FORM 1040 QUESTIONS

Name: _______________________ SS#: ____________ Home Phone: __________

Spouse: ______________________ SS#: ____________ Work Phone: __________

Dependent: ___________________ SS#: ____________ Work Phone: __________

Dependent: ___________________ SS#: _____________ E-mail: __________

Filing Status ?
Single
Married filing jointly
Married filing separately
Head of household
Qualifying widow(er)

Wages: __________

Taxable interest: __________

Dividends: __________

Taxable refunds: __________

Alimony received: __________

Business income/ loss: __________

Capital gain/ loss: __________

IRA distributions: __________

Pension/ annuities: __________

Rental real estate, royalties, partnerships, etc.: __________

Expense list for rental income? Y / N

Unemployment compensation: __________

Social Security Benefits: __________

IRA deduction: __________

Student loan interest: __________

Moving expenses: __________

Job Related? Y / N

Self employed SEP, SIMPLE, and qualified plans: __________

Alimony paid: _________

Recipient's SS#: __________

Credit for child and dependent care expenses: __________

Education credit: __________

Child tax credit: __________

Estimated Tax Payments: __________

SCHEDULE A & B QUESTIONS

Medical and Dental Expenses

Doctor: __________

Dental: __________

Insurance: __________

Co pays: __________

Taxes Paid

State and local income taxes: __________

Real estate taxes: __________

Personal property taxes: __________

Interest Paid

Home mortgage interest and points: __________

Home mortgage interest not reported to you: __________

Points not reported to you: __________

Do you have a 2^nd or 3^rd on the home? Y / N

Gifts to Charity

Gifts by cash or check: __________

Gifts made other than cash or check: __________

Casualty and theft loss(es) : __________

Job Expenses and Most Other Miscellaneous Deductions

Unreimbursed employee expenses: __________

Tax preparation fees: __________

Other: __________

SCHEDULE B QUESTIONS

Interest Received: __________

Dividends Received: __________

SCHEDULE D QUESTIONS (STOCK)

Description	Date Acquired	Date Sold	Sales Price	Cost or basis

SCHEDULE C QUESTIONS

INCOME

Gross Receipts: __________

Returns and Allowances: __________

Cost of Good Sold: __________

EXPENSES

Advertising: __________

Bad Debts: __________

Auto Expenses

Total miles __________

Business miles __________

Commuting miles: __________

Parking & tolls: __________

Commissions/ Fees: __________

Insurance (E&O, Business): __________

Insurance Medical: __________

Business Mortgage: __________

Legal and Professional: __________

Office Expense (postage, paper, supplies, etc.): __________

Pension and Profit Sharing Plans: __________

Rent or lease

Vehicles, machinery, and equipment: __________

Other business property: __________

Repairs and Maintenance: __________

Supplies: __________

Taxes and Licenses: __________

Travel Expenses

Travel: __________

Meals: __________

Entertainment: __________

Utilities

Telephone: __________

Cellular: __________

Electricity: __________

Gas: __________

Water: __________

Garbage: __________

COST OF GOODS SOLD

Inventory at beginning of year: __________

Cost of labor: __________

Materials and Supplies: __________

Inventory at end of year: __________