Client Tax Organizer

Please complete this Organizer before your appointment. Prior year clients should use the proforma Organizer provided.

1. Personal Information

Name Soc. Sec. No. Date of Birth Occupation Work Phone

Taxpayer

Spouse

Street Address City State ZIP Home Phone

Email Address

Taxpayer Spouse Marital Status

Blind Yes No Yes No Married Will file jointly Yes No

Disabled Yes No Yes No Single
Pres. Campaign Fund Yes No Yes No Widow(er), Date of Spouse's Death

2. Dependents (Children & Others)

Social Months Full Dependent's ID

Name Date of Lived
(First, Last) Relationship Birth Security With Disabled Time Gross Protection
Number Student Income PIN
You

Please provide for your appointment

- Last year's tax return (new clients only) - All statements (W-2s, 1098s, 1099s, etc)
- Name and address label (from government booklet or card)
Please answer the following questions to determine maximum deductions
1. Are you self-employed or do you 9. Were there any births, deaths,
receive hobby income? Yes* No marriages, divorces or adoptions
2. Did you receive income from in your immediate family? Yes No
raising animals or crops? Yes* No
10. Did you give a gift of more than $17,000
3. Did you receive rent from real to one or more people? Yes No
estate or other property? Yes* No
11. Did you have any debts cancelled, forgiven,
4. Did you receive income from or refinanced? Yes No
gravel, timber, minerals, oil, gas,
12. Did you go through bankruptcy
copyrights, patents? Yes* No Yes No
proceedings?
5. Did you withdraw or write
checks from a mutual fund? Yes No 13. (a) If you paid rent, how much did you pay?

6. Do you have a foreign bank (b) Was heat included? Yes No

account, trust, or business? Yes No
14. Did you pay interest on a student loan for
7. Do you provide a home for or yourself, your spouse, or your dependent
help support anyone not listed during the year? Yes No
in Section 2 above? Yes No
15. Did you pay expenses for yourself, your
8. Did you receive any correspondence spouse, or your dependent to attend
from the IRS or State Department classes beyond high school? Yes No
of Taxation? Yes No
16. Do you own an interest in an LLC or similar
entity that has a reporting obligation under
CTORG01 10-03-23 * Contact us for further instructions the Corporate Transparency Act? Yes No
17. Did you have healthcare coverage (health 20. Did you install any energy property to your
insurance) for you, your spouse and residence such as solar water heaters,
dependents during this tax season? If yes, Yes No generators or fuel cells or energy efficient
include Forms 1095-A, 1095-B, and 1095-C. improvements such as exterior doors or
windows, insulation, heat pumps, furnaces,
central air conditioners or water heaters ? Yes No
18. Did you or your spouse receive, sell,
Yes No
exchange, gift, or otherwise dispose of
a digital asset or a financial interest in 21. Did you own $50,000 or more in foreign
Yes No
a digital asset? financial assets?

19. Did you have any children under the age of 22. Have you or your spouse been a victim of identity theft and given
19 or 19 to 23 year old students with an identity theft protection PIN by the IRS? If yes, enter the six
Yes No
unearned income of more than $1,250? digit identity protection PIN number.

Taxpayer Spouse
3. Wage, Salary Income
7. Property Sold
Attach W-2s:
Employer Taxpayer Spouse Attach 1099-S and closing statements

Property Date Acquired Cost & Imp.

Personal Residence*
Vacation Home
Land
Other
* Provide information on improvements, prior sales of home,
and cost of a new residence. Also see Section 17
(Job-Related Moving).

4. Interest Income 8. I.R.A. (Individual Retirement Acct.)

Attach 1099-INT, Form 1097-BTC & broker statements
Contributions for tax year income
Payer Amount U for
Amount Date Roth
Taxpayer
Spouse

Amounts withdrawn. Attach 1099-R & 5498

Tax Exempt
Plan Reason for
Trustee Withdrawal Reinvested?
Yes No
Yes No
5. Dividend Income Yes No
Yes No
From Mutual Funds & Stocks - Attach 1099-DIV
Capital Non-
Payer Ordinary Gains Taxable 9. Pension, Annuity Income
Attach 1099-R Reason for
Payer* Withdrawal Reinvested?
Yes No
Yes No
Yes No
Yes No
* Provide statements from employer or insurance
company with information on cost of or
6. Partnership, Trust, Estate Income contributions to plan.

Did you receive: Taxpayer Spouse

List payers of partnership, limited partnership, S-corporation, trust,
or estate income - Attach K-1 Social Security Benefits Yes No Yes No
Railroad Retirement Yes No Yes No

Attach SSA 1099, RRB 1099

CTORG02 10-03-23
 10. Investments Sold

Stocks, Bonds, Mutual Funds, Gold, Silver, Partnership interest - Attach 1099-B & confirmation slips
Investment Date Acquired/Sold Cost Sale Price
/
/
/
/

11. Other Income 14. Interest Expense

List All Other Income (including non-taxable) Mortgage interest paid (attach 1098)
Interest paid to individual for your
Alimony Received home (include amortization schedule)
Child Support Paid to:
Scholarship (Grants) Name
Unemployment Compensation (repaid) Address
Prizes, Bonuses, Awards Social Security No.
Gambling, Lottery (expenses ) Investment Interest
Unreported Tips Premiums paid or accrued for qualified
Director / Executor's Fee mortgage insurance
Commissions
Jury Duty
15. Casualty/Theft Loss
Worker's Compensation
Disability Income
For property damaged by storm, water, fire, accident, or stolen.
Veteran's Pension
Location of Property
Payments from Prior Installment Sale
State Income Tax Refund
Description of Property
Other
Other
Federally Declared
Other
Disaster Losses
12. Medical/Dental Expenses
Amount of Damage
Insurance Reimbursement
Medical Insurance Premiums Repair Costs
(paid by you) Federal Grants Received
Prescription Drugs
Insulin
16. Charitable Contributions
Glasses, Contacts
Hearing Aids, Batteries
Braces Other
Medical Equipment, Supplies
Church
Nursing Care
United Way
Medical Therapy
Scouts
Hospital
Telethons
Doctor/Dental/Orthodontist
University, Public TV/Radio
Mileage (no. of miles):
Heart, Lung, Cancer, etc.
Wildlife Fund
Salvation Army, Goodwill
13. Taxes Paid
Other

Real Property Tax (attach bills) Non-Cash

Personal Property Tax
Other Volunteer (no. of miles) @ .14 $0.00

CTORG03 10-03-23
 17. Child & Other Dependent Care Expenses

Soc. Sec. No. or Amount

Name of Care Provider Address
Employer ID Paid

Also complete this section if you receive dependent care benefits from your employer.

18. Job-Related Moving Expenses 21. Business Mileage

U if you are a member of the Armed Forces on active duty Do you have written records? Yes No
and moving due to a permanent change of station due to
a military order. Did you sell or trade in a car used
for business? Yes No
Date of move
Move Household Goods If yes, attach a copy of purchase agreement
Lodging During Move
Make/Year Vehicle
Travel to New Home (no. of miles)
Date purchased
Total miles (personal & business)
19. Employment Related Expenses That You Paid Business miles (not to and from work)
(Not self-employed) From first to second job
Education (one way, work to school)
U if Armed Forces reservist, a qualified performing artist, Job Seeking
a fee-basis state or local government official, or an individual Other Business
with a disability claiming impairment-related work expenses.
Round Trip commuting distance
Dues - Union, Professional Gas, Oil, Lubrication
Books, Subscriptions, Supplies Batteries, Tires, etc.
Licenses Repairs
Tools, Equipment, Safety Equipment Wash
Uniforms (include cleaning) Insurance
Sales Expense, Gifts Interest
Tuition, Books (work related) Lease payments
Entertainment Garage Rent
Office in home:
In Square a) Total home
22. Business Travel
Feet b) Office
c) Storage
If you are not reimbursed for exact amount, give total expenses.
Rent
Insurance Airfare, Train, etc.
Utilities Lodging
Maintenance Meals (no. of days )
Taxi, Car Rental
Other
20. Investment-Related Expenses State use only
Reimbursement Received

Tax Preparation Fee

Safe Deposit Box Rental
Mutual Fund Fee
Investment Counselor
Other

CTORG04 10-03-23
 23. Estimated Tax Paid 24. Other Deductions

Alimony Paid to
Due Date Date Paid Federal State
Social Security No. $
Student Interest Paid $
Health Savings Account Contributions $
Archer Medical Savings Acct. Contributions $

26. Questions, Comments, & Other Information

25. Education Expenses

Student's Name Type of Expense Amount

Residence:
Town County
Village School District
City

27. Direct Deposit of Refund / or Savings Bond Purchases

Would you like to have your refund(s) directly deposited into your account? Yes No
(The IRS will allow you to deposit your federal tax refund into up to three
different accounts. If so, please provide the following information.)

ACCOUNT 1

Owner of account Taxpayer Spouse Joint

Type of account Checking Traditional Savings Traditional IRA Roth IRA

Treasury Direct Archer MSA Savings Coverdell Education Savings HSA Savings SEP IRA

Name of financial institution

Financial Institution Routing Transit Number (if known)

Your account number

ACCOUNT 2

Owner of account Taxpayer Spouse Joint

Type of account Checking Traditional Savings Traditional IRA Roth IRA

Treasury Direct Archer MSA Savings Coverdell Education Savings HSA Savings SEP IRA

Name of financial institution

Financial Institution Routing Transit Number (if known)

Your account number

CTORG05 10-03-23
ACCOUNT 3

Owner of account Taxpayer Spouse Joint

Type of account Checking Traditional Savings Traditional IRA Roth IRA

Treasury Direct Archer MSA Savings Coverdell Education Savings HSA Savings SEP IRA

Name of financial institution

Financial Institution Routing Transit Number (if known)

Your account number

Would you like to purchase Series I Savings bonds with a portion of your refund? If so, please answer the following:

Amount used for bond purchases for yourself (and spouse if filing jointly).

Amount used to buy bonds for someone else (or yourself only or spouse only if filing jointly).

Owner's name Co-owner or Beneficiary's X if name is for Bond purchase Amount

name if applicable a beneficiary

To the best of my knowledge the information enclosed in this client tax organizer is correct and includes all
income, deductions, and other information necessary for the preparation of this year's income tax returns for
which I have adequate records.

Taxpayer Date Spouse Date

CTORG06 10-03-23