***Income Tax Organizer***

Dixie Chan Tax Services

P.O. Box 1064, Lincoln, CA 95648

Office: (916) 645-1153---------FAX: (916) 645-1393--------Cell (916) 521-0967

Email: taxranch@yahoo.com

Income

o W-2s (please include a copy with organizer)

o Interest - (please attach any 1099s)

Payor                                              Amount

1. $
2. $
3. $
4. $

o Dividends- (please attach any 1099s)

Payor                                              Amount

1. $
2. $
3. $
4. $

o Partnerships- (please attach any K-1s)

Partnership name                                      Amount

1. $
2. $

o Other Income

Payor                                              Amount

1. $
2. $

  

Deductions

o Medical and Dental                          Amount

1. $
2. $
3. $
4. $

o Taxes paid                                     Amount

1. Real Estate $
2. State and local income tax $
3. Automobile taxes and fees $
4. Other $

o Mortgage interest (attach form 1098s)           Amount

1. $
2. $
3. $
4. $

o Charitable contributions                   Amount

1. $
2. $
3. $
4. $

o Other deductions                            Amount

1. $
2. $
3. $

 

Miscellaneous Questions

YES NO

 
    Were there any births, adoptions, marriages, divorces, or deaths in your immediate family during the year?
    Are any of your unmarried dependent children 19 years of age or older?
    Did you receive any income from a business or hobby?
    Were you a renter for at least six months last year?
    Did you or your spouse "rollover" a profit-share or retirement plan distribution into another plan? If yes, enter amount $___________________, and attach Form 1099-R.
    Did you or your spouse receive any disability income during the year? If yes, enter amount $_______________.
    Did you purchase, sell, or refinance your principal home or your second home, or make a home equity loan during the year? If yes, please include the escrow papers.
    Did you sell any stocks, bonds, or other investment property during the year? If yes, please include information on the transaction(s).
    Did you pay college expenses last year? If yes, include who they were for, what the expenses were for, and the amounts.
    Did you incur employee expenses that were not reimbursed by your employer?
    Did you incur moving expenses during the year due to a change in employment?
    Did you incur a loss due to stolen property or other casualties?
    Did you cash in any Series EE U.S. savings bonds?
    Did you make any energy efficient home improvements? 

Client Information (add the same information for spouse and children if you are a new client)

Name(s)        _______________________________

Address        _______________________________

City, State, Zip              _______________________________

Phone          _______________________________

Cell        _______________________________

Date(s) of Birth   _______________________________

e-Mail address _______________________________

Include names and social security numbers and birth dates of all children

 

 

COMMENTS:_______________________________________________________________________________________________________

 

For direct deposit please provide your bank's routing and account number (or attach a voided check).

Routing # (found on lower left of your check, usually begins with 12 or 32)____________________

Account # (follows the routing number)_________________________________________

 

 

Also, Dixie Chan Tax Services

P.O. Box 1064

Lincoln, CA 95648

(916) 645-1153  

 

email us: