• No results found

2014 INCOME TAX DATA ORGANIZER PLEASE ATTACH A VOIDED CHECK TO RECEIVE YOUR REFUND

N/A
N/A
Protected

Academic year: 2022

Share "2014 INCOME TAX DATA ORGANIZER PLEASE ATTACH A VOIDED CHECK TO RECEIVE YOUR REFUND"

Copied!
6
0
0

Loading.... (view fulltext now)

Full text

(1)

2014 INCOME TAX DATA ORGANIZER P LEASE A TTACH A V OIDED C HECK TO

R ECEIVE Y OUR R EFUND

NAME: ______________________________________________________________________________________

IF WE DO NOT HAVE THE FOLLOWING ON FILE:

(1) Please provide a picture ID such as a drivers’ license, passport, military ID or any other ID that has been issued by State or Federal government for each taxpayer (i.e. husband and wife) listed on the your tax return and for each dependent if available.

(2) Please provide a Social Security card for each person listed on your tax return (taxpayers and dependents). If the Social Security card is not available, Form W-9 (Request for Taxpayer Identification Number and Certificated) will be acceptable. Form W-9 can be found on our web site, www.lsfnonline.com, in the “Client Forms” section.

Returning clients, please complete this section only if a change has occurred

His Name: ___________________________________ S.S. #: ______________________ Date of Birth: ___________

Her Name: ___________________________________ S.S. #: ______________________ Date of Birth: ___________

Address: _________________________________________ City: __________________ State: _____ Zip: ___________

Home Phone: _____________________ Work Phone: ______________________ Cell #: _______________________

Her Work Phone: _______________________________ Her Cell #: _________________________________________

His Occupation: ________________________________ Her Occupation: ____________________________________

His Email: ____________________________________ Her Email: ________________________________________

His Driving License #_________________ST_______ Her Driving License #: ____________________ST_________

Dependents: (IRS requires a Social Security Number for your children.)

Name Date of Birth Relationship SS Number

1.____________________________ _________________ _________________ _________________________

2.____________________________ _________________ _________________ _________________________

3.____________________________ _________________ _________________ _________________________

4.____________________________ _________________ _________________ _________________________

If any dependent which you are claiming had income in 2014, please include their Tax Documents.

Were there any changes in your Dependents? If yes, explain. _______________________________________________

_________________________________________________________________________________________________

(2)

LifeStyle Financial Network, LLC 2 Did a spouse or dependent die last year? If yes, please list the date of death. _________________________________

Did you and your spouse divorce last year? Please provide a copy of the divorce decree and on a separate sheet of

paper. Describe: (1) agreement for claiming the children, (2) child support, (3) alimony and (4) sale of property, (5) disbursements of retirement funds, and (6) any questions you may have.

I NCOME

Wages: Please attach all W-2 Forms

Dividends and Interest Income: Please attach all 1099 Forms received from any source.

Did you receive a federal and/or state tax refund? Yes _____ No _____ If Yes: $ _______________

Did you receive alimony in 2014? Yes _____ No _____ If Yes: $ _______________

Payor's Name and address:_______________________________________________________________________

Did you pay alimony in 2014? Yes _____ No _____ If Yes: $_______________

Recipient's Name and Social Security Number: ___________________________________________________________

Did you have distributions from IRA's, pensions, annuities, and rollovers? Yes ____ No ____ If Yes: $__________

Capital Gains and Capital Losses:

Gains and /or losses from stock transactions, housing, or other transactions are to be reported on your tax return.

PLEASE ATTACH BROKERS’ STATEMENTS or MUTUAL FUND STATEMENTS.

If you sold your personal residence in 2014, please include all closing statements.

If you sold any other property in 2014, please include all closing statements.

Self -Employed Income

Please go to our web site (www.lsfnonline.com), click the “Client Forms” tab, and download the Business Income

and Expenses (Self-Employed) worksheet.

Advise us of your business venture, as we may know of deductions which you are not aware.

If you used your personal auto for your business, please list the type of auto, and the mileage for the following;

Business Miles Driven 1/01/2014 – 12/31/2014 ________ Personal Miles Driven 1/01/2014 – 12/31/2014 ________

Commuting Miles Driven 1/01/2014 – 12/31/2014 ________

If you use your home as a home office, go to our web site (www.lsfnonline.com), go to the “Client Form” tab, and download the “Business Use of Your Home” worksheet.

(3)

Rental and Royalty Income:

Rent received $ __________________________ Location of property:

Royalties received $___________________________ Location of property:

Please provide itemized expenses incurred during the year for each property.

Please go to our web site (www.lsfnoline.com), go to the “Client Forms” tab, and download the Rental Property worksheet.

Did you manage the property yourself? Yes _____ No _____ If yes, please provide details.

Did you sell any rental property? Yes _____ No _____ If yes, please provide the closing statement from the sale and purchase of the property, depreciation for the years you owned the property, and any other documentation.

Other Income:

Did you have farm income? Yes _____ No _____ If yes, attach a schedule of income and expenses.

Did you have unemployment compensation? Yes _____ No _____ If Yes: $ _______________

Did you receive Social Security benefits? Yes _____ No _____ If Yes: $ _______________ (Attach SSA 1099) Please advise if you had any other income not listed. ______________________________________________________

A DJUSTMENTS TO I NCOME

TEACHERS ONLY. Did you incur any expenses for your classroom for which you were not reimbursed?

Yes _____ No _____ If Yes: $__________________________

Did you contribute or convert to a Roth IRA? Yes _____ No______ If Yes: $_________________

Did you contribute to an IRA in 2014? Yes _____ No _____ If Yes: $ ________________

Do you wish to make an IRA or Roth IRA contribution for 2014? Yes _____ No _____ If Yes: $_________________

Do you have self-employed health insurance? Yes _____ No _____ If Yes: $ ________________

Do you have a self-employed retirement plan? Yes _____ No _____ If Yes: $ ________________

Do you have a Health Savings Account? Yes _____ No _____ If Yes: $ ________________

Do you have a penalty for early withdrawal of savings? Yes _____ No _____ If Yes: $ ________________

Do you have child or dependent care expenses? Yes _____ No _____ If Yes: $ ________________

Did you receive employer paid child or dependent care expenses? Yes _____ No _____ If Yes: $ ________________

Number of children which are in child care ________

List the name and address of day care provider and their Social Security number or their Tax ID Number.

Provider’s Name: ________________________________ Address: __________________________________________

(4)

LifeStyle Financial Network, LLC 4 Did you pay any higher education expenses? Yes _____ No_____ If Yes: $________________

(Please provide documentation and a list of the expenses paid) Moving Expenses:

Did you incur work-related moving expenses? (Over 50 miles) Yes _____ No _____ If Yes: $ _________

If yes, what was the distance from your old job to former home? _________ Miles What is the distance from your current job to former home? _________ Miles

List any other expenses incurred during the move such as temporary living expenses, travel, and lodging while searching for a residence.

Did your employer pay moving expenses for you? Yes ____ No _____ If Yes: $ ________

If yes, is moving included within your W-2? Yes ____ No_____ Don’t Know ______

D EDUCTIONS

The following are allowable deductions, although not all inclusive. You must be able to prove your deductions either by canceled check or receipts or both if audited. Please use a separate piece of paper if needed.

Medical and Dental Expenses:

Did you pay health insurance premiums? (After tax premiums only) Yes _____ No _____ If Yes: $ ______________

Did you pay Long Term Care Insurance Premiums? Yes _____ No _____ If Yes: $ ______________

 List non-reimbursed expenses for prescriptions, medicines and drugs.

 List non-reimbursed expenses for doctors, dentists, chiropractors, hospitals, therapy, nursing services, lab tests, etc.

List non-reimbursed medical aid items and equipment such as: artificial limbs, hearing aids and batteries, eyeglasses, contact lenses, crutches, etc.

 List non-reimbursed expenses for structural improvement to a residence to allow accessibility for wheelchair or special bathroom equipment for an impaired dependent.

 List non-reimbursed expenses for transportation to and from medical facilities.

 List non-reimbursed expenses for non-hospital lodging while receiving medical treatment.



State and local income taxes paid the past tax year (if not listed in W-2s) Yes ___ No ____ If Yes: $ ________

Real estate taxes paid the past tax year: Yes ___ No ____ If Yes: $ ________

Other taxes (e.g., Ad Valorem, car tag tax) Yes ___ No ____ If Yes: $ ________

Interest Paid: (Please bring the closing papers if you refinanced)

Home Mortgage interest paid to financial institutions: Yes ____ No ___ If Yes: $ ________

Please attach a copy of form 1098.

Did you have any real property transactions during the past tax year? Yes ____ No ____

If yes, attach a copy of your closing statement.

Home Mortgage interest paid to individuals: Yes ____ No _____ If Yes: $ ________

List individual's name, address and social security number

Points paid: Yes____ No _____ If Yes: $ _________

Did you have investment interest expenses? Yes____ No _____ If Yes: $ _________

If yes, please attach details of investments.

(5)

Contributions:

Total cash contributions: (a receipt is required from the organizations) $ ______________________________

If over $3,000, list organization(s)_____________________________________

Total non-cash contributions: (i.e. clothes, household items, etc.) $_______________________________

List donated property and its fair market value. If over $500, list organization and address________________________

If you donated an auto, please call our office for further instructions.

Did you work for a volunteer organization and incur expenses? Yes ____ No ____ If Yes: $ _________

PLEASE PROVIDE THE NAME AND ADDRESSES FOR YOUR NON-CASH CONTRIBUTIONS

Did you assume any business expenses that you were required to pay but which you were not reimbursed by your employer? Please go to our web site (www.lsfnonline.com), go to the “Client Form” tab, and download the Employee Business Expenses worksheet.

Are your reimbursed expenses included in your W-2 wages? Yes _____ No _____ If Yes: $ _______________

Other Miscellaneous Deductions:

Employee Business Expenses Yes ____ No ____ If Yes, please list.

Safety deposit box Yes ____ No ____ If Yes: $ ________

Tax return fee Yes____ No ____ If Yes: $ ________

Union dues Yes ____ No ____ If Yes: $ ________

Financial Planning / Investment Advice fees Yes ____ No ____ If Yes: $ _______

IRA Custodial Fees Yes ____ No ____ If Yes: $ _______

E STIMATED I NCOME T AX D EPOSITS FOR

Federal State

Date Paid Amount Date Paid Amount

________________ $___________________ ________________ $___________________

________________ $___________________ ________________ $___________________

________________ $___________________ ________________ $___________________

________________ $___________________ ________________ $___________________

________________ $___________________ ________________ $___________________

(6)

LifeStyle Financial Network, LLC 6 YOUR TAX RETURN WILL NOT BE COMPLETED WITHOUT

Affordable Care Act (aka Obamacare) and the Foreign (Off-Shores) Financial Accounts(s) Disclosures

For Alabama tax returns only:

Consumer Use Tax:

List the price you paid for items that were purchased from businesses located outside of Alabama through internet, telephone, mail order, etc. for which no Alabama State sales tax was collected. If any, list the sales taxes that you paid to other states on the above purchases.

State of Alabama “College Counts” 529 Plan contributions: $__________________________________

Donation of Refunds

Alabama Senior Services Trust Fund $1 $5 $10 Other $_________

Alabama Arts Development Fund $1 $5 $10 Other $_________

Alabama Non-Game Wildlife Fund $1 $5 $10 Other $_________

Alabama Veteran’s Program $1 $5 $10 Other $_________

Alabama Indian Children’s Scholarship Fund $1 $5 $10 Other $_________

Alabama Breast and Cervical Cancer Research Program $1 $5 $10 Other $_________

Child Abuse Trust Fund $1 $5 $10 Other $_________

Foster Care Trust Fund $1 $5 $10 Other $_________

Mental Health $1 $5 $10 Other $_________

________________________________________________________________________________________

Your tax return will be prepared to e-file unless otherwise noted. The information supplied herein is for the preparation of your Federal and State income tax returns and to the best of your knowledge is true, correct, and complete.

PLEASE ATTACH A VOIDED CHECK

___________________________________________ _______________________

Signature of Taxpayer Date

Please list other income and/or expenses that were not mentioned above or any questions that you may have.

Securities offered through Securities America Inc., Member FINRA/SIPC, C. Reed Terry, Registered Representative. Advisory services offered through Securities America Advisors, Inc., C. Reed Terry, Investment Advisor Representative. LifeStyle Financial Network, LLC and the Securities America companies are not affiliated.

Securities America, Inc. or Securities America Advisors, Inc. does not offer tax or legal advice.

References

Related documents

• Transfer your income sources and amounts from the Income and Expenses Worksheet to the dates income is paid on the Monthly Payment Calendar worksheet. • Transfer your expenses

Did you drive your car for work (non‐commuting)  in this business?  If yes, please fill out the 

If you have declared any income under Design and Creativity Consultancy please advise what you design and what your client will do with your completed

To download the VPN client, please go to www.uab.edu/vpn and click on the link “Click here to download the latest Windows 2000/XP/Vista client and enter your BlazerID and

Every year you’re in business, self-employed or receive income that isn’t taxed at source you’ll need to file a tax return with us.. Your return must include all the income you

(Please attach a voided check or deposit slip from your account for verification) C.‰By Electronic Refund Checking (7 to 14 Days) – Preparation and bank fees are deducted from

If your self employed income has changed since your business accounts were audited please complete this form.. If there has been no change to your self employed income since

If you are claiming due to a recent dip in your self-employed income, or if the nature of your business has changed, then your income and expenditure will