Client Tax Organizer - cchwebsites.com

1 Client Tax OrganizerPlease complete this Organizer before your appointment. Prior year clients should use the proforma Organizer Personal InformationWork PhoneNameSoc. Sec. of BirthOccupationTaxpayerSpouseStreet AddressCityStateZIPHome PhoneEmail AddressTaxpayerSpouseMarital StatusBlindDisabledPres. Campaign FundYesYesYesNoNoNoYesYesYesNoNoNoMarrie dSingleWidow(er), Date of Spouse's DeathWill file jointlyYesNo2. Dependents (Children & Others)Name(First, Last)RelationshipDate ofBirthSocialSecurityNumberMonthsLivedWi thYouDisabledFullTimeStudentDependent'sG rossIncomeIDProtectionPINP lease provide for your appointment--Last year's tax return (new clients only)Name and address label (from government booklet or card)- All statements (W-2s, 1098s, 1099s, etc)Please answer the following questions to determine maximum Are you self-employed or do youreceive hobby income?Were there any births, deaths,marriages, divorces or adoptionsin your immediate family?

2 Yes*NoYesNo2. Did you receive income fromraising animals or crops?Yes*No10. Did you give a gift of more than $15,000to one or more people?YesNo3. Did you receive rent from realestate or other property?Yes*No11. Did you have any debts cancelled, forgiven,or refinanced?YesNo4. Did you receive income fromgravel, timber, minerals, oil, gas,copyrights, patents?12. Did you go through bankruptcyproceedings?Yes*NoYesNo5. Did you withdraw or writechecks from a mutual fund?13. (a) If you paid rent, how much did you pay?YesNo6. Do you have a foreign bankaccount, trust, or business?YesNo(b) Was heat included?YesNo14. Did you pay interest on a student loan foryourself, your spouse, or your dependentduring the year?7. Do you provide a home for orhelp support anyone not listedin Section 2 above? you pay expenses for yourself, yourspouse, or your dependent to attendclasses beyond high school?8. Did you receive any correspondencefrom the IRS or State Departmentof Taxation?

3 YesNoYesNoCTORG01 01-21-22* Contact us for further instructions16. Did you have healthcare coverage (healthinsurance) for you, your spouse anddependents during this tax season? If yes,include Forms 1095-A, 1095-B, and you and/or your spouse receive the thirdeconomic impact payment?If so enter the payment amount andinclude Notice(s) NoYes you install any energy property to yourresidence such as solar water heaters,generators or fuel cells or energy efficientimprovements such as exterior doors orwindows, insulation, heat pumps, furnaces,central air conditioners or water heaters ?17. Did you and/or your spouse receive anyadvance child tax credit payments?If yes, enter the amount and include IRSL etter(s) NoYes No18. Did you have any children under the age of19 or 19 to 23 year old students withunearned income of more than $1100?21. Did you own $50,000 or more in foreignfinancial assets?Yes NoYes NoHave you or your spouse been a victim of identity theft and givenan identity theft protection PIN by the IRS?

4 If yes, enter the sixdigit identity protection PIN Wage, Salary IncomeAttach W-2s:TaxpayerSpouseEmployerTaxpayerSpous e7. Property SoldAttach 1099-S and closing statementsPropertyDate AcquiredCost & Residence*Vacation HomeLandOther* Provide information on improvements, prior sales of home,and cost of a new residence. Also see Section 17(Job-Related Moving).4. Interest IncomeAttach 1099-INT, Form 1097-BTC & broker statementsPayerAmount8. (Individual Retirement Acct.)Contributions for tax year incomeU forRothAmountDateTax ExemptTaxpayerSpouseAmounts withdrawn. Attach 1099-R & 5498 PlanTrusteeReason forWithdrawal5. Dividend IncomeReinvested?YesYesYesYesNoNoNoNoFro m Mutual Funds & Stocks - Attach 1099-DIVC apitalGainsNon-TaxablePayerOrdinary9. Pension, Annuity IncomeAttach 1099-RPayer*Reason forWithdrawalReinvested?YesYesYesYesNoNo NoNo6. Partnership, Trust, Estate Income*Provide statements from employer or insurancecompany with information on cost of orcontributions to payers of partnership, limited partnership, S-corporation, trust,or estate income - Attach K-1 TaxpayerSpouseDid you receive:Social Security BenefitsRailroad RetirementYesYesNoNoYesYesNoNoCTORG02 01-21-22 Attach SSA 1099, RRB 109910.

5 Investments SoldStocks, Bonds, Mutual Funds, Gold, Silver, Partnership interest - Attach 1099-B & confirmation slipsInvestmentDate Acquired/SoldCostSale Price////11. Other Income14. Interest ExpenseMortgage interest paid (attach 1098)Interest paid to individual for your home (include amortization schedule)List All Other Income (including non-taxable)Alimony ReceivedChild SupportScholarship (Grants)Paid to:NameAddressSocial Security Compensation (repaid)Prizes, Bonuses, AwardsGambling, Lottery (expenses )Investment InterestPremiums paid or accrued for qualified mortgage insuranceUnreported TipsDirector / Executor's FeeCommissionsJury Duty15. Casualty/Theft LossWorker's CompensationDisability IncomeVeteran's PensionFor property damaged by storm, water, fire, accident, or of PropertyDescription of PropertyPayments from Prior Installment SaleState Income Tax RefundEconomic Impact Payment 1 (First Stimulus Payment)Economic Impact Payment 2 (Second Stimulus Payment)OtherFederally DeclaredDisaster LossesOtherOtherOtherAmount of DamageInsurance ReimbursementRepair CostsFederal Grants Received12.

6 Medical/Dental ExpensesMedical Insurance Premiums (paid by you)16. Charitable ContributionsOtherPrescription DrugsInsulinGlasses, ContactsHearing Aids, BatteriesChurchUnited WayScoutsTelethonsBracesMedical Equipment, SuppliesNursing CareMedical TherapyHospitalUniversity, Public TV/RadioHeart, Lung, Cancer, FundSalvation Army, GoodwillDoctor/Dental/OrthodontistMileag e (no. of miles)Other13. Taxes PaidNon-CashReal Property Tax (attach bills)Personal Property TaxVolunteer (no. of miles)@ .14 OtherCTORG03 01-21-2217. Child & Other Dependent Care ExpensesName of Care ProviderAddressSoc. Sec. No. orEmployer IDAmountPaidAlso complete this section if you receive dependent care benefits from your Business Mileage18. Job-Related Moving ExpensesU if you are a member of the Armed Forces on active dutyand moving due to a permanent change of station due toa military you have written records?YesYesNoNoDid you sell or trade in a car usedfor business?

7 Date of moveMove Household GoodsIf yes, attach a copy of purchase agreementLodging During MoveMake/Year VehicleDate purchasedTravel to New Home (no. of miles)Total miles (personal & business)19. Employment Related Expenses That You Paid(Not self-employed)Business miles (not to and from work)From first to second jobEducation (one way, work to school)U if Armed Forces reservist, a qualified performing artist,a fee-basis state or local government official, or an individualwith a disability claiming impairment-related work SeekingOther BusinessRound Trip commuting distanceGas, Oil, LubricationBatteries, Tires, - Union, ProfessionalBooks, Subscriptions, SuppliesLicensesRepairsWashInsuranceTool s, Equipment, Safety EquipmentUniforms (include cleaning)Sales Expense, GiftsTuition, Books (work related)EntertainmentInterestLease paymentsGarage RentOffice in home:In Square a)b)c)Total homeOfficeStorage22. Business TravelFeetIf you are not reimbursed for exact amount, give total , Train, (no.

8 Of days )Taxi, Car RentalOtherReimbursement Received20. Investment-Related Expenses State use onlyTax Preparation FeeSafe Deposit Box RentalMutual Fund FeeInvestment Counselor23. COVID-19 Were you, your spouse, or a dependentdiagnosed with COVID-19?Yes NoOtherDid you experience adverse financialconsequences as a result of you, your spouse,or other member of your household beingquarantined, furloughed or laid off, experienceda reduction of work hours, or unable to work dueto a lack of childcare?Yes NoCTORG04 Tax DeductionsDue DateDate PaidFederalStateAlimony Paid toSocial Security Interest PaidHealth Savings Account ContributionsArcher Medical Savings Acct. Contributions$$$$ , Comments, & Other ExpensesStudent's NameType of ExpenseAmountResidence:TownVillageCityCo untySchool District28. Direct Deposit of Refund / or Savings Bond PurchasesWould you like to have your refund(s) directly deposited into your account?

9 YesNo(The IRS will allow you to deposit your federal tax refund into up to threedifferent accounts. If so, please provide the following information.) ACCOUNT 1 Owner of accountTaxpayerSpouseJointType of accountCheckingTraditional SavingsTraditional IRARoth IRAT reasury DirectArcher MSA SavingsCoverdell Education SavingsHSA SavingsSEP IRAName of financial institutionFinancial Institution Routing Transit Number (if known)Your account numberACCOUNT 2 Owner of accountTaxpayerSpouseJointType of accountCheckingTraditional SavingsTraditional IRARoth IRAT reasury DirectArcher MSA SavingsCoverdell Education SavingsHSA SavingsSEP IRAName of fin ancial institutionFinancial Institution Routing Transit Number (if known) Your account numberCTORG05 01-21-22 ACCOUNT 3 Owner of accountTaxpayerSpouseJointType of accountCheckingTraditional SavingsTraditional IRARoth IRAT reasury DirectArcher MSA SavingsCoverdell Education SavingsHSA SavingsSEP IRAName of financial institutionFinancial Institution Routing Transit Number (if known)

10 Your account numberWould you like to purchase Series I Savings bonds with a portion of your refund? If so, please answer the following:Amount used for bond purchases for yourself (and spouse if filing jointly).Amount used to buy bonds for someone else (or yourself only or spouse only if filing jointly).Owner's nameCo-owner or Beneficiary'sname if applicableX if name is fora beneficiaryBond purchase AmountTo the best of my knowledge the information enclosed in this Client tax Organizer is correct and includes allincome, deductions, and other information necessary for the preparation of this year's income tax returns forwhich I have adequate 01-21-22