Client Tax Organizer - Riley & Associates PC

1 Client Tax OrganizerTaxpayer Last NameFirst NameMISpouse Last NameFirst NameMI, 20 ., , endingFor the year Jan. 1-Dec. 31, 20 , or other tax year beginningSoc. Sec. Sec. the best of my knowledge the enclosed information is correct and includes all income, deductions, and otherinformation necessary for the preparation of this year's income tax returns for which I have adequate hereAttestation and Signature:X20 Date and time of appointment: Copies of two preceding years' tax returns (new clients only)Name and Address Label if available (from government booklet or card) All tax documents (W-2s, 1099s, and 1009-Rs, etc.)

2 Please bringAppointment (Bring original documents which we will copy and return to you, or legible copies that you can leave with us).WK4T P00001-001 561/2/2008 3:37:26 PMClient Tax Organizer1. Personal InformationLast NameSoc. Sec. Date OccupationTaxpayerSpouseStreet AddressCityState ZIPT axpayerSpouseMarital StatusBlindDisabledPres. Campaign FundYesYesYesNoNoNoYesYesYesNoNoNoMarrie dSingleWidow(er), Date of Spouse's DeathWill file jointlyYesNo2. Dependents (Children & Others)Name(First, Last)RelationshipDate ofBirthSocial SecurityNumberMonthsLivedWith YouDisabledFullTimeStudent(Please provide additional information on any question on the last page of this Organizer .)

3 You self-employed, or did you receive hobby income? Did you receive income from raising animals or crops?Did you receive rent from real estate or other property? CitizenFirst NameWork PhoneHome PhoneCell PhonePrimary Email Please complete this Organizer before your appointment. Please enter whole numbers only (no cents).QuestionnaireYesNo4. Did you receive income from gravel, timber, minerals, oil, gas, copyrights, or patents?1, 20 ., , endingFor the year Jan. 1-Dec. 31, 20 , or other tax year you withdraw or write checks from a mutual fund? Did you have a foreign bank account, trust, or business?

4 P00001-002 561/2/2008 3:37:27 you provide a home for or help support anyone not listed in Section 2 above?Did you receive any correspondence from the IRS or the State? (b)(a)Was heat included? there any births, deaths, marriages, divorces, or adoptions in your immediate family?Did you give a gift of more than $12,000 to one or more people?Did you go through bankruptcy proceedings?If you paid rent, how much did you pay?Did you pay interest on a student loan for yourself, your spouse, or your dependent during the year?Did you pay expenses for yourself, your spouse, or your dependent to attend classes beyond highschool?

5 YesNo3. Wage & Salary IncomeTaxpayerSpouseGross WagesFICAF ederal TaxState TaxEmployer NamePlease attach P00001-003 561/2/2008 3:37:27 PM5. Dividend Income from Mutual Funds and StocksT/S/JPayerPlease attach 1099-DIVs for each item listed Interest IncomeT/S/JBank or CreditUnion PayerPlease attach 1099-INTs & brokerage Bonds/ T- BillsFederal TaxWithheldMunicipal orTax-ExemptGrossDividend (Box 1a)Capital GainDistributionNontaxableDistributionFe deral TaxWithheld3WK4T P00001-004 561/2/2008 3:37:27 PM6. Partnership, Trust, Estate IncomePlease attach K-1 or Income Tax Letter for each item CorpPartnershipT/S/JPayer7.

6 Asset DispositionsPlease attach brokerage statements, 1099s, closing statements, and any other records available to help properly reportthese transactions. Additional information about any transaction should be entered on the last page of this AcquiredDate SoldSale PriceCost/Other Basis4WK4T P00001-005 561/2/2008 3:37:27 PMAmountTaxable Gross DistributionIRAR ollover DistributionPayerT/S/JPlease attach all 1099-Rs or other documentation of amounts Pension & Annuity Income/IRA Distributions9. Other IncomePlease list all other income (including non-taxable).Payer/SourceTaxpayer SpouseTax WithheldFederalAlimony ReceivedChild SupportScholarship (Grants)Prizes, Bonuses, AwardsUnreported TipsDirector/Executor's FeeCommissionsJury DutyWorker's CompensationDisability IncomeVeteran's PensionPayments from Prior Installment SaleState Income Tax RefundGambling, Lottery (Expenses)Social Security Benefits (Taxable amount)Medicare Premiums WithheldUnemployment Compensation ReceivedUnemployment Compensation RepaidOther Income5WK4T P00001-006 561/2/2008 3:37.

7 27 PMLong-term Care InsuranceAmountMedical Insurance Premiums (paid by you)Mileage (no. of miles)Doctor/Dentist/OrthodontistHospita lMedical TherapyNursing CareMedical Equipment, SuppliesBracesHearing Aids, BatteriesGlasses, ContactsInsulinPrescription Drugs10. Medical/Dental Expenses11. Taxes Paid/Interest ExpenseReal Estate Taxes PaidMortagage Interest Paid (please attach 1098s)(please attach tax bills, escrow statements, closing statements)Personal ResidencePersonal ResidenceHome Equity Loan(s)Paid to Individual for ResidenceState Income Tax (please list)(do not enter taxes withheld or estimates)Audit or other additional tax paidInvestment Interest (please list)

8 Paid to other statesOtherSSNC arryover from Prior YearNameAddressCity, State, ZIPB alance due last yearTaxes PaidInterest Expense6 General Sales Tax (please list amounts paid on large items such asautos, boats, motorcycles)Other Property (please list)Other Property (please list)Other (please list)Other (please list)0WK4T P00001-007 561/2/2008 3:37:27 PM12. Casualty/Theft LossFor property damaged by storm, water, fire, or accident or of PropertyDescription of PropertyAmount of DamageInsurance ReimbursementRepair CostsFederal Grants Received13. Contributions by Cash or Check, Noncash up to $500, and MileageChurchUnited WayScoutsTelethonsUniversity, Public TV/RadioHeart, Lung, Cancer, FundSalvation Army, GoodwillOther (please list)Non-Cash Up to $500 Volunteer (no.)

9 Of miles)@14 12345 Non-Cash Charitable ContributionsDescription of Property DonatedDonee Name and AddressFair Market ValueCost or Other BasisDate DonatedDate Acquired123457 Amount0WK4T P00001-008 561/2/2008 3:37:27 PM14. Job-Related Moving ExpensesDate of MoveDistance from old home to new workplaceDistance from old home to old workplaceCost to move and/or store household goodsTravel en route to new homeLodging en route to new homeReimbursements not included in W-2sPlease attach any moving-expense reimbursement documents from your Miscellaneous Itemized DeductionsEmployment-Related Expense (not for self-employed)Union DuesProfessional Dues, Subscriptions, BooksLicensesTools, Safety EquipmentUniformsMeals and EntertainmentOther (please list)

10 Other Miscellaneous DeductionsTax Preparation FeeSafety Deposit Box RentalInvestment ExpenseIRA Custodial FeesOther (please list)Other Deductions (from AGI or not subject to 2% AGI reduction)Gambling LossesExcess Estate Expenses (from final estate K-1)Student Interest PaidAlimony PaidRecipient Name, Address, SSNS ubject to reduction by 2% of AGI8WK4T P00001-009 561/2/2008 3:37:27 PMDo you use any part of your home regularly and exclusively for business?YesNoTotal area of home (in square feet)Total area used for businessBusiness use percentage (divide business area by total area)House InsuranceRepairs and MaintenanceUtilitiesRentProperty TaxesMortgage InterestHome Equity Loan InterestInternetPhoneOther (please list)(benefit business area only)Indirect Costs(whole house costs)Direct Costs16.