NON-CASH CONTRIBUTION WORKSHEET - Shoemake CPA

1 Your donation may be deductible if the type of giving and the recipient meets tax law criteria. Keep in mind you can't deduct your charitable contributions if you don't itemize deductions and not every non-profit organization is a tax-qualified charitable organization. If in doubt, ask the group whether your CONTRIBUTION is "tax-deductible." Use this published Salvation Army list as a valuation guideline. The IRS also requires that donated items are in good used condition or better. Please fill-in the below quantity and dollar amount prior to your tax appointment to receive this deduction. Also record the grand total on the back 's Items Low High Qty Total Bathing Suits $ $ Bathrobes $ $ Blouse $ $ Boots $ $ Bras $ $ Coats $ $ Dresses $ $ Evening Dresses $ $

2 Foundation Garments $ $ Fur Coats $ $ Fur Hats $ $ Handbags $ $ Hats $ $ Jackets $ $ Nightgowns $ $ Pants Suits $ $ Shoes $ $ Skirts $ $ Slacks $ $ Slips $ $ Socks $ $ Suits $ $ Sweaters $ $ Total Men s Items Low High Qty Total Jackets $ $ Over Coats $ $ Pajamas $ $

3 Pants-shorts $ $ Raincoat $ $ Shirts $ $ Shoes $ $ Slacks $ $ Suits $ $ Sweaters $ $ Swim Trunks $ $ Tuxedo $ $ Under-shirts $ $ Under-shorts $ $ Total Children s Items Low High Qty Total Bicycles $ $ Blouses $ $ Boots $ $ Coats $ $ Dresses $ $ Jackets $ $ Jeans $

4 $ Pants $ $ Shirts $ $ Shoes $ $ Skirts $ $ Slacks $ $ Snowsuits $ $ Socks $ $ Sweaters $ $ Underwear $ $ Total Dry Goods Low High Qty Total Bedspreads $ $ Blankets $ $ Chair Covers $ $ Curtains $ $ Drapes $ $ Pillows $ $ NON-CASH CONTRIBUTION WORKSHEET Below suggested prices from FORM: NON-CASH Rev.

5 061223 Sheets $ $ Throw Rugs $ $ Towels $ $ Total Furniture Low High Qty Total Bed Complete (double) $ $ Bed Complete (single) $ $ Bedroom Set (complete) $ $1,000. Carriage $ $ Chest $ $ China Cabinet $ $ Clothes Closet $ $ Coffee Table $ $ Convertible Sofa (w/ mattress) $ $ Crib (w/mattress) $ $ Desk $ $ Dining Room (complete set) $ $ Dresser w/Mirror $ $ End Tables ( 2 ) $ $ Floor Lamps $ $ Folding Beds $ $ Hi Riser $ $ High Chair $ $ Kitchen Cabinets $ $ Kitchen Chair $ $ Kitchen Set $ $ Mattress (double)

6 $ $ Mattress (single) $ $ Play-Pen $ $ Rugs $ $ Secretary $ $ Sofa $ $ Trunk $ $ Wardrobe $ $ Total Appliance Low High Qty Total Air Conditioner Dryer Gas Stove Heaters Radio

7 Refrigerator (Working) (B/W Working) (Color Working) Washing Machine Total Grand Total Additional NON-CASH Items I Yes No Write-in additional items that are not referenced above. You must have a valuation basis so to better determine value of your donated items we recommend that you visit the thrift store where your donation will be sold to verify their prices. Items Qty Total Items Qty Total Total Signature(s) are required to process this tax deductionIf audited, the IRS requires an original Donee receipt(s). I declare that the information I have provided to Nancy L Shoemake CPA, is to the best of my knowledge is true, correct and complete. Taxpayer Signature Spouse Signature Date Print Name Print Name Dat