]]]]]]]]]]
]]]]]]]]]]]]]]]]]]]]]]]]]]]]]
2010 overpayment applied to 2011 estimate ]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]
Balance of prior year(s)' tax paid in 2011 plus
amount paid with 2010 extensions ]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]
Estimated tax payments for 2010 paid in 2011 ]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]
2011 1st Quarter Estimate
2011 2nd Quarter Estimate
2011 3rd Quarter Estimate
2011 4th Quarter Estimate
]]]]]]]]]]]]]]]]]]]]]]]]]]]]]
]]]]]]]]]]]]]]]]]]]]]]]]]]]]]
]]]]]]]]]]]]]]]]]]]]]]]]]]]]]
]]]]]]]]]]]]]]]]]]]]]]]]]]]]]
2010 overpayment applied to 2011 estimate ]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]
Balance of prior year(s)' tax paid in 2011 plus
amount paid with 2010 extensions ]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]
Estimated tax payments for 2010 paid in 2011 ]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]
State and City Estimated Tax Payments:
State and City Estimated Tax Payments:
State and City Estimated Tax Payments:
State and City Tax Payments 20A
100401 05-09-11
Principal City and Country of EmploymentStart Date(Mo/Da/Yr)
End Date(Mo/Da/Yr)
Forms M-7, M-8 and M-9
Worksheet: 2555 - Foreign Earned Income Exclusion > General
TS ]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]
Foreign address ]]]]]]]]]]]]]]]]]]]]]]]]]]]]
Name of employer ]]]]]]]]]]]]]]]]]]]]]]]]]]
Employer's U.S. address ]]]]]]]]]]]]]]]]]]]]]]
Employer's foreign address ]]]]]]]]]]]]]]]]]]]]]
Employer type: Foreign entity, U.S. company,
Foreign affiliate of a U.S. company, Self ]]]]]]]]]]]
Enter the last year (after 1981) that Form 2555 was
filed to claim either of the exclusions ]]]]]]]]]]]]]
Type of exclusions revoked in prior years ]]]]]]]]]]]]]
If a separate foreign residence was maintained for your
family due to adverse living conditions, please provide
the city, country, and number of days maintained ]]]]]]
List tax home(s) during tax year and dates established ]]]]]
Country of citizenry or nationality ]]]]]]]]]]]]]]]]]
Qualified housing expenses for the tax year ]]]]]]]]]]]
Adjustment to employer provided amounts for qualified
housing expense ]]]]]]]]]]]]]]]]]]]]]]]]]
Most recent tax home
First previous tax home
Second previous tax home
Third previous tax home
]]]]]]]
]]]]]]
]]]]
]]]]]]
General Information:
Tax Home History:
Foreign Employment Information(Page 1 of 3)
30
100402 05-09-11
Relationship First Name MI Last Name Date Arrived Date LeftX if
EntirePeriod
Yes No
Occupants
First Name MI Last Name Relationship
Form M-8
Worksheet: 2555 - Foreign Earned Income Exclusion > Bona Fide Residence Test
Beginning date for foreign residence
Ending date for foreign residence
]]]]]]]]]]]]] (Mo/Da/Yr)
]]]]]]]]]]]]]]] (Mo/Da/Yr)
Kind of foreign living quarters:
Purchased house, Rented house or apartment, Rented room,
Quarters furnished by employer ]]]]]]]]]]]]]]]]]]]]]]
If any family members lived abroad with you during any part
of the tax year, enter their names. Include the dates when
the family members lived with you
Was a statement made to foreign country authorities declaring you
were not a resident of their country? ]]]]]]]]]]]]]]]]]]]
Were you required to pay income tax in that country?
Does the foreign country have an income tax?
]]]]]]]]]]]
]]]]]]]]]]]]]]]]
State any contractual terms or other conditions relating to the
length of employment abroad ]]]]]]]]]]]]]]]]]]]]]]]]
What type of visa was used to enter the foreign country? ]]]]]]]]]
Explain any limitations of the visa as to length of stay or
]]]]]]]]]]]]]]]]]]]]]]employment in a foreign country
If a home was maintained in U.S. while residing abroad, show
address, whether rented, names and relationships of occupants
Address
Street address
City
State
ZIP Code
]]]]]]]]]]]]]]]]]]]]]]]]]]]]]
]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]
]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]
]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]
X if rented ]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]
Bona Fide Residence Test Information:
Foreign Employment Information(Page 2 of 3)
30A
100403 05-09-11
Date Arrived in U.S.(Mo/Da/Yr)
Date Left U.S.(Mo/Da/Yr)
Number of Daysin U.S. on Business
Name of Country (Including U.S.)Date Arrived(Mo/Da/Yr)
Date Left(Mo/Da/Yr)
Full Days inCountry
Number of Days Presentin U.S. on Business
Form M-8 and M-9
Worksheet: 2555 - Foreign Earned Income Exclusion > Bona Fide Residence Test and Physical Presence Test
Days Present in the U.S. or Its Possessions During the Tax Year (Bona Fide Residence Test):
Travel Abroad for 12 Month Period (Physical Presence Test):
Foreign Employment Information(Page 3 of 3)
30B