Client Tax Organizer

Client Tax Organizer

8. Medical / Dental / Vision Expenses

1. Personal Information

10. Taxes Paid

12. Charitable Contributions

13. Miscellaneous Itemized Deductions

14. Education Expenses

15. Child & Dependent Care Expenses

16. Student Loan Interest Paid

Verification and Signature:

ID Information:

9. Home Mortgage Interest

Cash Contributions

Referred by:
Enter the name of the person who referred you
Preferred Tax Preparer:
Enter Your Tax Preparer
January 1 - December 31, 20
Client Tax Organizer

Ambitions Renewed Enterprises, LLC "Your Tax Angels"
Verification and Signature:
To the best of my knowledge the enclosed information is true and correct and includes all income, deductions, and other information necessary for the preparation of this year’s income tax return for which I have adequate records to prove such if needed by a Taxing Authority such as the IRS and any State Revenue Agency.
Taxpayer Signature
Date:

MonthDayYear
Date
Spouse Signature
Date:

MonthDayYear
Date
1. Personal Information
Filing Status
If your Filing Status is Qualifying Widower, please enter your Spouse Date of Death:

MonthDayYear
Date
Taxpayer Name:

First NameTaxpayer Last Name
Middle Initial
Taxpayer Middle Initial
Social Security #:
Date of Birth:

MonthDayYear
Spouse Name:

First NameSpouse Last Name
Middle Initial
Spouse Middle Initial
Social Security #:
Date of Birth:

MonthDayYear
Address

Street Address

Street Address Line 2

CityState

Zip Code
Home Phone:
Taxpayer
Work Phone:
Taxpayer
Cell Phone:
Taxpayer
Email:
Taxpayer (example@example.com)
Home Phone:
Spouse
Work Phone:
Spouse
Cell Phone:
Spouse
Email:
Spouse (example@example.com)
Occupation:
Taxpayer
Occupation:
Spouse
ID Information:
Driver’s License/State I.D. #:
Taxpayer
Issuing State:
Taxpayer
Issue Date:

MonthDayYear
Taxpayer
Expiration Date:

MonthDayYear
Taxpayer
Driver’s License/State I.D. #:
Spouse
Issuing State:
Spouse
Issue Date:

MonthDayYear
Spouse
Expiration Date:

MonthDayYear
Spouse
Taxpayer Initials
Spouse Initials
Taxpayer Blind
Taxpayer Disabled
Spouse Blind
Spouse Disabled

Rows	Taxpayer	Spouse
Blind
Disabled

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Did you, your spouse, &/or your dependents have insurance through the Marketplace (Obamacare)?

Please answer the following questions to determine maximum deductions:

Rows	Yes	No
1. Are you Self-Employed or do you receive hobby income?
2. Were there any births, deaths, marriages, divorces, or adoptions in your household?
3. Did you receive income from raising animals or crops?
4. Did you give a gift of more than $15,000 to one or more persons?
5. Did you have any debts cancelled, forgiven, or refinanced?
6. Did you receive income from gravel, timber, minerals, oil, gas, copyrights, and/or patents?
7. Did you go through bankruptcy?
8. Did you receive rent from real estate or other property?
9. Did you withdraw or write checks from a mutual fund?
10. Did you pay rent or mortgage?
a. If so, are you Head of your Household?
11. Do you have a foreign bank account, trust, or business?
12. Did you pay interest on a student loan for yourself, spouse, or your dependent during the year?
13. Do you provide a home for and/or help support anyone not listed in Section 2 below?
14. Did you pay expenses for yourself, your spouse, or your dependent to attend classes beyond high school?
15. Did you receive any correspondence from the IRS or State Department of Taxation?
16. Did you have any children under the age of 19 or 19-23 year old students that had unearned income of more than $950?
17. Did you purchase a new alternative technology vehicle or electric vehicle?
18. Did you own $50,000 of more in foreign assets?
19. Did you install any energy property to your residence such as solar water heaters, generators, etc... or make improvements such as exterior doors or windows, insulation, heat pumps, furnaces, central air conditioners, or water heaters?
20. Did you withdraw and/or borrow from your retirement Account?

2. Dependents (Children & Others); List in order from youngest to oldest. (Please Provide Social Security Cards or SSA printouts)

Rows	Exact name on Social Security Card	Relationship	D.O.B.	S.S.N.	Months Lived with you	Disabled	Full-Time Student	Gross Income (if any)
Dependent 1
Dependent 2
Dependent 3
Dependent 4
Dependent 5

Taxpayer Initials
Spouse Initials

3. Estimated Taxes Paid (not taxes withheld from earnings)

Rows	Date Paid	Federal	State
First Quarter
Second Quarter
Third Quarter
Fourth Quarter

4. Refund Options (Please Check One):
Taxpayer Initials
Spouse Initials
If any form of direct deposit is chosen, please complete the following:

(By providing your checking account information you authorize us to use your checking account information to collect unpaid fees due to us as agreed upon in your Client Engagement Letter & you accept & authorize the electronic transmission and/or debit for said fees, per the terms of your Client Engagement Letter.)
Bank Name
Banking Routing Number (9-Digit Number)
Account Number
Type a question

Other
Account Type
Please enter whole numbers only (no cents).

5. Interest Income (Please provide 1099-INTs & brokerage statements.)

Rows	Payer	T/S/J	Bank or Credit Union	U.S. Bonds/T Bills	Federal Tax Withheld	Municipal or Tax-Exempt
Payer 1
Payer 2
Payer 3
Payer 4

6. Dividend Income from Mutual Funds and Stocks (Please provide 1099-DIVs for each item listed below.)

Rows	Payer	T/S/J	Total ordinary Dividends (Box 1a)	Qualified Dividends (Box 1b)	Capital Gain Distribution (Box 2a)	Federal Tax Withheld
Payer 1
Payer 2
Payer 3
Payer 4

7. Other Income (Please list all other income).Payer/Source

Rows	Payer/Source	Taxpayer	Spouse	Federal Tax Withheld
Alimony Received
Prizes, Bonuses, Awards
Jury Duty
Social Security Benefits (Taxable Income)
Medicare Premiums Withheld
Unemployment Compensation Received
Unemployment Compensation Repaid
Gambling, Lottery
Worker's Compensation
Other Income
Other Income

Taxpayer Initials
Spouse Initials
8. Medical / Dental / Vision Expenses

To be deducted, medical expenses must exceed 7.5% of your adjusted gross income, and then only the amount that exceeds a 7.5% floor is deductible. Example: Your AGI is $40,000 for the year; your medical expenses must exceed $3,000. State deductible limits/requirments may differ from Federal, depending on your state.
8.1. Acupuncture/Chiropractic
8.2. Lodging for Away-From-Home Medical Purposes
8.3. Ambulance/Paramedics
8.4. Long-Term Care Insurance – Taxpayer
8.5. Medical Miles (for Taxpayer, Spouse, & Dependents, include all miles for medical, dental, vision, and medicinal purposes)
8.6. Long-Term Care Insurance – Spouse
8.7. Braces
8.8. Medical Equipment, Supplies
8.9. Medical, Dental, & Vision Doctor Visit Payments (discretionary cosmetic surgery is not deductible)
8.10. Medical Insurance Premiums (paid by you)
8.11. Medical, Dental, & Vision Deductibles (discretionary cosmetic surgery is not deductible)
8.12. Medical, Dental, & Vision Deductibles (discretionary cosmetic surgery is not deductible)
8.13. Handicapped Modification to Home
8.14. Nursing Homes, Nursing Care
8.15. Handicap Placard/Tag:
8.16. Parking Fees for Medical Purposes
8.17. Hearing Aid and/or Batteries
8.18. Prescription Drugs
8.19. Insulin
8.20. Psychotherapy, Psychological Counseling
8.21. Lab Fees & X-Rays
8.22. Insurance Reimbursement
8.23. Hospital
8.24. Other:
Amount of other expenses
Type of other medical expenses from # 8.24:
List the type of other expenses included in the amount on line 24.
9. Home Mortgage Interest
IF YOU HAVE PURCHASED, SOLD OR REFINANCED YOUR HOME THIS YEAR, IF POSSIBLEPLEASE PROVIDE YOUR ESCROW PAPERS.
Mortgage Company:
Amount Paid
Mortgage Company:
Amount Paid:
Mortgage Company:
Amount Paid:
Home Equity Loan:
Amount Paid:
Seller Financed Mortgage (Enter the Seller Name):
Seller Social Security # or Tax I.D. #:
Seller Address:

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Amount Paid:
Taxpayer Initials
Spouse Initials
10. Taxes Paid
Real Estate Taxes:
Auto License Fees (Specialty vehicle license fee portion only):
Property taxes on investment property:
Personal property tax – car, boat, etc.:
State Income Tax (that you paid directly to the state yourself):
Sales Tax:
Other Taxes:
Type of other taxes
List the other taxes you paid
Other Taxes:
Type of other taxes
List the other taxes you paid
11. Alimony Paid

(Do not include amount paid for child support. Child support is not deductible.)
Name

First NameLast Name
Social Security Number
Amount Paid
12. Charitable Contributions
Cash Contributions
Church/Tithes
Payroll Deduction
United Way
Cancer Society
Red Cross
Scouts
Other (please list):
Other (please list):
Other (please list):
Volunteer (no. of miles)

Non-Cash Charitable Contributions

Rows	Donee Name	Description of Property	Fair Market Value
Donee 1
Donee 2
Donee 3

Taxpayer Initials
Spouse Initials
13. Miscellaneous Itemized Deductions

As of 2018, unreimbursed employee expenses are no longer deductible for federal tax purposes, however, please complete this section as certain states, such as Alabama, still allow said deductions.

Rows	Taxpayer	Spouse
Telephone
Cell Phone
Credential Renewal & Transcripts
Continuing Education Courses
Internet
Job Seeking Expense
Professional Dues (CTA, NEA, etc...)
Professional Subscriptions
Safety Deposit Box
Safety Equipment
Tax Return Preparation Fee
Teaching Aids & Supplies
Uniforms & Laundry
Union Dues
Work Tools
Other (Please list):

14. Education Expenses

College or Other Continuing Education Expenses (Provide 1098-T or other supporting documentation)

Rows	Student’s Name	Type of Expense	Year of School	Amount
Student 1
Student 2
Student 3
Student 4
Student 5
Student 6

15. Child & Dependent Care Expenses

Care must enable you to work &/or look for work or attend school FULL TIME. (Care must be for a child under age 13 or a dependent who is physically or mentally incapable of self-care.)

*If childcare is for more than one child or dependent, please indicate how much was paid for each child or dependent.
Taxpayer Initials
Spouse Initials
16. Student Loan Interest Paid

(Please provide 1098-E or other supporting documentation)

Rows	Taxpayer	Spouse	Dependent
Interest Amount Paid

ACH Authorization (Page 4; number 4):

By selecting the option for an ACH credit (direct deposit) to an existing bank account, you authorize Ambitions Renewed Enterprises, LLC c/o Your Tax Angels, as of the date you sign this Agreement (defined below), to initiate a one-time ACH
debit from the personal bank account designated in this Client Tax Return Organizer Agreement, to collect any unpaid tax preparation fees, e-filing fees, bank processing fees and any other amounts that are due to us, in the event your federal
and/or state refund proceeds are reduced, delayed, or entirely intercepted due to a federal, state, or other authorized offset. This authorization is also backed by your signed Client Engagement Letter, your signed EPS Financial (Pathward) Refund Disbursement Application, your Tax Preparation Fee Acknowledgement Agreement and your invoice(s) from our company. This authorization shall remain valid until you revoke said authorization in writing to us at 1600 4th Court W., Birmingham, AL 35208 or by emailing us at custcare@are4you.com.

The authorization applies regardless of whether payment is first attempted by credit card, ACH, or tax refund deduction, and survives any chargeback, returned payment, or reversal until all amounts due under this Agreement are paid or the authorization is revoked in accordance with this Agreement.
Tax returns that require payment upfront will not be filed until payment is received in full. Thank you
Taxpayer Signature
Date:

MonthDayYear
Date
Spouse Signature
Date:

MonthDayYear
Date
Select how you would like to receive your copy of your tax return:
Sign and date here to confirm receipt of your tax return documents:

(the signature below is to be completed once tax return preparation is completed and tax return documents received)
Signature
Date:

MonthDayYear
Date
Taxpayer Initials
Spouse Initials
Please upload a picture ID (Driver's License, State ID, Passport, etc...) and Social Security Cards for you and/or your dependents.

Cancelof
Please upload your W-2's and/or any and all tax documents you have received from any employers, banks, IRS and/or State Notices, etc...

Cancelof
Should be Empty:

Provider Name

Address City, State, Zip

Provider SSN or EIN

Amount Paid

Child’s Name

Provider 1

Provider 2

Provider 3

Provider 4

Provider 5