GENERAL INFORMATION

Title Name (Last, First, MI) Occupation Birthdate

Self

Spouse

Dependents

Current Street Address___________________________________________

City______________________________State____________ZIP_________

County_____________________School District ______________________

Express Financial Services 409 W. La Habra Blvd. La Habra, CA 90631-5407

TEL: (562) 691-1915 sperez@efsbookkeeping.com

E-mail_______________________________________________________© Michael A. Lingis 12/3/2019Use reserved for clients of Express Financial Services or by written permission.

PLEASE PROVIDE:

A copy of your last previous year’s Federal and State tax returns (if it was not prepared by our firm). ALL W-2 and 1099, 1099R, SSA-1099 (Social Security) forms and ALL 1098 forms & Form 1095 (copies OK). Escrow settlement (closing) statements of real estate bought or sold during the year. If you received assisted payments on health insurance, we MUST HAVE your form 1095-A from the insurer Did you move in 2019? Complete Moving Expense Form. Did you have rental income? Use Rental Income Form

Y N Did you have money in OR signature authority over any foreign bank or financial account?Y N Did all foreign accounts total $10,000 or more at any time during 2019? (Report due 6/30/2020)

Tele

phon

e

Home

Work/Self

Work/Spouse

Cell

FAX

MAIN OFFICE (409 W. La Habra Blvd., La Habra, CA 90631) BY MAIL/FAX (FAX TO 562 691-0176)

_______________________________________

There are more changes in this year’s checklist which we have added to keep up with new IRS rules and to help us give you the best possible return results.

Save money and taxes by fully completing this checklist. We’ll be able to complete your taxes faster, find more deductions and plan for next year. Use this checklist to guide you in sorting your records. Add up the totals of your expenses, and you won’t need to provide canceled checks or receipts. Round to nearest dollar ($2.50=$3 $2.49=$2). Use Information Return Organizer

The forms below are available in PDF format upon request: Please check boxes below and send us your request:

If we already have this, just fill in your name and add any new information.Full-TimeStudent?

SocialSecurity #

PLEASE UPDATE Student status (a “full-time student” attended for a part of each of 5 calendar months)

If child nolonger adependent,please note

May we send confidential FAXES? Y N

NO APPOINTMENT NECESSARY TO

DROP OFF YOUR TAX DOCUMENTS

I AM FILING A FAFSA FORM THIS YEAR

Ministerial Inc/Exp Wrksheet Auto Expense Form Auto Mileage Record

Office in Home Worksheet Moving Expense Form Non-Cash Contributions Form

2019 TAX CHECKLIST For the 2019 tax year

Rental Income Form Sale/Exchange of Property Like-Kind Exchange Wrksht

FAX ( 562) 691-0176 mike@efsbookkeeping.com

PLEASE NOTE: Any tax work/docs received after March 25, 2020 subject to a 25% RUSH CHARGE

PLEASE NOTE: On any tax work/docs received after March 25, 2020 then the preparation fees will be subject to a 25% RUSH CHARGE

1. Did you pay post-high school tuition for a family member? Student’s Name___________________________________Year of Study (1=Freshman)_____School or college_________________________________Amount $___________Provide 1098-T. Amount paid for books and materials $___________

2. Do you have a Form 4361 Exemption From Social Security Tax? Please make sure we have an IRS-approved copy.3. Were there any births, adoptions, marriages, divorces, or deaths in your immediate family during the year?4. Is anyone in your household 65 years or older? Blind? (Vision in best eye 20/200 or worse?_______)5. Is anyone other than your spouse and children living with you? If so supply name, social security number, the

amount of support given them, their relationship to you, the amount of their income and its source.6. Do you pay for support of people who do not live with you? If so, supply names, SS#, amount of support, relationship to

you, their total income and its source (work, pension, etc.)7.8.9.

Are you or your spouse permanently disabled?Want to e-file your returns? If you do not wish to e-file, there is an additional $75 fee for non-efiled work. Do you plan to buy a home in the next 26 months?

10. Does anyone owe you money you can’t collect? Supply their name, address, SS#, loan amount, date, and steps youhave taken to collect .

12.11. Did any stock or securities you own become worthless in 2019? If so, supply details.

Did you change denominations in the past two years? (ministers only)13 Did you give more than $15,000 in money or property to any individual? If so, call for copy of Gift Tax form.14. Did you or your spouse Pay or Receive spousal support? If so, list name, SS# and amount received

or paid: Name____________________ SS#______--_____--_______ $_______________15. Do you , or your spouse , use a room in your home as a primary office? If so, please supply the total square feet

of your home (subtract hallways, stairs, entryway) ________, and the square feet used for business_______.Complete Housing Expense Section, next page.

16. Did you replace exterior doors, windows, water heater, furnace, or install solar/wind energy? Use Energy Credits Form.

State Date Paid$______________$______________ ____/_____/____$______________ ____/_____/____$______________ ____/_____/____$______________ ____/_____/____

Estimated Tax Payments FederalLast year’s overpayment credited to this year’s tax: $______________ Amount paid with extension (with Form 4868) $______________ Voucher 1 Estimated tax payments (Due April 15): $______________ Voucher 2 Estimated tax payments (Due June 15): $______________ Voucher 3 Estimated tax Payments (Due Sept. 15): $______________ Voucher 4 Estimated tax payments (Due Jan. 15): $______________ $______________ ____/_____/____

QUESTIONAIRE These items could lead to more deductions. PLEASE CHECK ALL THAT APPLY. YES NO

Retirement PlansDo you have a “dormant” retirement

Y / N plan? If so, please supply details.Did you or your employer contribute

Y / N to a plan?Please provide copies of year-endstatements

Plan Total Amount You Added 2019Self Spouse Self Spouse

TSA/403(b) $_________ $_________ $_________ $_________IRA or SEP IRA $_________ $_________ $_________ $_________Roth IRA $_________ $_________ $_________ $_________401K $_________ $_________ $_________ $_________Employer Plan $_________ $_________ $_________ $_________Other_____________ $_________ $_________ $_________ $_________

INCOME DO NOT INCLUDE “ACCOUNTABLE REIMBURSEMENT PLAN” REIMBURSEMENTSSOURCE Self Spouse INTEREST INCOME (Provide all 1099-INTs)Income from 1099’s [Provide Forms] $ From________________________________ $_________Income from W-2’s [Provide Forms] $ From________________________________ $_________Other Minister’s Income $___________ $___________ From________________________________ $_________Housing Allowance $___________ $___________ From________________________________ $_________Rental Value of Parsonage $___________ $___________ From________________________________ $_________Honoraria $___________ $___________ From________________________________ $_________State Tax Refund for 20___ $___________ $___________ From_______________________________ $_________Social Security [provide SSA-1099s] $___________ $___________Pensions/Annuities/IRA’s $___________ $___________ STOCK DIVIDENDS (Provide all 1099-DIVs)Unemployment/Disability Income $___________ $___________ From________________________________ $_________Jury Duty $___________ $___________ From________________________________ $_________Prizes & Awards $___________ $___________ From________________________________ $_________Sales of coins, jewelry, art, gold, etc, $___________ $___________ From________________________________ $_________Sales on eBay, Craig’s list, etc. $___________ $___________ From________________________________ $_________

[Provide Forms]

Page 2

What You Sold Purchase Date Date Sold Sales Price Cost or Basis Selling Expense Gain/Loss (Optional)

HOUSING EXPENSE [This section for ministers only, and/or office in home]Date you purchased home ___/___/___ Maintenance & Repairs $_________ Utilities (Except Phone) $_______Rent/Mortgage Payments $_________ Decorations $_________ Cleaning Supplies $_______Property Taxes* $_________ Furnishings $_________ Miscellaneous $_______Insurance* $_________ Gardening, Pool Service $_________ Telephone Base Rate $_______*If not included in rent/mortgage payment. List property tax also on Page 4. TOTAL $_______

SALE/EXCHANGE OF STOCK & PROPERTY - Include VehiclesMUTUAL FUND SALES: If you were not given an Average Cost Statement, provide all annual statements since purchase.

AUTO EXPENSE

Business/Professional use by: Self Spouse Self Spouse Self Spouse Self Spouse Activity (Ministry, Honoraria, Job, etc.) ________________ ________________ ________________ ________________Year, Make and Model of Vehicle ________________ ________________ ________________ ________________

$_______________ $_______________ $_______________ $____________________/______/____ _____/______/____ _____/______/____ _____/______/____________________ ________________ ________________ ___________________________________ ________________ ________________ ________________ _________________ ______________ ______________ _______________

Purchase PriceDate of Purchase/Lease* Mileage: Total driven Mileage: Professional Mileage: Notes Parking, Tolls $_______________ $_______________ $_______________ $_______________Gas, Oil, Repairs, Car Wash, Tires, etc. $_______________ $_______________ $_______________ $_______________Insurance Premium (Annual) $_______________ $_______________ $_______________ $_______________Auto Club $_______________ $_______________ $_______________ $_______________Auto License Renewal Fee (All) $_______________ $_______________ $_______________ $_______________Car Loan Interest Paid this Year $_______________ $_______________ $_______________ $_______________Car Lease/Rental $_______________ $_______________ $_______________ $_______________Round-trip commute distance between home and office: Self_________ Spouse_________Was vehicle available for personal use after hours? Yes No Was another vehicle available for personal use? Yes No Personal miles driven on employer-owned vehicle? Self_________ Spouse_________ *Enter ALL expenses for leased Vehicles

PROFESSIONAL/EMPLOYMENT EXPENSESUp to $25 per recipient for: SELF SPOUSE SELF SPOUSE-Gifts associated with profession: $________ $________ Purchase/Cleaning/ Prof. Garments $________ $________-Money to transients/indigents: $________ $________ Internet/DSL Services $________ $________Hired Services $________ $________ Cell Phone/Pager (Prof. Use Only) $________ $________Professional Dues/Required Tithes $________ $________ Long Distance/Message Units $________ $________Prof/Business Interest Paid $________ $________ Formal Education Expenses $________ $________IncomeTax Preparation $________ $________ Name of School _________________________ _________Other office & computer expenses $________ $________ Seminars/Conferences/Prof.Growth $________ $________Repairs $________ $________ Meeting Expenses $________ $________Postage/Stationery/Cards Etc. $________ $________ Other (List) ____________________ $________ $________Books/Periodicals/Papers $________ $________ Other _________________________ $________ $________Film/Tapes/Videos/DVDs $________ $________ Other _________________________ $________ $________Travel: Transportation $________ $________ Other _________________________ $________ $________

Lodging, Misc. $________ $________ Other _________________________ $________ $________ Meals $________ $________

Professional Entertainment* $________ $________*Entertaining at home, office,or restaurants and associated withthe active conduct of your profession.

EQUIPMENT PLACED IN SERVICE THIS YEAR: (ENTER HERE ONLY)Date Description %Business Spouse PurchaseMo/Day Use or Self? Price___/___ ______________ _________ ______ $___________/___ ______________ _________ ______ $___________/___ ______________ _________ ______ $________

NEW CLIENTS ONLY (For depreciation):Current Value Prof. Library $________ $________Current Value all equipment, $________ $________ office & professional [Provide List]

Provide escrow “Settlement or Closing Statement” if you bought or sold a home or other property. For more items, use Sale/Exchange Form

Do not include expenses reimbursed byan accountable reimbursement plan

Enter 1 vehicle/1 use per column, so one car may be listed in two or more columns. Reimbursed at less than $.58/mile, or need more columns? Request and Use Auto Expense Form

Page 3

DEDUCTIONSMEDICAL EXPENSESA. Medical/Disability Premiums $_____________

Long-Term Care Premiums:For you $_________ For Spouse $_________

B. Medical services not reimbursed by insurance:*These specifics NOT required, just the total.

Prescriptions * $_____________Doctors & Dentists * $_____________Hospitals & Clinics * $_____________Lab. Fees/X-Rays * $_____________Physical Therapy * $_____________Glasses/Contacts * $_____________Orthopedic Equipment * $_____________Hearing Aids/Batteries * $_____________Other *_______________ $_____________TOTAL of B. only $____________

C. Medical Travel miles ______Parking, tolls $________Insurance Reimbursement for medical travel: $________

TAXES Your local sales tax rate _________%Property Taxes $____________Auto License Fees $____________Tax Paid to Other States $____________Sales Tax on High-Cost Items* $____________* (Vehicles, boats, planes, homes, home building materials)

HOME MORTGAGE INTEREST (Provide 1098's).

1ST Home Mortgage 2ND Home Mortgage

Home Improvement/Equity Loan

$________________________$________________________$________________________

Mortage Paid to Individual:Paid to (Name) _________________________________ Address _________________________________ Social Security Number ___________________________

TAXPAYER STATEMENT: ALL INFORMATION CONTAINED IN THIS TAX CHECKLIST IS TRUE, CORRECT AND COMPLETE TO THEBEST OF MY/OUR KNOWLEDGE. EACH ITEM CAN BE SUBSTANTIATED BY RECEIPTS, CHECKS AND/OR OTHER DOCUMENTATION. IHAVE REPORTED ALL INCOME.S CLIENT SIGNATURE __________________________ SPOUSE SIGNATURE __________________________ DATE______________

I want information on: Tax Sheltered Annuities, Disability or Health Insurance, Long-Term Care Insurance Retirement Planning Life Insurance (including tax-deductible policies). Incorporating my ministry or business Payroll Services

CONSUMER DEBTCredit Cards Balance Interest Paid Balance Interest PaidLender ________________ $________________ $__________ Student Loans $____________ $__________Lender ________________ $________________ $__________ Car Loan $____________ $__________Lender ________________ $________________ $__________ Car Loan $____________ $__________Lender ________________ $________________ $__________ Other___________ $____________ $__________

USE TAX:NOTES AND ADDITIONAL INFORMATION:

CONTRIBUTIONSCash donations with NO receipt/check $_______________Small donations WITH receipt/check $_______________Churches & Charitable Organizations:Name________________________ $_______________Name________________________ $_______________Name________________________ $_______________Name________________________ $_______________Name________________________ $_______________Name________________________ $_______________

Charitable/Volunteer Travel (in miles) _____________

Contributions Of Goods (w/receipt) $_______________If non-cash donations exceed $500 please supply name of charity, address, type of property and amount of donations. Request and Use Non-Cash Contribution Form. _____________________________________________________

_______________________________ $____________

If your state, (including CA, KY, LA, MA, ME, MI, NY, OH, OK, RI, SC, UT, VT, VA) charges use tax on out-of-statepurchases, what is total amount of purchases on which you owe use tax? $_________

We cannot deliver your return to you without your signature(s) below:

Page 4

Child or Dependent Care Check here if had FSA __If more than one person, supply list. ALL info below required.Child or Dependent’s Name______________________Amount paid for care $_____________Provider Name ________________________________Address ________________________________Tax ID# or SS# ________________________Telephone (If California) ______________________

Union Dues $_________________Investment Expenses $_________________Job Seeking Expenses $_________________Uniforms/Purchase/Cleaning $_________________Other (List) $_________________

CASUALTY LOSSES (Unreimbursed portion only)Fire/Theft/Storm $_________________Auto Accident $_________________Property Damage $_________________

Was family covered by employer plan all year? Y N

$__________________

Current Street Address: State: ZIP: City: County: School District: E-mail: School or college: undefined_27: undefined_28: Other: undefined_29: undefined_30: undefined_31: undefined_32: undefined_39: undefined_40: undefined_43: undefined_44: undefined_47: undefined_48: undefined_51: undefined_52: 1: 2: 3: 4: 5: undefined_55: undefined_56: From: undefined_57: From_2: undefined_58: undefined_59: undefined_60: From_3: undefined_61: undefined_62: undefined_63: From_4: undefined_64: undefined_65: undefined_66: From_5: undefined_67: undefined_68: undefined_69: From_6: undefined_70: undefined_71: undefined_72: From_7: undefined_73: undefined_74: undefined_75: undefined_76: undefined_77: undefined_78: undefined_79: From_8: undefined_80: undefined_81: undefined_82: From_9: undefined_83: undefined_84: undefined_85: From_10: undefined_86: undefined_87: undefined_88: From_11: undefined_89: undefined_90: undefined_91: From_12: undefined_92: Purchase Date, Row 1: Date Sold, Row 1: Sales Price, Row 1: Cost or Basis, Row 1: Selling Expense, Row 1: GainLoss Optional, Row 1: 1_2: 1_3: 1_4: Round-trip commute distance between home and office: Self: Spouse: 1_5: Self: Spouse_2: Other_2: Other_3: Other_4: Other_5: Use 2: Use 3: or Self? Price 1: or Self? Price 2: or Self? Price 3: A MedicalDisability Premiums: For you: For Spouse: C Medical Travel miles 11-630: 71-1231: Parking, tolls: Insurance Reimbursement for medical travel: Your local sales tax rate: Paid to Name: Address: Social Security Number: Cash donations with NO receiptcheck: Name: Name_2: Name_3: Name_4: Name_5: Name_6: CharitableVolunteer Travel in miles: Child or Dependent’s Name: Amount paid for care: Provider Name: Address_2: Tax ID# or SS: Telephone If California: UniformsPurchaseCleaning: Lender: Lender_2: Lender_3: Lender_4: Other_7: Check Box2: OffCheck Box3: OffCheck Box4: OffCheck Box6: OffCheck Box7: OffCheck Box9: OffCheck Box10: OffCheck Box11: OffCheck Box12: OffCheck Box13: OffCheck Box14: OffCheck Box15: OffCheck Box16: OffCheck Box17: OffCheck Box18: OffCheck Box19: OffCheck Box20: OffTitle 1: Title2: Title3: Title4: Title5: Title6: Title7: Name TP: Name Spouse: Name D1: Name D2: Name D3: Name D4: Name D5: Occup TP: Occup Spouse: Occup D1: Occup D2: Occup D3: Occup D4: Occup D5: BirthdateD5: BirthdateD4: BirthdateD3: BirthdateD2: BirthdateD1: StudentTP: OffStudentSpouse: OffStudentD1: OffCheck Box Rental: OffStudentD3: OffStudentD4: OffSS-TP: SS-Spouse: SS-D1: SS-D4: SS-D3: SS-D2: Check Box30: OffCheck Box31: OffPhoneHome: TelWkSelf: TelWkSpouse: FAX: am: Offpm: OffCheck Box33: OffCheck Box34: OffCheck Box35: OffCheck Box36: OffCheck Box37: OffCheck Box38: OffCheck Box39: OffCheck Box40: OffCheck Box41: OffCheck Box42: OffCheck Box43: OffCheck Box44: OffCheck Box45: OffCheck Box46: OffCheck Box47: OffCheck Box48: OffCheck Box49: OffCheck Box50: OffCheck Box51: OffCheck Box52: OffCheck Box53: OffCheck Box54: OffCheck Box55: OffCheck Box56: OffCheck Box57: OffCheck Box58: OffCheck Box59: OffCheck Box60: OffCheck Box61: OffCheck Box62: OffCheck Box63: OffCheck Box64: OffCheck Box65: OffCheck Box66: OffCheck Box67: OffCheck Box68: OffCheck Box69: OffCheck Box70: OffCheck Box71: OffCheck Box72: OffCheck Box73: OffCheck Box74: OffCheck Box75: OffCheck Box76: OffStudent’ Name: YearStudy 1=Freshman: TuitionAmount: Vision: SupportAmount: TotalSqFt: square feet used for business: SSupportName: BooksMaterials: SSNAlimony: DateHomePurch: HsgPropTax: HsgIns: Check Box79: OffCheck Box80: OffCheck Box81: OffCheck Box82: OffHsg Utilities: HsgGardening: HsgFurnishings: HsgDecorations: HsgRentMortgage: HsgMaintRepairs: HsgCleaningSupplies: HsgMisc: HsgTelBase: HsgTotal: 0Check Box84: OffCheck Box5: OffCheck Box22: OffCheck Box23: OffCheck Box24: OffCheck Box25: OffCheck Box26: OffCheck Box27: OffActivity1: Activity2: Activity3: Activity4: YrMakeModel2: YrMakeModel1: YrMakeModel3: YrMakeModel4: TotMiles2: TotMiles3: TotMiles1: TotMiles4: MilesProfJanJune2: MilesProfJanJune3: MilesProfJanJune1: MilesProfJanJune4: MilesProfJulyDec2: MilesProfJulyDec3: MilesProfJulyDec1: MilesProfJulyDec4: School2: GiftsTP: MoneyTP: GiftsSP: MoneySP: Hired1: Hired2: DuesTithesTP: DuesTithesSP: InterestTP: InterestSP: TaxPrep1: TaxPrep2: Uniforms1: Uniforms2: Internet1: Internet2: Cell1: Cell2: Other_1: School1: OtherOffice1: OtherOffice2: Repairs1: Purchase Date, Row 2: Date Sold, Row 2: Sales Price, Row 2: Cost or Basis, Row 2: Selling Expense, Row 2: GainLoss Optional, Row 2: What You Sold3: PurchaseDate3: Date Sold3: Sales Price3: Selling Expense3: GainLoss3: What You Sold2: What You Sold1: Text31: OR Paid on TimeCheck Box77: OffCheck Box78: OffCheck Box83: OffCheck Box85: OffCheck Box86: OffCheck Box87: OffCheck Box88: OffCheck Box89: OffCheck Box90: OffCheck Box91: OffCheck Box92: OffCheck Box93: OffMoDay1: MoDay2: MoDay3: Desc1: Desc2: Desc3: Cost1: Books1: Charity Name, Address: TSA1: TSA2: TSAadd1: TSAadd2: IRA1: IRA2: IRAadd1: IRAadd2: RothTot1: RothTot2: RothContrib1: RothContrib2: 401KTot1: 401KTot2: 401KAdd1: 401KAdd2: EErPlanTOT1: EErPlanTOT2: FedOverPay: StateOverPay: FedPaidExt: StatePaidExt: EST_Fed1: EST_Fed2: EST_Fed3: EST_Fed4: EST_State2: EST_State1: EST_State4: EST_State3: Text1: UseTaxPurchases: StudentLoanInt: CarLoan1_Int: CarLoan2_Int: OtherInt: CardInt1: CardInt2: CardInt3: CardInt4: Mort_1st: EquityLoanInt: Mort_2nd: MortIntIndiv: Bal1: Bal2: Bal3: Bal4: SLoanBal: CarLoanBal1: CarLoanBal2: OtherLoanBal: UnionDues: InvestExp: JobExp: OtherItem: OtherItemAmount: Park1: Park2: GasOil2: GasOil1: GasOil3: GasOil4: Park3: Park4: CarIns2: CarIns3: CarIns1: CarIns4: AutoClub1: AutoClub2: AutoClub3: AutoClub4: DMV1: DMV2: DMV3: DMV4: CarLoanInt2: CarLoanInt1: CarLoanInt3: CarLoanInt4: CarLease1: CarLease2: CarLease3: CarLease4: LongDist1: LongDist2: Seminar1: Seminar2: Meeting1: Meeting2: OtherProExpT1: OtherProExpS1: OtherProExpT2: OtherProExpT3: OtherProExpT4: OtherProExpT5: OtherProExpS2: OtherProExpS3: OtherProExpS4: OtherProExpS5: Postage1: Postage2: Books2: FilmDVD1: FilmDVD2: Transp1: Transp2: Lodging1: Lodging2: Meals1: Meals2: ProfEnt1: ProfEnt2: PercentProf1: Cost2: Cost3: LibraryTP: LibrarySP: EquipValue1: EquipValue2: Month1: Year1: Month2: Month3: Month4: Day1: Day2: Day3: Year3: Day4: Year2: Year4: Educ1: FireTheft: Accident: PropDamage: PropTax: AutoLicFees: TaxOtherStates: SalesTaxHigh: GoodsValue2: GoodsLessThan500: Charity Address: DescGoods: WRcpt: Char1: Char2: Char3: Char4: Char5: Char6: ContTot: 0MedTOT: 0MedRx: MedDr: MedHosp: MedLab: MedTher: MedGlasses: MedOrtho: MedHear: MedNameOther: MedOther: MedTotC: Text3: BirthdateTP: BirthdateSpouse: Cell Self: Cell Spouse: Check Box Y Foreign Accts: OffCheck Box N Foreign Accts: OffCheck Box Y FBAR: OffCheck Box N FBAR: OffEduc2: ACA: Affordable Care Act: Provide copies of Form 1095 and/or ECN (Exemption Certificate) if received. Check Box8: OffCheck Box21: OffSS-D5: