Client Tax Information

***Income Tax Organizer***

Dixie L. Chan Tax Services

P.O. Box 1064, Lincoln, CA 95648

(916) 645-1153---------FAX: (916) 645-1393---------taxranch@yahoo.com

Income

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

o Interest - (please attach any 1099s)

Payor Amount

o Dividends- (please attach any 1099s)

Payor Amount

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

o Taxes paid Amount

o Mortgage interest (attach form 1098s) Amount

o Charitable contributions Amount

o Other deductions Amount

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?
		Do you have any children under age 14 with interest and dividend income in excess of $500, or total investment income in excess of $1300?
		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?
		Do you or your spouse want to allocate $3 to the Presidential Election Campaign Fund

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 _______________________________

COMMENTS:_______________________________________________________________________________________________________

Check here to have your refund directly deposited into your bank account.___________________

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)_________________________________________

P.O. Box 1064

Lincoln, CA 95648

(916) 645-1153 email us:

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