Schedule A: Homeowners-Itemize
Name
*
First Name
Last Name
Email
*
example@example.com
MEDICAL AND DENTAL EXPENSES
Rows
Total Medical
Total Mileage x .165
1.
1.
1. Doctor/Dentist/Hospital/Drugs/Transportation/Lodging (.165 cents x mi.) (Must exceed 7 1/2 of AGI)
TAXES
Rows
Primary Residence
Secondary Residence
(- Less Rebate)
6. (1)
6. (2)
6. (2)
6. Real Estate Taxes
Rows
8.
Other Taxes (List)
Rows
SWT $
SUI/SDI $
INTEREST YOU PAID
Rows
10. $
10.
10. Home Mortgage Interest/Points Paid to Bank on Form 1098
10. Home Mortgage Interest/Points Paid to Bank on Form 1098
Rows
Name
Address
SS#
11.
11. Other Home Mortgage Interest not reported on Form 1098
Rows
%
# of years
12.
12. Points Not Reported to you on Form 1098 (Refinanced Points)
Rows
13.
13. Qualified Mortgage Insurance (PMI)
Rows
14.
14. Invest Interest
GIFTS TO CHARITY *MUST HAVE PROOF
Rows
16.
16. Cash or Check contribution (if $250 or more, list)
Rows
17.
17. Non - cash contribution (Over $500 attach form 8283)
MISCELLANEOUS DEDUCTIONS (NOTE MUST EXCEED 2% OF AGI)
21. Unreimbursed Employee Expense (Complete & Attach 2016 or 2106EZ
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Rows
22.
22.
22. Tax Preparation Fees
22. Union Dues
Rows
28.
28. Gambling/Lottery losses (Note to exceed gambling winnings)
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