-1040/Client Organizer Blank Forms (Org)

Form ID: INDX

Client Organizer Topical Index

This client organizer topical index is designed to help you quickly locate the items listed. To use the index just locate the topic and refer to the page number listed. The page number corresponds to the number printed in the top right corner of your organizer sheets. Please note this organizer is customized specifically for you, and may not contain all of the pages listed here. Topic Page ABLE account distributions 71 Adoption expenses 82 Affordable Care Act Health Coverage 67, 68 Alaska Permanent Fund dividends 16, 75 Alimony paid 47 Alimony received 16 Annuity payments received 8, 22 Automobile information ‐ Business or profession 66 Employee business expense 58 Farm, Farm Rental 66 Rent and royalty 66 Bank account information 3 Business income and expenses 26, 27, 28 Business use of home 65 Cancellation of debt 17 Casualty and theft losses, business 61, 63 62, 64 Casualty and theft losses, personal Child and dependent care expenses 78 Children's interest and dividend 74, 75 Charitable contributions 55, 59, 60 Contracts and straddles 20 Dependent care benefits received 10 Dependent information 1, 5 Depreciable asset acquisitions and dispositions ‐ Business or profession 91, 92 Employee business expense 91, 92 Farm, Farm Rental 91, 92 Rent and royalty 91, 92 Direct deposit information 3 Disability income 22, 79 Dividend income, including foreign 9, 12 Early withdrawal penalty 11 Education Credits and tuition and fees deduction 50 Education Savings Account & Qualified Tuition Programs 51 Electronic filing 4 Email address 2 Employee business expenses 57 Estate income 8, 37 Excess farm losses 88 Farm income and expenses 31, 32, 33 Farm rental income and expenses 34, 35 Federal estimate payments 6 Federal student aid application information (FAFSA) 52 Federal withholding 10, 18, 22, 23 First‐time homebuyer credit repayment 77 Foreign bank accounts & financial assets 42, 43 Foreign earned income & housing deduction 44, 45 21 Foreign employer compensation Foreign taxes paid 81 Fuel tax credit 83, 84, 85

Topic Page Gambling winnings 8, 16, 18 Gambling losses 55 Health savings account (HSA) 69, 70 Household employee taxes 76 Identity authentication 5 Installment sales 39, 40 Interest income, including foreign 9, 11 Interest paid 54 Investment expenses 55 Investment interest expenses 54 IRA contributions 24 IRA distributions 8, 22 Like‐kind exchange of property 41 Long‐term care services and contracts (LTC) 70 Medical and dental expenses 53 Medical savings account (MSA) 69, 70 Minister earnings and expenses 10, 26, 57, 73 Miscellaneous income 16, 16a, 16b Miscellaneous adjustments 47 Miscellaneous itemized deductions 55 Mortgage interest expense 54, 56 Moving expenses 46 Partnership income 8, 36 Payments from Qualified Education Programs (1099‐Q) 8, 51 Pension distributions 8, 22 Personal property taxes paid 53 Railroad retirement benefits 23 Real estate taxes 53 REMIC's 14 Rent and royalty, vacation home, income and expenses 29, 30 Residential energy credit 80 Roth IRA contributions 24 S corporation income 8, 19, 36 39, 40 Sale of business property Sale of personal residence 38 Sale of stock, securities, and other capital assets 15, 15a Self‐employed health insurance premiums 26, 31, 67 Self‐employed Keogh, SEP and SIMPLE plan contributions25 13 Seller‐financed mortgage interest received Social security benefits received 23 State and local income tax refunds 16 7 State & local estimate payments State & local withholding 10, 18, 22 Statutory employee 10, 26 Student loan interest paid 49 Taxes paid 53 Trust income 37 Unemployment compensation 16 Unreported tip or unreported wage income 72 U.S. savings bonds educational exclusion 48 Wages and salaries 8, 10

Please note the following conventions used throughout your client organizer: T/S/J and T/S headings should be used to indicate if an item belongs to the (T)axpayer, (S)pouse, or (J)oint. Also, if an item did not occur in your resident state, please indicate the state's postal code abbreviation in which the item occurred. Control totals and [ ] numbers are for preparer use only. Form ID: INDX

Personal Information

Form ID: 1040

1

Filing (Marital) status code (1 = Single, 2 = Married filing joint, 3 = Married filing separate, 4 = Head of household, 5 = Qualifying widow(er)) Mark if you were married but living apart all year Mark if your nonresident alien spouse does not have an Individual Taxpayer Identification Number (ITIN) Taxpayer Social security number [4] First name [6] Last name [8] Occupation [10] Designate $3.00 to the presidential election campaign fund? (1 = Yes, 2 = No, 3 = Blank) [12] [15] Mark if dependent of another taxpayer Taxpayer with income less than 1/2 support age 18 or 19 ‐ 23 full‐time student? (Y, N)[17] Mark if legally blind [20] Date of birth [22] Date of death [26] Work/daytime telephone number/ext number [28] [29] [32] Home/evening telephone number Do you authorize us to discuss your return with the IRS? (Y, N) [34]

[1] [2] [3]

Spouse [5] [7] [9] [11] [14] [16] [21] [24] [27] [30]

[31] [33]

Present Mailing Address Address Apartment number City, state postal code, zip code Foreign country name In care of addressee

[38] [39] [40]

[42]

[41]

[44] [47]

Dependent Information (*Please refer to Dependent Codes located at the bottom) First Name[48]

Last Name

Date of Birth

Social Security No.

Relationship

Care Months*** Dep expenses in Codes paid for home * ** dependent

Name of child who lived with you but is not your dependent Social security number of qualifying person

[49] [50]

Dependent Codes 1 = Child who lived with you **Other 1 = Student (Age 19 ‐ 23) 2 = Child who did not live with you 2 = Disabled dependent 3 = Other dependent 3 = Dependent who is both a student and disabled 5 = Qualifying child for Earned Income Credit only 6 = Children who lived with you, but do not qualify for Earned Income Credit 7 = Children who lived with you, but do not qualify for Child Tax Credit 8 = Children who lived with you, but do not qualify for Child Tax Credit or Earned Income Credit ***Months77 = Reported on odd year return 88 = Reported on even year return 99 = Not reported on return *Basic

Form ID: 1040

Form ID: Info

Client Contact Information

2

Preparer ‐ Enter on Screen Contact Tax matters person (Indicate which spouse handles tax return related questions) (Blank = Both, T = Taxpayer, S = Spouse) Taxpayer email address Spouse email address

Taxpayer Fax telephone number Mobile telephone number Mobile telephone #2 number Pager number Other: Telephone number Extension Preferred method of contact: Email, Work phone, Home phone, Fax, Mobile phone, Mobile phone #2

[8] [9] [10]

Spouse [11]

[19]

[12]

[20]

[13]

[21]

[14]

[22]

[15]

[23]

[16]

[24]

[17]

[25]

[18]

[26]

NOTES/QUESTIONS:

Form ID: Info

Form ID: Bank

3

Direct Deposit/Electronic Funds Withdrawal Information

If you would like to have a refund direct deposited into or a balance due debited from your bank account(s), please enter information in the fields below. Note that electronic funds will be withdrawn only from the primary account listed below. Primary account: [1] Financial institution routing transit number [2] Name of financial institution [3] Your account number Type of account (1 = Savings, 2 = Checking, 3 = IRA*) [4] Mark if married filing jointly and this is a joint account (Both taxpayer and spouse names are on the account) [5] Mark if financial institution is foreign based (Not located in the territorial jurisdiction of the United States) [6] Enter the maximum dollar amount, or percentage of total refund Dollar [7] or Percent (xxx.xx) [8] Secondary account #1: Financial institution routing transit number Name of financial institution Your account number Type of account (1 = Savings, 2 = Checking, 3 = IRA*) Mark if married filing jointly and this is a joint account (Both taxpayer and spouse names are on the account) Mark if financial institution is foreign based (Not located in the territorial jurisdiction of the United States) Enter the maximum dollar amount, or percentage of total refund Dollar Secondary account #2: Financial institution routing transit number Name of financial institution Your account number Type of account (1 = Savings, 2 = Checking, 3 = IRA*) Mark if married filing jointly and this is a joint account (Both taxpayer and spouse names are on the account) Mark if financial institution is foreign based (Not located in the territorial jurisdiction of the United States) Enter the maximum dollar amount, or percentage of total refund Dollar

[23] [24] [25] [26] [27] [28] [9]

or

Percent (xxx.xx)

[10]

[29] [30] [31] [32] [33] [34] [13]

or

Percent (xxx.xx)

[14]

*Refunds may only be direct deposited to established traditional, Roth or SEP‐IRA accounts. Make sure direct deposits will be accepted by the bank or financial institution.

Refund ‐ U.S. Series I Savings Bond Purchases

A tax refund may be used to buy up to $5,000 of U.S. Series I Savings bonds and registered for up to three different persons. If you would like to purchase U.S. Series I Savings bonds (in increments of $50) with your refund, if applicable, please complete the following information. Please note you may enter only one name per registration (with exception of married filing joint returns) and must enter the party's given name, do not use nicknames. Indicate either a maximum dollar amount (up to $5,000), or percentage of refund you would like used to purchase bonds The bonds will be registered to the name(s) on the return. For married filing joint returns this means the bonds will be registered in both names listed on the return. To register the bonds separately, leave these fields blank and use the fields provided below.

Enter either a dollar amount or percent, but not both

Dollar

[11]

or

Percent (xxx.xx)

[15]

or

Percent (xxx.xx)

[12]

Bond information for someone other than taxpayer and spouse, if married filing jointly Dollar Maximum dollar amount (up to $5,000), or percentage of refund used to purchase bonds Owner's name (First Last) Co‐owner or beneficiary (First Last) Mark if the name listed above is a beneficiary

[36]

[37]

[38]

[39]

Bond information for someone other than taxpayer and spouse, if married filing jointly Maximum dollar amount (up to $5,000), or percentage of refund used to purchase bonds Dollar Owner's name (First Last) Co‐owner or beneficiary (First Last) Mark if the name listed above is a beneficiary

[41]

[42]

[43]

[44]

[16]

[40]

[19]

or

Percent (xxx.xx)

[20]

[45]

Form ID: Bank

Form ID: ELF

4

Electronic Filing

IRS regulations require paid tax preparers who expect to prepare a certain amount of federal individual tax returns to file them electronically To comply with this requirement your return will be electronically filed this year if it qualifies for electronic filing under IRS rules. Taxpayers may choose to file a paper return instead of filing electronically. Mark if you want to file a paper return even if you qualify for electronic filing Receive email notification(s) when your electronic file is accepted by the taxing agency (Blank = None, 1 = Return, 2 = Return & Extension) If 1 or 2, please provide email address on Organizer Form ID: Info Mark if you are filing a balance due return electronically and you want to pay the amount due by debiting your financial institution account The IRS requires a Personal Identification Number (PIN) be used in signing returns that are electronically filed. Each taxpayer and spouse, if applicable, must provide a 5 digit self‐selected PIN of your choice other than all zeroes. Taxpayer self‐selected Personal Identification Number (PIN) Spouse self‐selected Personal Identification Number (PIN)

[1] [2]

[9]

[7] [8]

NOTES/QUESTIONS:

Form ID: ELF

Form ID: IDAuth

Identity Authentication

Taxpayer ‐ Form of identification (1 = Driver's license, 2 = State issued identification) Identification number Issue date Expiration date Location of issuance Spouse ‐ Form of identification (1 = Driver's license, 2 = State issued identification) Identification number Issue date Expiration date Location of issuance

5

[1] [2] [3] [4] [5]

[6] [7] [8] [9] [10]

NOTES/QUESTIONS:

Form ID: IDAuth

Form ID: Est

6

Estimated Taxes

If you have an overpayment of 2015 taxes, do you want the excess: Refunded Applied to 2016 estimated tax liability Do you expect a considerable change in your 2016 income? (Y, N) If yes, please explain any differences:

[52] [53] [54] [55] [56] [57] [58]

Do you expect a considerable change in your deductions for 2016? (Y, N) If yes, please explain any differences:

[59] [60] [61] [62] [63]

Do you expect a considerable change in the amount of your 2016 withholding? (Y, N) If yes, please explain any differences:

[64] [65] [66] [67] [68]

Do you expect a change in the number of dependents claimed for 2016? (Y, N) If yes, please explain any differences:

[69] [70] [71] [72] [73]

Mark if you use the Electronic Federal Tax Payment System (EFTPS) to pay your estimated taxes

[74]

2015 Federal Estimated Tax Payments 2014 overpayment applied to 2015 estimates Mark if you paid the calculated amounts on the dates due indicated below. Skip the remaining fields.

+

[1] [5]

If your estimated payments were not made on the date due or were for an amount other than the calculated amount below, please enter the actual date and amount paid.

1st quarter payment 2nd quarter payment 3rd quarter payment 4th quarter payment Additional payment

Date Due Date Paid if After Date Due 4/15/15 + [6] 6/15/15 + [8] 9/15/15 + [10] 1/15/16 + [12] + [14]

Amount Paid

Calculated Amount

Method*

[7] [9] [11] [13] [15]

*Method of payment indicated in prior year EFW = Electronic funds withdrawal EFTPS = Electronic Federal Tax Payment System Voucher = Form 1040‐ES estimated tax payment voucher

NOTES/QUESTIONS:

Control Totals+

Form ID: Est

Form ID: St Pmt

7

2015 State Estimated Tax Payments

Taxpayer/Spouse/Joint (T, S, J) State postal code

[1] [2]

Amount paid with 2014 return 2014 overpayment applied to '15 estimates Treat calculated amounts as paid

+ +

[4] [8]

Date Paid 1st quarter payment 2nd quarter payment 3rd quarter payment 4th quarter payment Additional payment

[3]

Amount Paid + + + + +

[9] [11] [13] [15] [17]

Calculated Amount [10] [12] [14] [16] [18]

2015 City Estimated Tax Payments City #1 City name Amount paid with 2014 return + 2014 overpayment applied to '15 estimates+ Treat calculated amounts as paid Date Paid 1st quarter payment 2nd quarter payment 3rd quarter payment 4th quarter payment

[28] [31] [32] [36]

Amount Paid [37] [39] [41] [43]

+ + + +

Date Paid [38] [40] [42] [44]

Calculated Amount 1st quarter payment 2nd quarter payment 3rd quarter payment 4th quarter payment

Date Paid

1st quarter payment 2nd quarter payment 3rd quarter payment 4th quarter payment

[72]

[83] [85] [87]

[53] [54] [58]

Amount Paid [59] [61] [63] [65]

+ + + +

[60] [62] [64] [66]

[75] [76] [80]

City #4 City name + Amount paid with 2014 return 2014 overpayment applied to '15 estimates+ Treat calculated amounts as paid

Amount Paid [81]

[50]


City #3 City name + Amount paid with 2014 return 2014 overpayment applied to '15 estimates+ Treat calculated amounts as paid


City #2 City name Amount paid with 2014 return + 2014 overpayment applied to '15 estimates+ Treat calculated amounts as paid

+ + + +


Control Totals+

Date Paid [82] [84] [86] [88]


[94] [97] [98] [102]

Amount Paid [103] [105] [107] [109]

+ + + +

[104] [106] [108] [110]


Form ID: St Pmt

Form ID: SumRep

Income Summary

8

Below is a list of the forms as reported in last year's tax return. Please provide copies of all of the forms you received. To indicate which forms are attached, enter a "1" for attached in the field provided next to the Description. To indicate which forms are not applicable, enter a "2" for not applicable (N/A) in the field provided next to the Description. Otherwise, leave this field blank. Form

T/S/J

Description

1 = Attached 2 = N/A

Form ID: SumRep

Form ID: IntDiv

Interest and Dividend Summary

9

Below is a list of the forms as reported in last year's tax return. Please provide copies of all 1099‐INT and 1099‐DIV you received. To indicate which forms are attached, enter a "1" for attached in the field provided. To indicate which forms are not applicable, enter a "2" for not applicable (N/A) in the field provided. Otherwise, leave this field blank. Form

T/S/J

Description

Mark if 1 = Attached Foreign 2 = N/A

Form ID: IntDiv

Form ID: W2

10

Wages and Salaries #1 Please provide all copies of Form W‐2. 2015 Information

Taxpayer/Spouse (T, S) Employer name Were these wages earned for service as: (1 = Minister, 2 = Military, 3 = Farming / Fishing, 4 = National Guard) Mark if this is your current employer + Federal wages and salaries (Box 1) Federal tax withheld (Box 2) + Social security wages (Box 3) (If different than federal wages) + Social security tax withheld (Box 4) + Medicare wages (Box 5) (If different than federal wages) + Medicare tax withheld (Box 6) + SS tips (Box 7) + Allocated tips (Box 8) + Dependent care benefits (Box 10) + Box 13 ‐ Statutory employee Retirement plan Third‐party sick pay State postal code (Box 15) State wages (Box 16) (If different than federal wages) + State tax withheld (Box 17) + Local wages (Box 18) + Local tax withheld (Box 19) + Name of locality (Box 20)

Prior Year Information [1] [3] [5] [6] [10] [12] [14] [16] [18] [21] [23] [25] [27] [29] [30] [31] [32] [34] [36] [38] [40] [43]

Control Totals+

Wages and Salaries #2 Please provide all copies of Form W‐2. 2015 Information Taxpayer/Spouse (T, S) Employer name Were these wages earned for service as: (1 = Minister, 2 = Military, 3 = Farming / Fishing, 4 = National Guard) Mark if this your current employer Federal wages and salaries (Box 1) + + Federal tax withheld (Box 2) Social security wages (Box 3) (If different than federal wages) + Social security tax withheld (Box 4) + Medicare wages (Box 5) (If different than federal wages) + + Medicare tax withheld (Box 6) SS tips (Box 7) + Allocated tips (Box 8) + Dependent care benefits (Box 10) + Box 13 ‐ Statutory employee Retirement plan Third‐party sick pay State postal code (Box 15) State wages (Box 16) (If different than federal wages) + State tax withheld (Box 17) + Local wages (Box 18) + Local tax withheld (Box 19) + Name of locality (Box 20)

Prior Year Information [1] [3] [5] [6] [10] [12] [14] [16] [18] [21] [23] [25] [27] [29] [30] [31] [32] [34] [36] [38] [40] [43]

Control Totals+ Form ID: W2

Form ID: B‐1

11

Interest Income Please provide copies of all Form 1099‐INT or other statements reporting interest income. *Whole numbers will be treated as $ amounts. Enter percentages in the XXX.XX format. For example, enter 100% as 100.00 or 75.5% as 75.50.

Type T/S/J Code (**See codes below)

1

+

+

+

+

Payer Amounts

10

+

Payer Amounts

9

+

Payer Amounts

8

+

Payer Amounts

7

+

Payer Amounts

6

Foreign Taxes Paid Prior Year Information

Payer Amounts

5

U.S. Obligations* Tax Exempt* Penalty on Early Withdrawal $ or % $ or %

Payer Amounts

4

Tax Exempt Income

Payer Amounts

3

[1]

Payer Amounts

2

Interest Income

+

Payer Amounts

+

Blank = Regular Interest 3 = Nominee Distribution

**Interest Codes 4 = Accrued Interest 5 = OID Adjustment

Control Totals +

6 = ABP Adjustment 7 = Series EE & I Bond

Form ID: B‐1

Form ID: B‐2

12

Dividend Income Please provide copies of all Form 1099‐DIV or other statements reporting dividend income. *Whole numbers will be treated as $ amounts. Enter percentages in the XXX.XX format. For example, enter 100% as 100.00 or 75.5% as 75.50.

T S Type Ordinary [2] Qualified Dividends J Code (**See codes below) Dividends

1

+

+

+

+

+

Payer Amounts

10

+

Payer Amounts

9

+

Payer Amounts

8

+

Payer Amounts

7

Prior Year Information

Payer Amounts

6

Foreign Taxes Paid

Payer Amounts

5

Tax Exempt* $ or %

Payer Amounts

4

U.S. Obligations* $ or %

Payer Amounts

3

Sec. 1202

28% Tax Exempt Capital Gain Dividends

Payer Amounts

2

Total Cap Gain Distributions Section 1250

+

Payer Amounts

+

**Dividend Codes Blank = Other 3 = Nominee

Control Totals +

Form ID: B‐2

Form ID: B‐3

13

Seller Financed Mortgage Interest Income Please provide copies of all Form 1099‐INT or other statements reporting interest income. 2015 Information


Taxpayer/Spouse/Joint (T, S, J) Payer's name Payer's street address Payer's city, state, zip code Payer's social security number Interest income amount received in 2015

+

[1]


+

[1]


+

[1]


+

[1]


+

[1]


+

[1]


+

[1]


+

[1]

Control Totals+

Form ID: B‐3

Form ID: B‐4

Income from REMICs

14

Please provide all Schedules Q. Taxpayer/Spouse/Joint (T, S, J) Name of activity Employer identification number State postal code

[1]

Taxpayer/Spouse/Joint (T, S, J) Name of activity Employer identification number State postal code

[1]

NOTES/QUESTIONS:

Form ID: B‐4

Form ID: D

Sales of Stocks, Securities, and Other Investment Property

15

Please provide copies of all Forms 1099‐B and 1099‐S Did you have any securities become worthless during 2015? (Y, N) Did you have any debts become uncollectible during 2015? (Y, N) Did you have any commodity sales, short sales, or straddles? (Y, N) Did you exchange any securities or investments for something other than cash? (Y, N) T/S/J

Description of Property[1]

Control Totals+

Date Acquired

Date Sold

[8] [9] [10] [12]

Gross Sales Price Cost or Other Basis (Less expenses of sale) + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + Form ID: D

Form ID: InfoD

15a

Sales of Stocks, Securities, and Other Investment Property Please provide copies of all Forms 1099‐B and 1099‐S

T/S/J

Description of Property[1]

Date Acquired

Date Sold

Gross Sales Price (Less expenses of sale)

+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +

Cost or Other Basis + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +

NOTES/QUESTIONS: Form ID: InfoD

Form ID: Income

State and local income tax refunds Alimony received Unemployment compensation Unemployment compensation federal withholding Unemployment compensation state withholding Unemployment compensation repaid Alaska Permanent Fund dividends

T/S/J

Self‐ Employment Income ? (Y, N)

16

Other Income

+ + + + + +

2015 Information + Taxpayer Spouse [3] + [8] + [8] + [8] + [11] + [17] +

Prior Year Information [1] [4] [9] [9] [9] [12] [18]

2015 Information Other income, such as: Commissions, Jury pay, Director fees, Taxable scholarships + [14] + + + + + + + + + + + + + + + + + + + + + + + + + + + + +


NOTES/QUESTIONS:

Control Totals+

Form ID: Income

Form ID: 1099M

16a

Miscellaneous Income #1 Preparer use only

Please provide all Forms 1099‐MISC

Name of payer Taxpayer/Spouse/Joint (T, S, J) State postal code Rents (Box 1) Royalties (Box 2) Other income (Box 3) Federal income tax withheld (Box 4) Fishing boat proceeds (Box 5) Medical and health care payments (Box 6) Nonemployee compensation (Box 7) Substitute payments in lieu of dividends or interest (Box 8) Payer made direct sales of $5,000 or more of consumer products (Box 9) Crop Insurance proceeds (Box 10) Excess golden parachute payments (Box 13) Gross proceeds paid to an attorney (Box 14) Section 409A deferrals (Box 15a) Section 409A income (Box 15b) State tax withheld (Box 16) State/Payer's state no. (Box 17) State income (Box 18)

[3] [5] [6]

+ + + + + + + +

[13] [15] [17] [19] [21] [23] [25] [27] [29]

+ + + + + +

[31] [36] [38] [40] [42] [44] [46]

+

[47]

Control Totals +

Miscellaneous Income #2 Preparer use only

Please provide all Forms 1099‐MISC

Name of payer Taxpayer/Spouse/Joint (T, S, J) State postal code Rents (Box 1) Royalties (Box 2) Other income (Box 3) Federal income tax withheld (Box 4) Fishing boat proceeds (Box 5) Medical and health care payments (Box 6) Nonemployee compensation (Box 7) Substitute payments in lieu of dividends or interest (Box 8) Payer made direct sales of $5,000 or more of consumer products (Box 9) Crop Insurance proceeds (Box 10) Excess golden parachute payments (Box 13) Gross proceeds paid to an attorney (Box 14) Section 409A deferrals (Box 15a) Section 409A income (Box 15b) State tax withheld (Box 16) State/Payer's state no. (Box 17) State income (Box 18)

[3] [5] [6]

+ + + + + + + +

[13] [15] [17] [19] [21] [23] [25] [27] [29]

+ + + + + +

[31] [36] [38] [40] [42] [44] [46]

+

[47]

Control Totals +

NOTES/QUESTIONS:

Form ID: 1099M

Form ID: 1099PATR

16b

Taxable Distributions Received from Cooperatives #1 Preparer use only

Please provide all Forms 1099‐PATR

Name of payer Taxpayer/Spouse/Joint (T, S, J) State postal code Patron dividends (Box 1) Nonpatronage distributions (Box 2) Per‐unit retain allocations (Box 3) Federal income tax withheld (Box 4) Redemption of nonqualified notices and retain allocations (Box 5) Domestic production activities deductions (Box 6) Investment credit (Box 7) Work opportunity credit (Box 8) Patron's AMT adjustments (Box 9) Other credits and deductions #1 (Box 10) Other credits and deductions #2 (Box 10)

[3] [5] [6]

+ + + + + + + + + + +

[10] [12] [14] [16] [18] [20] [22] [24] [26] [28] [30]

Control Totals + Form ID: 1099PATR

Taxable Distributions Received from Cooperatives #2 Preparer use only

Please provide all Forms 1099‐PATR

Name of payer Taxpayer/Spouse/Joint (T, S, J) State postal code Patron dividends (Box 1) Nonpatronage distributions (Box 2) Per‐unit retain allocations (Box 3) Federal income tax withheld (Box 4) Redemption of nonqualified notices and retain allocations (Box 5) Domestic production activities deductions (Box 6) Investment credit (Box 7) Work opportunity credit (Box 8) Patron's AMT adjustments (Box 9) Other credits and deductions #1 (Box 10) Other credits and deductions #2 (Box 10)

[3] [5] [6]

+ + + + + + + + + + +

[10] [12] [14] [16] [18] [20] [22] [24] [26] [28] [30]

Control Totals +

NOTES/QUESTIONS:

Form ID: 1099PATR

Form ID: 1099C

17

Cancellation of Debt, Abandonment #1 Preparer use only

Please provide all Forms 1099‐C and 1099‐A

Enter a brief description of the debt (i.e. type of debt) and why it was canceled to assist in determining tax ramifications: [51]

Taxpayer/Spouse/Joint (T, S, J) State postal code Name of creditor/lender

[5] [6] [3]

Form 1099‐C Cancellation of Debt Date of identifiable event (Box 1) Amount of debt discharged (Box 2) + Interest if included in box 2 (Box 3) + Personally liable for repayment of the debt (if checked) (Box 5) Identifiable event code (Box 6) (A = Bankruptcy, B = Other judicial debt relief, C = Statue of limitations, D = Foreclosure, E = Debt relief from probate F = By agreement, G = Decision to discontinue collection, H = Expiration of nonpayment testing period, I = Other)

Fair market value of property (Box 7)

+

Form 1099‐A Acquisition or Abandonment of Secured Property Date of lender's acquisition or knowledge of abandonment (Box 1) Balance of principal outstanding (Box 2) Fair market value of property (Box 4) Personally liable for repayment of the debt (if checked) (Box 5)

[10] [11] [12] [13] [14] [15] [16]

+ +

[17] [18] [19]

Control Totals+

Cancellation of Debt, Abandonment #2 Preparer use only

Please provide all Forms 1099‐C and 1099‐A

Enter a brief description of the debt (i.e. type of debt) and why it was canceled to assist in determining tax ramifications: [51]

Taxpayer/Spouse/Joint (T, S, J) State postal code Name of creditor

[5] [6] [3]

Form 1099‐C Cancellation of Debt Date of identifiable event (Box 1) Amount of debt discharged (Box 2) + Interest if included in box 2 (Box 3) + Personally liable for repayment of the debt (if checked) (Box 5) Identifiable event code (Box 6) (A = Bankruptcy, B = Other judicial debt relief, C = Statue of limitations, D = Foreclosure, E = Debt relief from probate F = By agreement, G = Decision to discontinue collection, H = Expiration of nonpayment testing period, I = Other)

Fair market value of property (Box 7)

+

Form 1099‐A Acquisition or Abandonment of Secured Property Date of lender's acquisition or knowledge of abandonment (Box 1) Balance of principal outstanding (Box 2) Fair market value of property (Box 4) Personally liable for repayment of the debt (if checked) (Box 5)

[10] [11] [12] [13] [14] [15] [16]

+ +

[17] [18] [19]

Control Totals+

NOTES/QUESTIONS:

Form ID: 1099C

Form ID: W2G

18

Gambling Winnings #1 Please provide all copies of Form W‐2G. 2015 Information

Taxpayer/Spouse (T, S) Payer name State postal code Mark if professional gambler Gross winnings (Box 1) Date won (Box 2) Type of wager (Box 3) Federal withholding (Box 4) Transaction (Box 5) Race (Box 6) Identical wager winnings (Box 7) Cashier (Box 8) Taxpayer identification number (Box 9) Window (Box 10) First ID (Box 11) Second ID (Box 12) Payer's state ID no. (Box 13) State winnings (Box 14) State withholding (Box 15) Local winnings (Box 16) Local withholding (Box 17) Name of locality (Box 18)

Prior Year Information [1] [3] [4] [9]

+

[11] [13] [15]

+

[17] [19] [21]

+

[23] [25] [27] [28] [30] [31] [32]

+ + + +

[33] [35] [37] [39] [42]

Control Totals+

Gambling Winnings #2 Please provide all copies of Form W‐2G. 2015 Information Taxpayer/Spouse (T, S) Payer name State postal code Mark if professional gambler Gross winnings (Box 1) Date won (Box 2) Type of wager (Box 3) Federal withholding (Box 4) Transaction (Box 5) Race (Box 6) Identical wager winnings (Box 7) Cashier (Box 8) Taxpayer identification number (Box 9) Window (Box 10) First ID (Box 11) Second ID (Box 12) Payer's state ID no. (Box 13) State winnings (Box 14) State withholding (Box 15) Local winnings (Box 16) Local withholding (Box 17) Name of locality (Box 18)


+

[11] [13] [15]

+

[17] [19] [21]

+

[23] [25] [27] [28] [30] [31] [32]

+ + + +

[33] [35] [37] [39] [42]

Control Totals+

NOTES/QUESTIONS: Form ID: W2G

Form ID: 2439

Shareholders Undistributed Capital Gain #1

19

Please provide all copies of Form 2439 2015 Information Taxpayer/Spouse (T, S) RIC or REIT name State postal code Total undistributed long‐term capital gains (Box 1a) + Unrecaptured section 1250 gain (Box 1b) + Section 1202 gain (Box 1c) + If your interest in the RIC/REIT was held on the date the RIC/REIT acquired the Section 1202 stock and continuously until sold indicate the appropriate section 1202 code (1 = 50% exclusion, 2 = 60% exclusion within an empowerment zone, 3 = 75% exclusion, 4 = 100% exclusion)

Collectibles (28%) gain (Box 1d) Tax paid by the RIC or REIT on the box 1a gains (Box 2)

+ +

Prior Year Information [1] [3] [4] [9] [11] [13]

[15] [17] [19]

Control Totals +

Shareholders Undistributed Capital Gain #2 Please provide all copies of Form 2439 2015 Information Taxpayer/Spouse (T, S) RIC or REIT name State postal code Total undistributed long‐term capital gains (Box 1a) + Unrecaptured section 1250 gain (Box 1b) + Section 1202 gain (Box 1c) + If your interest in the RIC/REIT was held on the date the RIC/REIT acquired the Section 1202 stock and continuously until sold indicate the appropriate section 1202 code (1 = 50% exclusion, 2 = 60% exclusion within an empowerment zone, 3 = 75% exclusion, 4 = 100% exclusion)


+ +


[15] [17] [19]

Control Totals+

Shareholders Undistributed Capital Gain #3 Please provide all copies of Form 2439 2015 Information [1] Taxpayer/Spouse (T, S) [3] RIC or REIT name State postal code [4] Total undistributed long‐term capital gains (Box 1a) + [9] [11] Unrecaptured section 1250 gain (Box 1b) + Section 1202 gain (Box 1c) + [13] If your interest in the RIC/REIT was held on the date the RIC/REIT acquired the Section 1202 stock and continuously until sold indicate the appropriate section 1202 code (1 = 50% exclusion, 2 = 60% exclusion within an empowerment zone, 3 = 75% exclusion, 4 = 100% exclusion)


+ +


[15] [17] [19]

Control Totals+

NOTES/QUESTIONS:

Form ID: 2439

Contracts & Straddles ‐ General Information

Form ID: 6781

20

Subject to self‐employment tax code (T = Taxpayer, S = Spouse, J = Joint) Mark to indicate all the elections that apply: Mixed straddle election Mixed straddle account election (Attach explanation)

[1] [2] [3]

Straddle‐by‐straddle identification election Net section 1256 contracts loss election

[4] [5]

Section 1256 Contracts Marked to Market Identification of Account A Identification of Account B Identification of Account C

[6]

Account A Taxpayer/Spouse/Joint (T, S, J) State postal code ‐Loss/Gain for entire year (Enter losses as a negative amount) Total Form 1099‐B adjustment Total net 1256 contract loss carryback

Account B

+ + +

Account C

+ + +

+ + +

Gains and Losses From Straddles Description of Property A Name of Contract Component Description of Property B Name of Contract Component Description of Property C Name of Contract Component Description of Property D Name of Contract Component

[7]

Type

Type

Type

Type

Property A Taxpayer/Spouse/Joint (T, S, J) State postal code Date entered into/acquired Date closed out/sold Gross sales price Cost plus expense of sale Unrecognized gain

+ + +

Property B

+ + +

Property C

Property D

+ + +

+ + +

Unrecognized Gain From Positions Held on Last Business Day Description of Property A Description of Property B Description of Property C

[8]

Property A Date acquired Fair market value on last business day Cost or other basis as adjusted

+ +

Control Totals+

Property B + +

Property C + +

Form ID: 6781

Form ID: FEC

21

Foreign Employer Compensation Enter foreign employer compensation that was not reported to you on Form 1099‐MISC.

Taxpayer/Spouse (T/S) State

[3]

Foreign Employer Identification (ID) number Foreign Employer Name Foreign Employer Address Foreign street address Foreign city Foreign country code/name Foreign province/county Foreign postal code Name "in care of"

[1]

[4]

[2] [6] [7] [8]

[9] [10] [11] [12]

Employee address, if different from home address on Organizer Form ID: 1040 Enter U.S. (street, city, state, zip code) OR foreign (street, city, country, province, postal code) Street address City, state, zip code [17] Foreign country code/name Foreign province/county Foreign postal code

[13] [14]

[15]

[16] [18] [19] [20]

Income Prior Year Information

2015 Information Foreign employer compensation

[22]

NOTES/QUESTIONS:

Form ID: FEC

Form ID: 1099R

22

Pension, Annuity, and IRA Distributions #1 Please provide all Forms 1099‐R. 2015 Information

Taxpayer/Spouse (T, S) Name of payer State postal code Gross distributions received (Box 1) Taxable amount received (Box 2a) Federal withholding (Box 4) Distribution code (Box 7) Mark if distribution is from an IRA, SEP, SIMPLE retirement plan State withholding (Box 12) Local withholding (Box 15) Amount of rollover Mark if distribution was due to a pre‐retirement age disability

Prior Year Information [1] [3] [5]

+ + +

[7] [9] [11] [14] [16]

+ + +

[17] [19] [21] [23]

Control Totals+

Pension, Annuity, and IRA Distributions #2 Please provide all Forms 1099‐R. 2015 Information Taxpayer/Spouse (T, S) Name of payer State postal code Gross distributions received (Box 1) Taxable amount received (Box 2a) Federal withholding (Box 4) Distribution code (Box 7) Mark if distribution is from an IRA, SEP, SIMPLE retirement plan State withholding (Box 12) Local withholding (Box 15) Amount of rollover Mark if distribution was due to a pre‐retirement age disability


+ + +

[7] [9] [11] [14] [16]

+ + +

[17] [19] [21] [23]

Control Totals+

Pension, Annuity, and IRA Distributions #3 Please provide all Forms 1099‐R. 2015 Information Taxpayer/Spouse (T, S) Name of payer State postal code Gross distributions received (Box 1) Taxable amount received (Box 2a) Federal withholding (Box 4) Distribution code (Box 7) Mark if distribution is from an IRA, SEP, SIMPLE retirement plan State withholding (Box 12) Local withholding (Box 15) Amount of rollover Mark if distribution was due to a pre‐retirement age disability


+ + +

[7] [9] [11] [14] [16]

+ + +

[17] [19] [21] [23]

Control Totals+

NOTES/QUESTIONS:

Form ID: 1099R

Form ID: SSA‐1099

23

Social Security, Tier 1 Railroad Benefits Please provide a copy of Form(s) SSA‐1099 or RRB‐1099

Taxpayer/Spouse (T, S) State postal code

[1] [2]

Social Security Benefits Prior Year Information

2015 Information If you received a Form SSA ‐ 1099, please complete the following information: Net Benefits for 2015 (Box 3 minus Box 4) (Box 5) Voluntary Federal Income Tax Withheld (Box 6) From the DESCRIPTION OF AMOUNT IN BOX 3 area of Form SSA‐1099: Medicare premiums Prescription drug (Part D) premiums

+ +

[8] [10]

+ +

[12] [14]

Tier 1 Railroad Benefits Prior Year Information

2015 Information If you received a Form RRB ‐ 1099, please complete the following information: Net Social Security Equivalent Benefit: + Portion of Tier 1 Paid in 2015 (Box 5) + Federal Income Tax Withheld (Box 10) + Medicare Premium Total (Box 11)

[22] [25] [27]

Additional Information About Benefits Received

Additional information about the benefits received not reported above. For example did you repay any benefits in 2015 or receive any prior year benefits in 2015. This information will be reported in the SSA‐1099 DESCRIPTION OF AMOUNT IN BOX 3 area or in the RRB‐1099 Boxes 7 through 9 [40] [41] [42] [43] [44]

NOTES/QUESTIONS:

Control Totals +

Form ID: SSA‐1099

Traditional IRA

Form ID: IRA

24 Taxpayer

Are you or your spouse (if MFJ or MFS) covered by an employer's retirement plan? (Y, N) Do you want to contribute the maximum allowable traditional IRA contribution amount? If yes, enter the applicable code: (1 = Deductible only, 2 = Both deductible and nondeductible) Enter the total traditional IRA contributions made for use in 2015 +

Spouse [1]

[2]

[3]

[4]

[5]

+

+ + +

[11]

+ + +

[12]

+ + + + +

[17]

+ + + + +

[18]

Taxpayer Enter the nondeductible contribution amount made for use in 2015 Enter the nondeductible contribution amount made in 2016 for use in 2015 Traditional IRA basis Value of all your traditional IRA's on December 31, 2015:

Spouse [13] [15]

..

[6]

[14] [16]

Roth IRA Please provide copies of any 1998 through 2014 Form 8606 not prepared by this office Taxpayer Spouse Mark if you want to contribute the maximum Roth IRA contribution [27] [29] + Enter the total Roth IRA contributions made for use in 2015 + Enter the total amount of Roth IRA conversion recharacterizations for 2015 + [37] + Enter the total contribution Roth IRA basis on December 31, 2014 + [41] + + Enter the total Roth IRA contribution recharacterizations for 2015 [43] + Enter the Roth conversion IRA basis on December 31, 2014 + [45] + Value of all your Roth IRA's on December 31, 2015: + [47] + + + + + + + + +

[28] [30] [38] [42] [44] [46] [48]

NOTES/QUESTIONS:

Control Totals+

Form ID: IRA

Form ID: Keogh

25

Keogh, SEP, SIMPLE Contributions

Preparer use only Business activity or profession name Taxpayer/Spouse (T, S) State postal code Contribute the maximum allowable contribution amount? (1 = Keogh, 2 = SEP, 3 = SIMPLE 401(k), 4 = Solo 401(k), 5 = SIMPLE IRA, 6 = SARSEP) Plan contribution rate. Enter in xx.xx format (Limitation percentage) Enter the total amount of contributions made to a Keogh plan in 2015 + Enter the total amount of contributions made to a Solo 401(k) plan in 2015 + Enter the total amount of contributions made to a SEP plan in 2015 + Enter the total amount of contributions made to a SARSEP plan in 2015 + Enter the total amount of contributions made to a defined benefit plan in 2015 + Enter the total amount of contributions made to a profit‐sharing plan in 2015 + Enter the total amount of contributions made to a money purchase plan in 2015 + Enter the total amount of contributions made to a SIMPLE 401(k) plan in 2015 + Enter the total amount of contributions to a SIMPLE IRA plan in 2015 +

[3] [4] [5] [6] [7] [8] [9] [10] [11] [12] [13] [14] [15] [16]

Catch‐up Contributions Enter the amount of catch‐up contributions made to a Solo 401(k) or SARSEP in 2015 Enter the amount of catch‐up contributions made to a SIMPLE Plan in 2015

+ +

[17] [18]

Elective Deferrals Enter the total contributions to a Solo 401(k) or SARSEP made through elective deferrals in 2015 Enter the amount of elective deferrals designated as Roth contributions in 2015

+ +

[19] [20]

NOTES/QUESTIONS:

Control Totals+

Form ID: Keogh

Form ID: C‐1

26

Schedule C ‐ General Information Preparer use only 2015 Information

Taxpayer/Spouse/Joint (T, S, J) Employer identification number Business name Principal business/profession Business code Business address, if different from home address on Organizer Form ID: 1040 Address City/State/Zip [15] Accounting method (1 = Cash, 2 = Accrual, 3 = Other) If other: Inventory method (1 = Cost, 2 = LCM, 3 = Other) If other enter explanation:


[16]

[17] [18] [20] [21] [23]

Enter an explanation if there was a change in determining your inventory: [24]

Did you "materially participate" in this business? (Y, N) If not, number of hours you did significantly participate Mark if you began or acquired this business in 2015 Did you make any payments in 2015 that require you to file Form(s) 1099? (Y, N) If "Yes", did you or will you file all required Forms 1099? (Y, N) Mark if this business is considered related to qualified services as a minister or religious worker Did you receive wages as a statutory employee or as a minister? (1 = Statutory employee, 2 = Minister) Medical insurance premiums paid by this activity + Long‐term care premiums paid by this activity + Amount of wages received as a statutory employee +

[25] [27] [29] [30] [32] [34] [36] [40] [44] [47]

Business Income 2015 Information


Gross receipts and sales

Returns and allowances Other income:

+ + + + +

[52]

+ + + +

[57]

[55]

Cost of Goods Sold 2015 Information Beginning inventory Purchases Labor:

Materials Other costs:

Ending inventory

Control Totals+


+ +

[59]

+ + +

[63]

+ + + + +

[67]

[61]

[65]

[69]

Form ID: C‐1

Form ID: C‐2

27

Schedule C ‐ Expenses

Preparer use only Principal business or profession 2015 Information Advertising + Car and truck expenses + Commissions and fees + Contract labor + Depletion + Depreciation + Employee benefit programs (Include Small Employer Health Ins Premiums credit): + + Insurance (Other than health): + + Interest: Mortgage (Paid to banks, etc.) + + + Other: + + Legal and professional services + Office expense + Pension and profit sharing: + + Rent or lease: Vehicles, machinery, and equipment + Other business property + + Repairs and maintenance Supplies + Taxes and licenses: + + + + + Travel, meals, and entertainment: Travel + Meals and entertainment + Meals (Enter 100% subject to DOT 80% limit) + Utilities + Wages (Less employment credit): + + Other expenses: + + + + + + + + + +

Control Totals+

Prior Year Information [6] [8] [10] [12] [14] [16] [18]

[20]

[22]

[24] [26] [29] [31]

[33] [35] [37] [39] [41]

[43] [45] [47] [51] [53]

[55]

Form ID: C‐2

Form ID: C‐3

28

Schedule C ‐ Carryovers

Preparer use only Principal business or profession Preparer use only Carryovers Operating + Short‐term capital + Long‐term capital + 28% rate capital + Section 1231 loss + Ordinary business gain/loss + Section 179 +

Regular

AMT [12] [14] [16] [18] [20] [22] [24]

+ + + + + + +

[13] [15] [17] [19] [21] [23] [25]

NOTES/QUESTIONS:

Control Totals+

Form ID: C‐3

Form ID: Rent

29

Rent and Royalty Property ‐ General Information Preparer use only

2015 Information [2] Description Taxpayer/Spouse/Joint (T, S, J) [3] State postal code [4] Physical address: Street [5] City, state, zip code [6] [7] [8] Foreign country [10] Foreign province/county [11] Foreign postal code [12] Type (1=Single‐family, 2=Multi‐family, 3=Vacation/short‐term, 4=Commercial, 5=Land, 6=Royalty, 7=Self‐rental, 8=Other, 9=Personal ppty) [13] Description of other type (Type code #8) [14] [16] Did you make any payments in 2015 that require you to file Form(s) 1099? (Y,N) If "Yes", did you or will you file all required Forms 1099? (Y, N) [18] Fair rental days (If not full year) (For types 1, 2, 4, 5, 7 and 8 only) (Use Rent‐2 for type 3) [20] [22] Percentage of ownership if not 100% Business use percentage, if not 100% (Not vacation home percentage) [24]


Rent and Royalty Income Rents and royalties

2015 Information +

Prior Year Information [33]

Rent and Royalty Expenses 2015 Information Advertising Auto Travel Cleaning and maintenance Commissions:

Percent if not 100%

+ + + +

[35]

[36]

[38]

[39]

[41]

[42]

[44]

[45]

+ +

[47]

[49]

+ + +

[50]

[52]

[54]

[55]

+ +

[57]

[59]

+ + + +

[60]

[62]

[63]

[65]

[66]

[67]

+ + + +

[69]

[71]

[72]

[73]

[75]

[76]

[78]

[80]


Insurance:

Legal and professional fees Management fees:

Mortgage interest paid to banks, etc (Form 1098)

Other mortgage interest Qualified mortgage insurance premiums Other interest:

Repairs Supplies Taxes:

+ + + + +

Utilities Depreciation Depletion Other expenses:

+ + + +

Control Totals+

[81]

[82]

[84]

[85]

[87]

[88]

[90]

Form ID: Rent

Form ID: Rent‐2

Rent and Royalty Properties ‐ Points, Vacation Home, Passive Information

30

Preparer use only Description

Refinancing Points Preparer ‐ Enter on Screen Rent 2015 Information Refinancing points paid ‐ Recipient's/Lender's name Date of refinance Total # Payments Reported on 1098 in 2015 Total points paid Points deemed as paid in current year (Preparer use only) Refinancing points paid ‐ Recipient's/Lender's name Date of refinance Total # Payments Reported on 1098 in 2015 Total points paid Points deemed as paid in current year (Preparer use only) Refinancing points paid ‐ Recipient's/Lender's name Date of refinance Total # Payments Reported on 1098 in 2015 Total points paid Points deemed as paid in current year (Preparer use only)


[92]

Vacation Home Information 2015 Information Number of days home was used personally Number of days home was rented Number of day home owned, if not 365 Carryover of disallowed operating expenses into 2015 Carryover of disallowed depreciation expenses into 2015


+ +

[20] [21]

Passive and Other Information Preparer use only Carryovers Operating + Short‐term capital + Long‐term capital + 28% rate capital + Section 1231 loss + Ordinary business gain/loss + Comm revitalization + Section 179 +

Control Totals+

Regular

AMT [29] [31] [33] [35] [37] [39] [41] [43]

+ + + + + + + +

[30] [32] [34] [36] [38] [40] [42] [44]

Form ID: Rent‐2

Form ID: F‐1

31

Farm Income ‐ General Information Please provide all Forms 1099‐K Preparer use only

2015 Information

Taxpayer/Spouse/Joint (T, S, J) Employer identification number Description Principal Product State postal code Accounting method (1 = Cash, 2 = Accrual) Agricultural activity code Did you "materially participate" in this business? (Y, N) Did you make any payments in 2015 that require you to file Form(s) 1099? (Y, N) If "Yes", did you or will you file all required Forms 1099? (Y, N) Mark if Schedule F net income or loss should be excluded from self‐employment income + Medical insurance premiums paid by this activity Long‐term care premiums paid by this activity +

Prior Year Information [2] [3] [4] [5] [6] [7] [9] [12] [14] [16] [18] [22] [26]

Schedule F Income Sales Code**

2015 Information


Income description + + + + +

[36]

** Sales Codes 1 = Cash sales of items bought for resale 4 = Custom hire (machine work) 2 = Cash sales of items raised 5 = Other income 3 = Accrual sales 2015 Information Cost or other basis of livestock and other items you bought for resale (Cash method) Beginning inventory of livestock and other items (Accrual method) Accrual cost of livestock, produce, grains, and other products purchased Ending Inventory of livestock and other items (Accrual method) Total cooperative distributions you received Taxable cooperative distributions you received 2015 Total

+ + + + + +



2015 Taxable

Agricultural program payments + + +

+ + +

[51]


2015 Information CRP payments received while enrolled to receive social security or disability benefits+ Commodity credit loans reported under election: + + Total commodity credit loans forfeited + Taxable commodity credit loans forfeited + 2015 Total

[53] [55] [57] [59]


2015 Taxable

Total crop insurance proceeds you received in 2015 + + + Mark if electing to defer crop insurance proceeds to 2016 Crop insurance proceeds deferred from 2014 Control Totals+

+ + +

[62]

[64]

+

[66]

Form ID: F‐1

Form ID: F‐2

32

Farm Expenses

Preparer use only Description 2015 Information Car and truck expenses + + Chemicals Conservation expenses + Custom hire (machine work) + Depreciation + Employee benefit programs (Include Small Employer Health Ins Premiums credit) + Feed purchased + Fertilizers and lime + Freight and trucking + + Gasoline, fuel, and oil Insurance (Other than health) + + + Mortgage interest (Paid to banks, etc.) + + + Other interest + Labor hired (Less employment credit) + Pension and profit sharing + + Rent ‐ vehicles, machinery, and equipment Rent ‐ other + + Repairs and maintenance + Seed and plants purchased + Storage and warehousing Supplies purchased + Taxes: + + + + + Utilities + + Veterinary, breeding, and medicine Other expenses: + + + + + + + + + + + + + + + Preproductive period expenses +

Control Totals+


[5] [7] [9] [11] [13] [15] [17] [19] [21] [23] [26]

[28]

[30] [32] [34] [36] [38] [40] [42] [44] [46] [48]

[50] [52] [54]

[56]

Form ID: F‐2

Form ID: F‐3

33

Farm Passive and Other Carryover Information Preparer use only

Description

Preparer use only Carryovers Operating + Short‐term capital + Long‐term capital + 28% rate capital + Section 1231 loss + Ordinary business gain/loss + Section 179 + Excess farm loss +

Regular

AMT [13] [15] [17] [19] [21] [23] [25] [29]

+ + + + + + + +

[14] [16] [18] [20] [22] [24] [26] [30]

NOTES/QUESTIONS:

Control Totals+

Form ID: F‐3

Form ID: 4835

34

Farm Rental ‐ General Information Preparer use only

2015 Information

Taxpayer/Spouse/Joint (T, S, J) Employer identification number Description State postal code Did you "actively participate" in the operation of this business this year? (Y, N)

Prior Year Information [2] [3] [4] [5] [6]

Income Items 2015 Information


Income from production of livestock, produce, grains, and other crops: + + + + + + +

Total cooperative distributions you received Taxable cooperative distributions you received

2015 Total

[16]

[18] [20]

2015 Taxable


Agricultural program payments: + + +

[22] +

[23]

+ +


2015 Information Commodity credit loans reported under election: + + + +

Total commodity credit loans forfeited Taxable commodity credit loans forfeited

2015 Total

[25] [27] [29]


2015 Taxable

Crop insurance proceeds you received in 2015 + + +

[31] +

[32]

+ +

2015 Information Mark if electing to defer crop insurance proceeds to 2016 Crop insurance proceeds deferred from 2014 Other income:

Control Totals+

+ + + + + + + + + + + + + + + +


[34] [36] [39]

Form ID: 4835

Farm Rental Expenses

Form ID: 4835‐2

35

Preparer use only Description 2015 Information Car and truck expenses Chemicals Conservation expenses Custom hire (machine work) Depreciation Employee benefit programs Feed purchased Fertilizers and lime Freight and trucking Gasoline, fuel, and oil Insurance (Other than health):


+ + + + + + + + + +

[6]

+ + +

[26]

+ + + + + + + + + + + +

[28]

+ + + + + + +

[49]

+ + + + + + + + + +

[55]

[8] [10] [12] [14] [16] [18] [20] [22] [24]

Mortgage interest (Paid to banks, etc.):

Other interest Labor hired (Less employment credit) Pension and profit sharing Rent ‐ vehicles, machinery, and equipment Rent ‐ other Repairs and maintenance Seed and plants purchased Storage and warehousing Supplies purchased Taxes:

Utilities Veterinary, breeding, and medicine Other expenses:

Preproductive period expenses

Preparer use only Carryovers Operating + Short‐term capital + Long‐term capital + 28% rate capital + Section 1231 loss + Ordinary business gain/loss + Section 179 + Excess farm loss + Control Totals+

[31] [33] [35] [37] [39] [41] [43] [45] [47]

[51] [53]

[57]

Regular

AMT [66] [68] [70] [72] [74] [76] [78] [82]

+ + + + + + + +

[67] [69] [71] [73] [75] [77] [79] [83]

Form ID: 4835‐2

Form ID: K1‐1

Partnerships and S Corporations

36

Please provide copies of Schedules K‐1 showing income from partnerships and S‐corporations. Taxpayer/Spouse/Joint (T, S, J) Employer identification number Name of entity State postal code Type of entity (1 = Partnership, 2 = S Corporation, 3 = Foreign partnership, 4 = Publicly traded partnership)

Enter on K1‐7

Preparer use only Carryovers Operating Short‐term capital Long‐term capital 28% rate capital Section 1231 loss Ordinary business gain/loss Other losses ‐ 1040 pg.1 Comm revitalization Section 179 Excess farm loss

Regular

[2] [6] [9] [10] [13]

AMT [14]

[15]

[16]

[17]

[18]

[19]

[20]

[21]

[22]

[23]

[24]

[25]

[26]

[27]

[28]

[29]

[30]

[31]

[34]

[35]

Taxpayer/Spouse/Joint (T, S, J) Employer identification number Name of entity State postal code Type of entity (1 = Partnership, 2 = S Corporation, 3 = Foreign partnership, 4 = Publicly traded partnership)

Enter on K1‐7


Regular

[2] [6] [9] [10] [13]

AMT [14]

[15]

[16]

[17]

[18]

[19]

[20]

[21]

[22]

[23]

[24]

[25]

[26]

[27]

[28]

[29]

[30]

[31]

[34]

[35]

Taxpayer/Spouse/Joint (T, S, J) Employer identification number Name of entity State postal code Type of entity (1 = Partnership, 2 = S Corporation, 3 = Foreign partnership, 4 = Publicly traded partnership)

Enter on K1‐7


Regular

[2] [6] [9] [10] [13]

AMT [14]

[15]

[16]

[17]

[18]

[19]

[20]

[21]

[22]

[23]

[24]

[25]

[26]

[27]

[28]

[29]

[30]

[31]

[34]

[35]

Form ID: K1‐1

Form ID: K1T

37

Estates and Trusts

Please provide all copies of Schedules K‐1 showing income from estates and trusts. Taxpayer/Spouse/Joint (T, S, J) Employer identification number Name of activity State postal code Preparer use only Carryovers Operating Enter on K1T‐3 Short‐term capital Long‐term capital 28% rate capital Section 1231 loss Ordinary business gain/loss Comm revitalization

Regular

[15]

[16]

[17]

[18]

[19]

[20]

[21]

[22]

[23]

[24]

[25]

[26]

[27]

[5]

[3] [4] [5]

Regular

AMT [14]

[15]

[16]

[17]

[18]

[19]

[20]

[21]

[22]

[23]

[24]

[25]

[26]

[27]

[2] [3] [4] [5]

Regular

AMT [14]

[15]

[16]

[17]

[18]

[19]

[20]

[21]

[22]

[23]

[24]

[25]

[26]

[27]

Taxpayer/Spouse/Joint (T, S, J) Employer identification number Name of activity State postal code

Preparer use only Carryovers Enter Operating on K1T‐3 Short‐term capital Long‐term capital 28% rate capital Section 1231 loss Ordinary business gain/loss Comm revitalization

[4]

[2]



[3]

AMT [14]



[2]

[2] [3] [4] [5]

Regular

AMT [14]

[15]

[16]

[17]

[18]

[19]

[20]

[21]

[22]

[23]

[24]

[25]

[26]

[27]

Form ID: K1T

Form ID: Home

38

Sale of Principal Residence

Description Taxpayer/Spouse/Joint (T, S, J) State postal code Mark if electing to pay tax on entire gain (No exclusion will be calculated and entire gain will be reported on Schedule D) Date former residence was acquired Date former residence was sold Selling price of former residence + Expenses related to the sale of your old home + Original cost of home sold including capital improvements +

[1] [5] [6] [7] [9] [10] [11] [12] [13]

Exclusion Information Mark if meet use and ownership test without exceptions (2 years use within 5‐year period preceding sale date) Reduced exclusion days: (Enter only days within 5‐year period ending on sale date) Number of days each person used property as main home Number of days each person owned property used as main home Number of days between date of sale of the other home and date of sale of this home

[19]

Taxpayer [21]

Spouse [22]

[23]

[24]

[25]

[26]

Form 6252 ‐ Current Year Installment Sale Mortgage and other debts the buyer assumed Total current year payments received

+ +

[28] [29]

Form 6252 ‐ Related Party Installment Sale Information Related party name Address City, State and Zip [32] Identifying number of related party Was the property sold as a marketable security? (Y, N) Enter date of second sale if more than 2 years after the first sale Indicate special conditions if applicable (1 = Sale/exchange, 2 = Involuntary conv, 3 = Death of seller, 4 = No tax avoidance) Selling price of property sold by a related party

[30] [31] [33]

[34] [35] [36] [37] [38]

+

[40]

NOTES/QUESTIONS:

Control Totals+

Form ID: Home

Form ID: InstPY

39

Prior Year Installment Sale Preparer use only

2015 Information

Description Taxpayer/Spouse/Joint (T, S, J) State postal code Date acquired Date sold Gross sales price of property sold Mortgage and other debts the buyer assumed Cost or other basis Commissions and other expenses of the sale Gross profit percentage Total current year principal payments received Prior year principal payments received Total ordinary income to recapture Total ordinary income previously recaptured


[3] [7] [8] [19] [20]

+ + + +

[21] [23] [25] [27] [29]

+ + + +

[35] [37] [39] [41]

Control Totals+

Prior Year Installment Sale Preparer use only Description Taxpayer/Spouse/Joint (T, S, J) State postal code Date acquired Date sold Gross sales price of property sold Mortgage and other debts the buyer assumed Cost or other basis Commissions and other expenses of the sale Gross profit percentage Total current year principal payments received Prior year principal payments received Total ordinary income to recapture Total ordinary income previously recaptured

2015 Information

Prior Year Information [3] [7] [8] [19] [20]

+ + + +

[21] [23] [25] [27] [29]

+ + + +

[35] [37] [39] [41]

Control Totals+

NOTES/QUESTIONS:

Form ID: InstPY

Form ID: Sale

40

Form 4797 and 6252 ‐ General Information

Preparer use only Description Taxpayer/Spouse/Joint (T, S, J) State postal code Mark to include gross proceeds for 1099‐S reporting on Form 4797, line 1 Mark if disposition is due to casualty or theft Mark if disposition was to a related party

[3] [9] [10] [15] [19] [21]

Sale Information Date acquired Date sold Gross sales price or insurance proceeds received Cost or other basis Commissions and other expenses of sale Depreciation allowed or allowable

[23] [24]

+ + + +

[25]

+

[30]

[26] [27] [28]

Form 4797, Part III ‐ Recapture Additional depreciation after 1975 (Section 1250) Applicable percentage (if not 100%) (Section 1250) Additional depreciation after 1969 (Section 1250) Soil, water and land clearing expenses (Section 1252) Applicable percentage (if not 100%) (Section 1252) Intangible drilling and development costs (Section 1254) Applicable payments excluded from income under sec. 126 (Section 1255)

[31]

+ +

[32] [33] [34]

+ +

[35]

+ +

[37]

[36]

Form 6252 ‐ Current Year Installment Sale Mortgage and other debts the buyer assumed Total current year payments received

[38]

Form 6252 ‐ Related Party Installment Sale Information Related party name Address State, City and Zip [41] Identifying number of related party Was the property sold as a marketable security? (Y, N) Enter date of second sale Indicate special conditions if applicable (1 = Sale/exchange, 2 = Involuntary conv, 3 = Death of seller, 4 = No tax avoidance) Selling price of property sold by a related party

[39] [40] [43]

[42]

[44] [45] [46] [47]

+

[49]

NOTES/QUESTIONS:

Control Totals+

Form ID: Sale

Like‐Kind Exchange General Information

Form ID: 8824

41

Preparer use only Description of property given up

[4] [5]

Taxpayer/Spouse/Joint (T, S, J) State postal code Description of property received

[6] [7] [10] [11]

Date Information Date the like‐kind property given up was acquired Date you transferred your property to the other party Date the like‐kind property received was identified Date you received the like‐kind property from the other party

[16] [17] [18] [19]

Gain and Basis Information Fair market value of other property given up Adjusted basis of other property given up Cash received Fair market value of other (not like‐kind) property received Installment obligation received in like‐kind exchange Fair market value of like‐kind property you received Fair market value of non‐section 1245 property you received Liabilities, including mortgages, assumed by you Cash paid Adjusted basis of like‐kind property given up Adjusted basis of like‐kind property from pass through entity Cost or other basis Depreciation allowed or allowable excluding Section 179 Section 179 expense deduction passed through Section 179 carryover Liabilities, including mortgages, assumed by the other party Exchange expenses incurred by you

+ + + + + + + + + + + + + + + +

[20] [21] [22] [23] [24] [25] [26] [27] [28] [29] [30] [31] [32] [33] [34] [35]

Related Party Exchange Information Name of related party Address of related party City State Zip code Identifying number of related party Relationship to you During this tax year, did the related party sell or dispose of the property received? (Y, N) During this tax year, did you sell or dispose of the like‐kind property you received? (Y, N) Indicate if any special conditions apply (1 = Death of either party, 2 = Involuntary conversion, 3 = No tax avoidance) Mark if this exchange is a prior year like‐kind exchange

[38] [39] [40] [41] [42] [43] [44] [45] [46] [47] [49]

NOTES/QUESTIONS:

Control Totals+

Form ID: 8824

Form ID: 8938‐2

Statement of Specified Foreign Financial Assets

42

This form is used to report other foreign assets (not held in a foreign financial account), as required by the Internal Revenue Service. Report foreign financial assets held in a foreign financial account on Organizer Form ID: FrgnAcct. 2015 Information Asset description Asset identifying number or other designation Date asset acquired Date asset disposed Asset jointly owned with spouse Maximum value of asset


[2] [3] [4] [6] [7] [9]

Asset foreign entity information ‐ (Enter either foreign entity information or issuer/counterparty information, but not both) Type of foreign entity:(P = Partnership, C= Corporation, T = Trust, E = Estate) Foreign entity name Foreign entity address City, state, zip code [17] [20] Foreign country code/name Foreign province/county Foreign postal code Asset issuer or counterparty information ‐ (Enter either foreign entity information or issuer/counterparty information, but not both) Type: (I = Issuer, C = Counterparty) Entity: (I = Individual, P = Partnership, C = Corporation, T = Trust, E = Estate) If an individual, select either U.S. or foreign (1 = U.S. Person, 2 = Foreign Person) Individual or organization name Address of issuer or counterparty City, state, zip code Foreign country code/name Foreign province/county Foreign postal code

[14] [15] [16] [18]

[19] [21] [22] [23]

[24]

Asset issuer or counterparty information ‐ (Enter either foreign entity information or issuer/counterparty information, but not both) Type: (I = Issuer, C = Counterparty) Entity: (I = Individual, P = Partnership, C = Corporation, T = Trust, E = Estate) If an individual, select either U.S. or foreign (1 = U.S. Person, 2 = Foreign Person) Individual or organization name Address of issuer or counterparty City, state, zip code Foreign country code/name Foreign province/county Foreign postal code

NOTES/QUESTIONS:

Form ID: 8938‐2

Form ID: FrgnAcct

Foreign Financial Accounts

43

This form is used to report financial accounts in foreign countries, as required by the Internal Revenue Service. Taxpayer/Spouse/Joint (T, S, J)

[1]

2015 Information Deposit or Custodial account (D= Deposit, C = Custodial) Type of Account: Bank Securities Other Maximum value of account Account number or other designation


[4] [5] [6] [7] [8] [10]

Financial institution Address of financial institution City, state, zip code Foreign country code/name For addresses in Mexico, enter state Foreign province/county Foreign postal code Account jointly owned with spouse Account opened during the tax year Account closed during the tax year Information is reported for a financial account which is:

[11] [12] [13]

[14]

[15]

[16]

[17] [19] [22] [23] [24] [46] [48] [26]

2 = Owned separately, 3 = Owned jointly, 4 = Authority over but no financial interest

Complete this section if there is a joint owner other than the spouse, or you have signature authority only over the account Taxpayer identification number of account holder/joint owner Foreign identification number of account holder/joint owner (If no Taxpayer identification number) Last name or organization name of account holder/joint owner First name and middle initial of account holder/joint owner Address and apartment City, state, zip code Foreign country code/name For addresses in Mexico, enter state Foreign postal code Number of joint owners (Not including taxpayer, if applicable) Filer's title with this owner (If applicable)

[27] [28] [29] [30] [32] [34] [37]

[35]

[31] [33] [36] [38] [40] [43] [44] [45]

NOTES/QUESTIONS:

Form ID: FrgnAcct

Form ID: 2555

Foreign Earned Income Exclusion

44

Taxpayer/Spouse (T, S) [1] State postal code Foreign street address [4] City State/Province Country code Country Postal code Employer's name U.S. address [5] City State postal code Zip code [6] City Foreign street address State/Province Country code Country Postal code Employer type (A = Foreign entity, B = U.S. company, C = Self, D = Foreign affiliate of a U.S. company, E = Other) [7] If other, specify type Country of citizenship If maintained a separate foreign residence for your family due to adverse living conditions, provide city, country, and days: City/Country Days [12] City/Country Days List tax home(s) during the tax year and dates established: Tax home [13] Date Tax home Date

[3]

[2]

[8] [11]

Foreign Earned Income Allocation Information *U.S. Business Days and Travel Type Code: 1=Travel to United States; 2=Travel to restricted country; 3=Travel to foreign country U.S. business days and travel information:[16] No. of U.S. Type Code* Name of Country including United States Date Arrived Date Left business days

Foreign days worked before and after foreign assignment [17] Total number of days worked during year (defaults to 240)

Total days worked before and after foreign assignment

[18] [19]

Bona Fide Residence Test Date foreign residence began Date foreign residence ended [21] Kind of foreign living quarters (A = Purchased house, B = Rented house or apartment, C = Rented room, D = Quarters furnished by employer) If any family members lived abroad with you during any part of tax year, list who and for what period: Relationship Period abroad Relationship Period abroad Relationship Period abroad Relationship Period abroad Mark if you submitted a statement to foreign country authorities that you are not a resident of that country Mark if required to pay income tax to that country List any contractual terms or other conditions relating to length of employment abroad

[22] [23] [24]

[25] [26] [27]

Type of visa used to enter foreign country Explanation if visa limited length of stay or employment

[28] [29]

If maintained a home in U.S., enter address, whether it was rented, names of occupants and their relationship to you: Address City [30] State postal code Zip code Rented Occupant Relationship Address City [30] State postal code Zip code Rented Occupant Relationship

Physical Presence Test Principal country of employment

[31]

Form ID: 2555

Foreign Earned Income Exclusion

Form ID: 2555‐2

45

Employer's name Taxpayer/Spouse (T, S) State postal code

Foreign Earned Income *Please use the Foreign Earned Income Allocation Codes located below Allocation Code* Noncash income: Home (lodging) Meals Car Other properties or facilities (Please enter code here and description and amount below):

[10]

[11]

[13]

[14]

[16]

[17]

Amount

+ + +

[12]

+ + + + +

[20]

+ + + + +

[22]

+ + + + +

[32]

+ + + + + +

[34]

[15] [18]

[19]

Allowances, reimbursements or expenses paid on behalf: Cost of living and overseas differential Family Education Home leave Quarters Other purposes (Please enter code here and description and amount below):

[21] [23] [25] [27] [29]

[24] [26] [28] [30]

[31]

Other foreign earned income (Please enter code here and description and amount below):

[33]

Excludable meals and lodging under section 119

[35]

*Foreign Earned Income Allocation Codes 1 = 100% foreign during assignment 2 = 100% U.S. during assignment 3 = U.S. and foreign days worked during assignment 4 = U.S. and foreign days before/after assignment 5 = Days worked before, during, and after assignment

Deductions Allocable to Foreign Earned Income Allocation Code* Other allocable deductions

[36]

Amount +

[37]

+

[47]

Housing Exclusion/Deduction Qualified housing expense

NOTES/QUESTIONS: Control Totals+

Form ID: 2555‐2

Moving Expenses

Form ID: 3903

Preparer use only Description of move Taxpayer/Spouse/Joint (T, S, J) Mark if the move was due to service in the armed forces Number of miles from old home to new workplace Number of miles from old home to old workplace Mark if move is outside United States or its possessions Transportation and storage expenses Travel and lodging (not including meals) Miles driven to new home Total amount reimbursed for moving expenses

46

[2] [3] [7] [8] [9] [10]

+ +

[11] [12] [13]

+

[15]

NOTES/QUESTIONS:

Control Totals+

Form ID: 3903

Other Adjustments

Form ID: OtherAdj

Alimony Paid: T/S/J

Recipient name

47

Recipient SSN

2015 Information +


Address +

Address +

Address 2015 Information Taxpayer

Prior Year Information Spouse

Educator expenses: + +

[3]

+ +

[4]

+ + + + + + + + + + + + + + + + + + + + + + + + +

[6]

+ + + + + + + + + + + + + + + + + + + + + + + + +

[7]

Other adjustments:

NOTES/QUESTIONS:

Control Totals+

Form ID: OtherAdj

Form ID: Educate

48

Exclusion of Interest Income from Series EE or I U.S. Savings Bonds Complete if you cashed qualified U.S. Savings bonds in 2015 that were issued after 1989, and you paid qualified higher education expenses in 2015 for yourself, your spouse, or your dependents.

Taxpayer/Spouse/Joint (T, S, J) SSN of person enrolled at eligible educational institution Name of person enrolled at eligible educational institution (First/Last) Name of eligible educational institution Address of eligible educational institution City, state, and zip code Qualified higher education expenses you paid in 2015 for person listed above + Enter any nontaxable educational benefits received for 2015 for person listed above + Type of qualified education program, if contributions made for enrollee (ESA = Coverdell ESA, QTP = Qualified Tuition Program) Financial institution name (ESA) or name of program (QTP) Financial institution address (ESA) or address of program (QTP) City, state and zip code Taxpayer/Spouse/Joint (T, S, J) SSN of person enrolled at eligible educational institution Name of person enrolled at eligible educational institution (First/Last) Name of eligible educational institution Address of eligible educational institution City, state, and zip code Qualified higher education expenses you paid in 2015 for person listed above + Enter any nontaxable educational benefits received for 2015 for person listed above + Type of qualified education program, if contributions made for enrollee (ESA = Coverdell ESA, QTP = Qualified Tuition Program) Financial institution name (ESA) or name of program (QTP) Financial institution address (ESA) or address of program (QTP) City, state and zip code Taxpayer/Spouse/Joint (T, S, J) SSN of person enrolled at eligible educational institution Name of person enrolled at eligible educational institution (First/Last) Name of eligible educational institution Address of eligible educational institution City, state, and zip code Qualified higher education expenses you paid in 2015 for person listed above + Enter any nontaxable educational benefits received for 2015 for person listed above + Type of qualified education program, if contributions made for enrollee (ESA = Coverdell ESA, QTP = Qualified Tuition Program) Financial institution name (ESA) or name of program (QTP) Financial institution address (ESA) or address of program (QTP) City, state and zip code Total proceeds from Series EE or I U.S. Savings bonds issued after 1989 and cashed in 2015

+

[1]

[1]

[1]

[3]

NOTES/QUESTIONS:

Control Totals+

Form ID: Educate

Student Loan Interest Paid

Form ID: Educate2

49

Complete this section if you paid interest on a qualified student loan in 2015 for qualified higher education expenses for you, your spouse, or a person who was your dependent when you took out the loan. Please provide all copies of Form 1098‐E. Form 1098‐E from the lender reports interest received in 2015. The amounts reported by the lender may differ from the amounts you actually paid. TS

2015 Interest Paid

Qualified loan interest recipient/lender + + + +


NOTES/QUESTIONS:

Control Totals+

Form ID: Educate2

Form ID: Educ3

50

Education Credits and Tuition and Fees Deduction

Please provide all copies of Form 1098‐T. Educational institutions use Form 1098‐T to report qualified education expenses. An eligible educational institution is any college, university, or vocational school eligible to participate in a student aid program administered by the U.S. Department of Education. Preparer ‐ Enter on Screen Educate2 Taxpayer/Spouse (T, S) Education code (1=American Opportunity Credit, 2=Lifetime Learning Credit, 3=Tuition and Fees Deduction) Student's social security number Student's first name Student's last name

[8]

Institution Information

Enter information from each institution on a separate page, including the complete address and federal identification number of the instituti Institution's federal identification number Institution's name Institution's street address Institution's city, state, zip code

[8]

Tuition Paid and Related Information Amounts reported in Box 1 or Box 2 may not reflect the actual amount paid for the student during 2015. Enter the amount actually paid during 2015. 2015 Information Tuition paid (Enter only the amount actually paid) (Box 1) + [8] Tuition billed (Enter only the amount actually paid) (Box 2) Educational institution changed its reporting method for 2015 (Box 3) Adjustments made for a prior year (Box 4) Scholarships or grants (Box 5) Adjustments to scholarships or grants for a prior year (Box 6) Box 1 or 2 includes amounts for an academic period beginning January ‐ March 2016 (Box 7) At least half‐time student (Box 8) Graduate student (Box 9) (1=Yes, 2=No) Insurance contract reimbursement/refund (Box 10) Non‐Institution expenses (Books and fees not paid directly to the educational institution) American Opportunity Tax Credit (AOTC) disqualifier


1 = Not pursuing degree, 2 = Not enrolled at least half‐time, 3 = Felony drug conviction, 4 = 4 yrs post‐secondary education before 2015

NOTES/QUESTIONS:

Control Totals+

Form ID: Educ3

Form ID: 1099Q

51

Qualified Education Programs Please provide all copies of Form 1099Q

Taxpayer/Spouse (T, S) Payer name State postal code Type of account (1= Private QTP, 2 = State QTP, 3 = ESA) Relationship to account (1 = Beneficiary, 2 = Account owner, 3 = Both, 4 = Neither) Final distribution

[1] [3] [4] [6] [7] [8]

Contributions and Basis Beneficiary's Information (if not taxpayer or spouse) Social security number First name Last name

[11] [12] [13]

2015 Information Amount contributed in current year Basis of this account at 12/31/14 Value of this account at 12/31/15 Distribution by beneficiary of previously taxed contributions (if not taxpayer or spouse)

+ + + +


Payments from Qualified Education Programs 2015 Information Gross distribution (Box 1) Earnings (Box 2) Basis (Box 3) Trustee‐to‐trustee rollover (Box 4) Trustee‐to‐trustee rollover amount if different than Box 1 Box 5 ‐ Private QTP State QTP Coverdell ESA Check if the recipient is not the designated beneficiary (Box 6) Qualified education expenses Elementary and secondary education expenses

+ + +


+

[37] [39] [40] [41] [42]

+ +

[43] [45]

NOTES/QUESTIONS:

Control Totals+

Form ID: 1099Q

Form ID: FAFSA

52

Federal Student Aid Application Information #1

Complete a FAFSA information section for both the parent and student. Both may be required to complete the FAFSA. If the parent or student tax return was prepared elsewhere, please provide the completed tax return. Preparer use only

This FAFSA information is for the:

2015 Information Who is listed as the primary taxpayer on the tax return of the individual to whom this information applies? (1 = Father or stepfather, 2 = Mother or stepmother, 3 = Student, 4 = Student's spouse)


The information for the FAFSA worksheet will be: (1 = Calculated for the taxpayer on this return, 2 = Entered from someone else's return)

Taxpayer's (and spouse's) current balance of all cash, savings and checking accounts+ Taxpayer's (and spouse's) net worth in investments, including real estate but do not include the primary residence + Taxpayer's (and spouse's) net worth in current businesses and/or investment farms+ Child support paid because of divorce, separation, or a result of a legal requirement+ Taxable earnings from need‐based employment programs + Student grant and scholarship aid included in adjusted gross income + Earnings from work under a cooperative education program offered by a college + Child support received but do not include foster care or adoption payments + Veterans noneducation benefits + Other untaxed income not reported elsewhere, such as worker's compensation, disability, etc., but do not include student aid, earned income credit, additional child tax credit, welfare payments, untaxed Social Security benefits, SSI, on‐base military housing or a military housing allowance, or combat pay. + Money received or paid on behalf of the student (For the student's worksheet only)+

[2] [5] [7] [9] [11] [13] [15] [17] [19] [21]

[23] [25]

Control Totals+

Federal Student Aid Application Information #2 Preparer use only

This FAFSA information is for the:

2015 Information Who is listed as the primary taxpayer on the tax return of the individual to whom this information applies? (1 = Father or stepfather, 2 = Mother or stepmother, 3 = Student, 4 = Student's spouse)


The information for the FAFSA worksheet will be: (1 = Calculated for the taxpayer on this return, 2 = Entered from someone else's return)

Taxpayer's (and spouse's) current balance of all cash, savings and checking accounts+ Taxpayer's (and spouse's) net worth in investments, including real estate but do not include the primary residence + Taxpayer's (and spouse's) net worth in current businesses and/or investment farms+ Child support paid because of divorce, separation, or a result of a legal requirement+ Taxable earnings from need‐based employment programs + Student grant and scholarship aid included in adjusted gross income + Earnings from work under a cooperative education program offered by a college + Child support received but do not include foster care or adoption payments + Veterans noneducation benefits + Other untaxed income not reported elsewhere, such as worker's compensation, disability, etc., but do not include student aid, earned income credit, additional child tax credit, welfare payments, untaxed Social Security benefits, SSI, on‐base military housing or a military housing allowance, or combat pay. + Money received or paid on behalf of the student (For the student's worksheet only)+

[2] [5] [7] [9] [11] [13] [15] [17] [19] [21]

[23] [25]

NOTES/QUESTIONS:

Control Totals+

Form ID: FAFSA

Form ID: A‐1

T/S/J

[1]

53

Schedule A ‐ Medical and Dental Expenses

2015 Information Prior Year Information Medical and dental expenses, such as: Doctors, Dentists, Hospital/nursing home fees, Lab/x‐ray fees, Medical supplies, Hearing aids, Eyeglasses/contact lenses, and Insurance reimbursements received + [2] + + + + + Medical insurance premiums you paid: (Do not include pre‐tax amounts paid by an employer‐sponsored plan or amounts entered elsewhere, such as amounts paid for your self‐employed business (Sch C, Sch F, Sch K‐1, etc.) or Medicare premiums entered on Form SSA‐1099.)

+ + + +

[4]

[5]

Long‐term care premiums you paid: (Do not include pre‐tax amounts paid by an employer‐sponsored plan or amounts entered elsewhere, such as amounts paid for your self‐employed business (Sch C, Sch F, Sch K‐1, etc.)) [7]

+ +

[8]

+ + +

[11]

Prescription medicines and drugs: [10]

[13]

Miles driven for medical items

[14]

Schedule A ‐ Tax Expenses T/S/J

2015 Information


State/local income taxes paid: [18]

+ + + + +

[19]

+ + +

[22]

+ + +

[25]

+ +

[28]

+ + +

[31]

+ +

[37]

+ + +

[40]

2014 state and local income taxes paid in 2015: [21]

Real estate taxes paid: [24]

Personal property taxes: [27]

Other taxes, such as: foreign taxes and State disability taxes [30]

Sales tax paid on major purchases: [36]

Sales tax paid on actual expenses: [39]

Control Totals+

Form ID: A‐1

Form ID: A‐2

T/S/J

54

Interest Expenses

Home mortgage interest: From Form 1098 + + + + + + + + +

[1]

2015 2015 Points Paid Type* Mortgage Ins. Prior Year Information Premiums Paid

2015 Interest Paid[2] + + + + + + + + +

+ + + + + + + + +

*Mortgage Types Blank = Used to buy, build or improve main/qualified second home 3 = Used to pay off previous mortgage, excess proceeds invested 1 = Not used to buy, build, improve home or investment 4 = Taken out before 7/1/82 and secured by home used by taxpayer 2 = Used to pay off previous mortgage T/S/J

Payee's Name SSN or EIN Other, such as: Home mortgage interest paid to individuals

2015 Information +

[4]


Address City, state and zip code +

Address City, state and zip code T/S/J Name and address of other person who received Form 1098 for jointly liable mortgage interest you paid ‐ Payer's/Borrower's name [7] Street Address City/State/Zip code Refinancing Points paid in 2015 ‐ [11] Taxpayer/Spouse/Joint (T, S, J) Recipient/Lender name Total points paid at time of refinance Percentage of principal exceeding original mortgage (For AMT adjustment) Points deemed as paid in 2015 (Preparer use only) [12] + Date of refinance Term of new loan (in months) Reported on Form 1098 in 2015 Taxpayer/Spouse/Joint (T, S, J) Recipient/Lender name Total points paid at time of refinance Percentage of principal exceeding original mortgage (For AMT adjustment) Points deemed as paid in 2015 (Preparer use only) + Date of refinance Term of new loan (in months) Reported on Form 1098 in 2015 T/S/J

2015 Information Investment interest expense, other than on Schedule(s) K‐1: + + + + + + + +

[15]

Control Totals +

[16]

Form ID: A‐2

Form ID: A‐3

55

Charitable Contributions

T/S/J


2015 Information Contributions made by cash or check (including out‐of‐pocket expenses)

[2]

+ + + + + + + + +

[3]

[5]

Volunteer miles driven Noncash items, such as: Goodwill/Salvation Army/clothing/household goods + + + + + +

[6]

[8]

[9]

Miscellaneous Deductions T/S/J

2015 Information


Unreimbursed expenses, such as: Uniforms, Professional dues, Business publications, Job seeking expenses, Educational expenses + + + + +

[11]

[12]

Union dues: + + [17] Tax preparation fees + Other expenses, subject to 2% AGI limit, such as: Legal/accounting/custodial fees [20] + + + + [23] Safe deposit box rental + Investment expenses, other than on Schedule(s) K‐1 or Form(s) 1099‐DIV/INT: [26] + + + Other expenses, not subject to the 2% AGI limit: [30] + + + + Gambling losses: (Enter only if you have gambling income) [33] + + [14]

Control Totals+

[15] [18] [21]

[24] [27]

[31]

[34]

Form ID: A‐3

Form ID: MortgInt

Home Mortgage Interest Subject To Limitations

56

Complete this section if you have home acquisition/improvement debt over $1,000,000 or home equity debt over $100,000.

Mortgages taken out before 10/14/87 generally qualify as grandfather debt regardless of how the proceeds are used. Home acquisition debt is a mortgage taken out after 10/13/87, the proceeds of which are used to buy, build or substantially improve your hom Home equity debt is a mortgage taken out after 10/13/87, the proceeds of which are NOT used to buy, build, or substantially improve your ho 2015 Information Description of loan/property Taxpayer/Spouse/Joint (T, S, J) Loan origination date Fair market value of home Number of months loan was outstanding in 2015, if not 12 Number of months home was a qualifying home


+

[5] [7] [9]

(If different from number of months loan was outstanding)

Principal paid in 2015 Interest paid during 2015 Points reported on Form 1098 for 2015 Home mortgage interest you paid, not reported on Form 1098: Recipient name Recipient SSN or EIN Recipient address Recipient city, state, zip code

+ + +

[11] [13] [15] [18] [19] [20]

[21]

[22]

Grandfather debt as of 12/31/14 (or first day mortgage was outstanding) + Grandfather debt as of 12/31/15 (or last day mortgage was outstanding) + Home acquisition/improvement debt as of 12/31/14 (or first day mortgage was outstanding) + Home acquisition/improvement debt as of 12/31/15 (or last day mortgage was outstanding) + + Home equity debt as of 12/31/14 (or first day mortgage was outstanding) Home equity debt as of 12/31/15 (or last day mortgage was outstanding) + Average balance in 2015 of grandfather debt + Average balance in 2015 of home acquisition/improvement debt + Average balance for 2015 all types of debt +

[23] [24] [26] [28] [30] [32] [34] [37] [39] [41]

NOTES/QUESTIONS:

Control Totals+

Form ID: MortgInt

Form ID: 2106

57

Employee Business Expenses Preparer use only


2015 Information

Taxpayer/Spouse (T, S) Occupation in which expenses were incurred State postal code If the employee expenses were from an occupation listed below, enter the applicable code 1 = Qualified performing artist, 2 = Impairment‐related work expenses, 3 = Fee‐basis official Mark if these employee expenses are related to qualified services as a minister or religious worker Parking fees and tolls + Local transportation + Travel expenses + Other business expenses: + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + Nonvehicle depreciation + Meals and entertainment + + Meals for individuals subject to DOT hours of service limitation

[2] [3] [5] [6] [10] [17] [19] [22] [25]

[28] [31] [33]

Employer Reimbursements Enter Reimbursements not entered on Screen W2, Box 12, Code L 2015 Information Reimbursements for other expenses not included on Form W‐2 + Reimbursements for meals and entertainment not included on Form W‐2 + Reimbursements for meals for DOT service limitation not included on Form W‐2+

Control Totals+


[60] [62] [64]

Form ID: 2106

Form ID: 2106‐2

58

Employee Business Expenses

Preparer use only Taxpayer/Spouse (T, S) Occupation in which expenses were incurred State postal code

[2] [3] [4]

Vehicle Questions 2015 Information If you used your automobile for work purposes, please answer the following questions: Was the vehicle available for off‐duty personal use? (Y, N, Blank = Not applicable) Was another vehicle available for personal use? (Y, N) Do you have evidence to support your deduction? (1 = Yes ‐ written, 2 = Yes ‐ not written, 3 = No)


[5] [7] [9]

Vehicle Information Vehicle 1 ‐ Date placed in service Description Comments Vehicle 2 ‐ Date placed in service Description Comments Vehicle 3 ‐ Date placed in service Description Comments Vehicle 4 ‐ Date placed in service Description Comments

[11] [12] [62] [63] [109] [110] [156] [157]

Vehicles Actual Expenses Vehicle 1 Total mileage for the year Business mileage Average daily round trip commuting mileage Total commuting mileage Gasoline + Oil + + Repairs Maintenance + Tires + + Car washes Insurance + Interest + Registration + Licenses + + Property taxes (Plates, tags, etc) Vehicle rentals + Inclusion amt (Preparer only) + Other vehicle expenses+ Value of employer + provided vehicle Depreciation +


Prior Year Information Vehicle 3

Vehicle 2



Vehicle 4

[20]

[69]

[116]

[163]

[24]

[71]

[118]

[165]

[26]

[73]

[120]

[167]

[28]

[75]

[122]

[30] [32] [34] [36] [38] [40] [42] [44] [46] [48] [50] [52] [54] [56] [58] [60]

+ + + + + + + + + + + + + +

[77]

+ +

[105]

Control Totals+

[79] [81] [83] [85] [87] [89] [91] [93] [95] [97] [99] [101] [103]

[107]

+ + + + + + + + + + + + + +

[124]

+ +

[152]

[126] [128] [130] [132] [134] [136] [138] [140] [142] [144] [146] [148] [150]

[154]

[169]

+ + + + + + + + + + + + + +

[171]

+ +

[199]

[173] [175] [177] [179] [181] [183] [185] [187] [189] [191] [193] [195] [197]

[201]

Form ID: 2106‐2

Form ID: 8283

59

Noncash Contributions Exceeding $500

For donated securities, include the company name and number of shares in the donated property description, below Taxpayer/Spouse/Joint (T, S, J) Donated property description Name of donee organization Address of donee organization City State postal code Zip code Date contributed Date acquired by donor How was donated property acquired: (P = Purchase, I = Inheritance, G = Gift, E = Exchange) Donor's cost or basis Fair market value Method used to determine fair market value (A = Appraisal, C = Catalog, T = Thrift shop value, S = Sales/comparative, O = Other) If other:

[1] [4] [5] [6] [7] [8] [9] [10] [11] [12]

+ +

[13] [14] [15] [16]

Control Totals+

Noncash Contributions Exceeding $500 For donated securities, include the company name and number of shares in the donated property description, below Taxpayer/Spouse/Joint (T, S, J) Donated property description Name of donee organization Address of donee organization City State postal code Zip code Date contributed Date acquired by donor How was donated property acquired: (P = Purchase, I = Inheritance, G = Gift, E = Exchange) Donor's cost or basis Fair market value Method used to determine fair market value (A = Appraisal, C = Catalog, T = Thrift shop value, S = Sales/comparative, O = Other) If other:

[1] [4] [5] [6] [7] [8] [9] [10] [11] [12]

+ +

[13] [14] [15] [16]

Control Totals+

Noncash Contributions Exceeding $500 For donated securities, include the company name and number of shares in the donated property description, below Taxpayer/Spouse/Joint (T, S, J) Donated property description Name of donee organization Address of donee organization City State postal code Zip code Date contributed Date acquired by donor How was donated property acquired: (P = Purchase, I = Inheritance, G = Gift, E = Exchange) Donor's cost or basis Fair market value Method used to determine fair market value (A = Appraisal, C = Catalog, T = Thrift shop value, S = Sales/comparative, O = Other) If other:

[1] [4] [5] [6] [7] [8] [9] [10] [11] [12]

+ +

[13] [14] [15] [16]

Control Totals+ Form ID: 8283

Form ID: 1098C

Contributions of Motor Vehicles, Boats & Airplanes

60

Please provide all Forms 1098‐C. If you received a different acknowledgement from the donee organization in lieu of Form 1098‐C, enter the equivalent donation information in the fields provided below. Taxpayer/Spouse (T, S) Donee's name State postal code Date of contribution (Box 1) Odometer mileage (Box 2a) Year of vehicle (Box 2b) Make of vehicle (Box 2c) Model of vehicle (Box 2d) Vehicle or other identification number (Box 3) Donee certifies that vehicle was sold in arm's length transaction to unrelated party (Box 4a) Date of sale (Box 4b) Gross proceeds from sale (Box 4c) Donee certifies that vehicle will not be transferred for money, other property, or services before completion of material improvement or significant intervening use (Box 5a) Donee certifies that vehicle is to be transferred to a needy individual for significantly below fair market value in furtherance of donee's charitable purpose (Box 5b) Detailed description of material improvements or significant intervening use and duration of use (Box 5c)

[1] [4] [3] [9] [10] [11] [12] [13] [14] [15] [16]

+

[17] [18] [19] [20]

Did you provide goods or services in exchange for the vehicle? (Box 6a) Yes Value of goods and services provided in exchange for the vehicle (Box 6b) Donee certifies that the goods and services consisted solely of intangible religious benefits (Box 6c) Description of goods and services (Box 6c)

[21]

+

No

[22] [23] [24] [25]

Under the law, the donor may not claim a deduction of more than $500 for this vehicle if this box is checked (Box 7)

[26]

Other Information for Donated Property Overall physical condition of property Date property was acquired by donor How property was acquired by donor (P = Purchase, I = Inheritance, G = Gift, E = Exchange) Donor's cost or basis Fair market value on date of contribution Method used to determine FMV (A = Appraisal, C = Catalog, T = Thrift shop value, S = Sales/comparative, O = Other) If other: Bargain sale amount received Donee's address, and ZIP code

[31] [32] [33]

+ +

[35] [36] [37] [38] [42]

[43]

Donee's telephone number

[34]

[44]

[45] [46]

NOTES/QUESTIONS:

Control Totals+

Form ID: 1098C

Form ID: 4684B

61

Casualty and Theft ‐ Business/Income Producing Properties Preparer use only

Occurrence description Taxpayer/Spouse/Joint (T, S, J) State postal code Date of casualty or theft

[3] [4] [5] [7]

Casualty and Theft ‐ Business/Income Producing Properties Description of casualty or theft ‐ Property A Description of casualty or theft ‐ Property B Description of casualty or theft ‐ Property C Description of casualty or theft ‐ Property D

[10] [23] [36] [49]

A Property type (1 = Business, 2 = Income producing, 3 = Employee prop) Date acquired Cost or other basis of property + Insurance or other reimbursement + Fair market value before casualty + Fair market value after casualty +

B

C

D

[13]

[26]

[39]

[52]

[17]

[30]

[43]

[56]

[18]

+ + [20] + [21] +

[31]

+ + [33] + [34] +

[44]

[32]

+ + [46] + [47] +

[57]

[19]

[45]

[58] [59] [60]

Business/Income Use Replacement Information Description of replacement property A Description of replacement property B Description of replacement property C Description of replacement property D

[61] [65] [69] [73]

A Mark if property was acquired from a related party Date acquired Cost of replacement property +

B

C

D

[62]

[66]

[70]

[63]

[67]

[71]

[64]

+

[68]

+

[72]

[74] [75]

+

[76]

NOTES/QUESTIONS:

Control Totals+

Form ID: 4684B

Form ID: 4684P

62

Casualty and Theft ‐ Personal Use Properties Preparer use only


[3] [4] [5] [8]

Casualty and Theft ‐ Personal Use Properties Description of casualty or theft ‐ Property A Description of casualty or theft ‐ Property B Description of casualty or theft ‐ Property C Description of casualty or theft ‐ Property D

[17] [29] [41] [52]

A Date acquired Cost or other basis of property Insurance or other reimbursement Fair market value before casualty Fair market value after casualty

+ + + +

B

C

D

[23]

[35]

[47]

+ [25] + [27] + [28] +

[36]

+ [37] + [39] + [40] +

+ [49] + [50] + [51] +

[24]

[58]

[48]

[59] [60] [61] [62]

Personal Use Replacement Information Description of replacement property A Description of replacement property B Description of replacement property C Description of replacement property D

[63] [67] [71] [75]

A Mark if property was acquired from a related party Date acquired Cost of replacement property +

B

C

D

[64]

[68]

[72]

[76]

[65]

[69]

[73]

[77]

[66]

+

[70]

+

[74]

+

[78]

NOTES/QUESTIONS:

Control Totals +

Form ID: 4684P

Form ID: 4684PY

63

Prior Year Casualty and Theft ‐ Business/Income Producing Properties Preparer use only


[3] [4] [5] [6]

Prior Year Casualty and Theft ‐ Business/Income Producing Properties (Cont'd) Description of casualty or theft ‐ Property A Description of casualty or theft ‐ Property B Description of casualty or theft ‐ Property C Description of casualty or theft ‐ Property D

[8] [17] [26] [35]

A Property type (1 = Business, 2 = Income producing, 3 = Employee prop) Date acquired Cost or other basis of property + Insurance or other reimbursement + Fair market value before casualty + Fair market value after casualty +

B

C

D

[9]

[18]

[27]

[12]

[21]

[30]

[39]

+ [14] + [15] + [16] +

[22]

+ [23] + [24] + [25] +

[31]

+ [32] + [33] + [34] +

[40]

[13]

[36]

[41] [42] [43]

Current Year Business/Income Use Replacement Information Description of replacement property A Description of replacement property B Description of replacement property C Description of replacement property D

[44] [50] [56] [62]

A Date acquired Prior year cost of replacement property Cost of replacement property Postponed gain Adjusted basis of replacement property

+ + + +

B

C

D

[45]

[51]

[57]

[63]

+ [47] + [48] + [49] +

[52]

+ [53] + [54] + [55] +

[58]

+ [59] + [60] + [61] +

[64]

[46]

[65] [66] [67]

NOTES/QUESTIONS:

Control Totals+

Form ID: 4684PY

Form ID: CasPY

64

Prior Year Casualty and Theft ‐ Personal Use Properties

Occurrence description Taxpayer/Spouse/Joint (T, S, J) State postal code Date of casualty or theft Damage to personal residence from corrosive drywall Amount paid to repair damage to home or household appliances 25% loss available from 2014

[1] [2] [3] [4] [5]

+ +

[6] [7]

Prior Year Casualty and Theft ‐ Personal Use Properties (Cont'd) Description of casualty or theft ‐ Property A Description of casualty or theft ‐ Property B Description of casualty or theft ‐ Property C Description of casualty or theft ‐ Property D

[15] [23] [31] [39]

A Date acquired Cost or other basis of property Insurance or other reimbursement Principal residence exclusion taken Fair market value before casualty Fair market value after casualty

+ + + + +

B

C

D

[17]

[25]

[33]

[41]

+ [19] + [20] + [21] + [22] +

+ [27] + [28] + [29] + [30] +

[34]

+ [35] + [36] + [37] + [38] +

[42]

[26]

[18]

[43] [44] [45] [46]

Personal Use Replacement Information Description of replacement property A Description of replacement property B Description of replacement property C Description of replacement property D

[47] [53] [59] [65]

A Date acquired Prior year cost of replacement property Cost of replacement property Postponed gain Adjusted basis of replacement property

+ + + +

B

C

D

[48]

[54]

[60]

[66]

+ [50] + [51] + [52] +

[55]

+ [56] + [57] + [58] +

[61]

+ [62] + [63] + [64] +

[67]

[49]

[68] [69] [70]

NOTES/QUESTIONS:

Control Totals+

Form ID: CasPY

Form ID: 8829

65

Home Office General Information

Preparer use only Principal business or profession Taxpayer/Spouse/Joint (T, S, J) State postal code

[3] [4] [5]

Business Use of Home 2015 Information Total area of home Area used exclusively for business Information for day‐care facilities only: Total hours used for day‐care during this year Total hours used this year, if less than 8760 Special computation for certain day‐care facilities: Area used regularly and exclusively for day‐care business Area used partly for day‐care business


[14] [16] [18] [20] [22] [24]

List as direct expenses any expenses which are attributable only to the business part of your home. List as indirect expenses any expenses which are attributable to the overall upkeep and running of your home. 2015 Information Direct Expenses Indirect Expenses [29] + [34] + [37] + [42] + [45] + [51] + [54] + [57] +

Mortgage interest: + Mortgage insurance premiums + Real estate taxes: + Excess mortgage interest and insurance premiums + Insurance + + Rent Repairs & maintenance + Utilities + Other expenses, such as: Supplies & Security system + + + + + + + + + + Excess casualty losses Carryovers: Operating expenses Casualty losses Depreciation Business expenses not from business use of home, such as: Travel, Supplies, Business telephone expenses Depreciation

[60]

+ + + + + + + + + + + + + + + +

Prior Year Information [31] [35] [39] [43] [47] [52] [55] [58] [61]

[63] [64] [65] [67] [68] [72]

NOTES/QUESTIONS:

Control Totals+

Form ID: 8829

Form ID: Auto

66

Auto Worksheet If you used your automobile for business purposes, please complete the following information.

Preparer use only Description of business or profession

[3]

Vehicles Vehicle 1 ‐

Vehicle 2 ‐

Vehicle 3 ‐

Vehicle 4 ‐

Date placed in service Description Comments Date placed in service Description Comments Date placed in service Description Comments Date placed in service Description Comments

[4] [5] [9] [10] [14] [15] [19] [20]

Vehicle Questions Vehicle Prior Vehicle Prior 1 Year 2 Year If you used your automobile for work purposes, answer the following questions: [60] [62] Was the vehicle available for off‐duty personal use? (Y, N) [68] [70] Was another vehicle available for personal use? (Y, N) [76] [78] Do you have evidence to support your deduction? (Y, N) [84] [86] Is this evidence written? (Y, N)

Vehicle Prior 3 Year

Vehicle Prior 4 Year

[64]

[66]

[72]

[74]

[80]

[82]

[88]

[90]

Vehicle Expenses Prior Year Information Vehicle 2

Vehicle 1 Total miles for year Commuting miles Business miles Parking fees + Tolls + + Gasoline + Oil + Repairs + Maintenance + Tires + Car washes + Insurance + Interest + Registration + Licenses + Property taxes Other vehicle expenses+ Vehicle rentals + Inclusion amt (Preparer only) + Depreciation +



Vehicle 3


Vehicle 4

[32]

[34]

[36]

[38]

[42]

[44]

[46]

[48]

[52]

[54]

[56]

[92] [100] [108] [116] [124] [132] [140] [148] [156] [164] [172] [180] [188] [196] [204] [212] [220]

+ + + + + + + + + + + + + + + + +

Control Totals+

[94] [102] [110] [118] [126] [134] [142] [150] [158] [166] [174] [182] [190] [198] [206] [214] [222]

+ + + + + + + + + + + + + + + + +

[96] [104] [112] [120] [128] [136] [144] [152] [160] [168] [176] [184] [192] [200] [208] [216] [224]

[58]

+ + + + + + + + + + + + + + + + +

[98] [106] [114] [122] [130] [138] [146] [154] [162] [170] [178] [186] [194] [202] [210] [218] [226]

Form ID: Auto

Health Care Coverage and Exemptions

Form ID: Coverage

67

“Your family” for health care coverage refers to you, your spouse if filing jointly, and anyone you can claim as a dependent. Please provide all copies of Form(s) 1095‐B and/or 1095‐C 2015 Information Was your entire family covered for the full year with minimum essential health care coverage? (Y, N)


[1]

If your entire family was not covered for the full year with minimum essential health care coverage, enter information for all family members who are covered, or are exempt from the requirement to maintain minimum essential health coverage. Enter either the Exemption Certificate Number issued by the Marketplace, or the Other Exemption Type you are claiming. Mark Full Year if the coverage or exemption is for the entire year, otherwise indicate the Start Month and End Month.

Social Security No.

First Name

Exemption Other Certificate Exemption Full Type * Year Number

Last Name

Start End Month Month [7]

A = Unaffordable coverage B = Short coverage gap C = Exempt noncitizen D = Health care sharing ministry E = Indian tribe member

*Other Exemption Type Codes F = Incarcerated individual G = Hardship (combined coverage unaffordable, initial open enrollment, CHIP) H = Medicaid/TRICARE/Fiscal year employer plan X = Insured with minimum essential coverage (coverage info found on Form(s) 1095‐B or 1095‐C)

2015 Information Taxpayer Spouse Self‐employed health insurance premiums: (Not entered elsewhere) + + Self‐employed long‐term care premiums: (Not entered elsewhere) + +


[12]

+ +

[13]

[15]

+ +

[16]

NOTES/QUESTIONS:

Control Totals+

Form ID: Coverage

Form ID: 1095A

ACA ‐ Health Insurance Marketplace Statement #1

68

Please provide all Forms 1095‐A Taxpayer/Spouse (T,S) Marketplace identifier (Box 1) Marketplace‐assigned policy number (Box 2) Policy issuer's name (Box 3) Part III Household Information ‐

January February March April May June July August September October November December Annual total

A. 2015 Monthly Premium Amount [12] + [13] + [14] + [15] + + [16] + [17] + [18] + [19] + [20] + [21] + [22] + [23] + [24]

[1] [6] [7] [2]


B. 2015 Monthly C. 2015 Monthly Prior Premium Amount of Second Advance Payment Year Lowest Cost Silver Plan (SLCSP) of Premium Tax Credit Information + + [25] [38] + + [26] [39] + [27] [40] + + + [28] [41] + + [29] [42] + + [30] [43] + + [31] [44] + + [32] [45] + + [33] [46] + + [34] [47] [48] + + [35] [49] + + [36] [50] + + [37] Control Totals+

ACA ‐ Health Insurance Marketplace Statement #2 Please provide all Forms 1095‐A Taxpayer/Spouse (T,S) Marketplace identifier (Box 1) Marketplace‐assigned policy number (Box 2) Policy issuer's name (Box 3) Part III Household Information ‐

January February March April May June July August September October November December Annual total

A. 2015 Monthly Premium Amount [12] + [13] + + [14] [15] + [16] + [17] + [18] + [19] + + [20] [21] + [22] + [23] + [24] +

[1] [6] [7] [2]


B. 2015 Monthly C. 2015 Monthly Prior Premium Amount of Second Advance Payment Year Lowest Cost Silver Plan (SLCSP) of Premium Tax Credit Information + [38] [25] + [39] [26] + + [40] [27] + + [41] [28] + + [42] [29] + + [43] [30] + + + [44] [31] + [45] [32] + + [46] [33] + + [47] [34] + + [48] [35] + + [49] [36] + + [50] [37] + + Control Totals+

NOTES/QUESTIONS:

Form ID: 1095A

Form ID: 5498SA

Medical and Health Savings Account Contributions

69

Please provide all Forms 5498‐SA. 2015 Information [1] Taxpayer/Spouse (T, S) [4] Name of Trustee [2] State postal code Indicate type of health or medical savings account: [6] HSA Archer MSA [7] MA (Medicare Advantage) MSA [9] Total HSA/MSA contributions made for 2015 (Enter all amounts contributed, including through employer cafeteria plans) + [10] [12] Indicate type of coverage under qualifying high deductible health plan (1 = Self‐Only, 2 = Family) Number of months in qualified high deductible health plan in 2015 [13] Mark if you want to contribute the maximum allowable health or medical savings account contribution amount [14] Total HSA/MSA contribution to be made for 2015 + [15] Fair market value of HSA, Archer MSA, or MA MSA (Form 5498‐SA, Box 5) + [16] + [19] Excess contributions for 2014 taken as constructive contributions for 2015 + Rollover contribution (Form 5498‐SA, Box 4) [21]


Complete this section if your account is an Archer MSA or MA MSA Amount of annual deductible Enter compensation from employer maintaining high deductible health plan If self‐employed, enter earned income from business under which plan was established

+

[24]

+

[27]

+

[31]

Complete this section if your account is an HSA Was the high deductible health plan in effect for December 2015? (Y, N)

[33]

NOTES/QUESTIONS:

Control Totals+

Form ID: 5498SA

Form ID: 1099SA

70

Health, Medical Savings Account Distributions Please provide all Forms 1099‐SA. 2015 Information

Taxpayer/Spouse (T, S) Name of Trustee State postal code Gross distributions received (Box 1) + + Earnings on excess contributions (Box 2) Distribution code (Box 3) Fair Market Value on date of death (Box 4) + Box 5 ‐ HSA Archer MSA MA MSA All distributions were used to pay unreimbursed qualified medical expenses If some distributions were used to pay for other than qualified medical expenses, + enter the unreimbursed qualified medical expenses for 2015 Withdrawal of excess contributions by the due date of the return + + Amount of distribution rolled over for 2015 If the distribution is due to the death of the account holder, enter the qualified decedent medical expenses paid by the taxpayer + + If MA (Medicare Advantage) MSA, enter value of account on 12/31/14 For HSA accounts: Was the high deductible health plan coverage started in 2014 and in effect for the month of December 2014? (Y, N) Was the high deductible health plan coverage ended before 12/31/15? (Y, N)


[1] [4] [2] [7] [9] [11] [12] [13] [14] [15] [17] [19] [21] [23] [26] [27]

[29] [30]

Long Term Care (LTC) Service and Contracts Please provide all Forms 1099‐LTC. 2015 Information Name of the insured chronically ill individual Social security number of insured Gross long‐term care (LTC) benefits paid (Box 1) + + Accelerated death benefits paid (Box 2) Check one (Box 3) Per diem Reimbursed amount Qualified contract (Box 4) Check, if applicable (Box 5) Chronically ill Terminally ill Are there other individuals who received LTC payments during 2015? (Y, N) If the insured is terminally ill, were payments received on account of terminal illness? (Y, N) Number of days during the long‐term care period Cost incurred for qualified long‐term care services during the long‐term care period +


[39] [40] [42] [44] [46] [47] [48] [49] [50] [52] [53] [54] [55]

NOTES/QUESTIONS:

Control Totals+

Form ID: 1099SA

Form ID: 1099QA

71

ABLE Account Information #1 Please provide all Forms 1099‐QA and 5498‐QA

2015 Information Taxpayer/Spouse (T, S) Payer name State postal code Recipient's Social Security Number Recipient's Name Gross distribution (Form 1099‐QA Box 1) Earnings (Form 1099‐QA Box 2) Basis (Form 1099‐QA Box 3) Program‐to‐program transfer (Form 1099‐QA Box 4) Check if ABLE account terminated in 2015 (Form 1099‐QA Box 5) Check if the recipient is not the designated beneficiary (Form 1099‐QA Box 6) Qualified disability expenses Amount of rollover Amount contributed in 2015 (Form 5498‐QA Box 1) Value of account on 12/31/15 (Form 5498‐QA Box 4)

[1] [3] [4] [7] [8]

[9]

+ + +

[10] [12] [14] [16] [17] [18]

+ + + +

[19] [21] [23] [25]

Control Totals+

ABLE Account Information #2 Please provide all Forms 1099‐QA and 5498‐QA 2015 Information Taxpayer/Spouse (T, S) Payer name State postal code Recipient's Social Security Number Recipient's Name Gross distribution (Form 1099‐QA Box 1) Earnings (Form 1099‐QA Box 2) Basis (Form 1099‐QA Box 3) Program‐to‐program transfer (Form 1099‐QA Box 4) Check if ABLE account terminated in 2015 (Form 1099‐QA Box 5) Check if the recipient is not the designated beneficiary (Form 1099‐QA Box 6) Qualified disability expenses Amount of rollover Amount contributed in 2015 (Form 5498‐QA Box 1) Value of account on 12/31/15 (Form 5498‐QA Box 4)

[1] [3] [4] [7] [9]

[8]

+ + +

[10] [12] [14] [16] [17] [18]

+ + + +

[19] [21] [23] [25]

Control Totals+

NOTES/QUESTIONS:

Form ID: 1099QA

Form ID: OtherTax

72

Social Security Tax on Unreported Tips Complete if you received cash/charge tips of $20 or less in a month in 2015. 2015 Information Taxpayer

Total cash and charge tips under $20 per month and not reported to employer

+

Prior Year Information Spouse

[3]

+

[4]

Complete if you received cash/charge tips of $20 or more in a month and did not report all of those tips to your employer. Employer name

Employer Total tips Total tips identification number received in 2015 reported in 2015

Taxpayer information [1]

Spouse information [2]

Social Security Tax on Unreported Wages Complete if you received pay from a firm for services performed not as an independent contractor and social security and Medicare taxes were not withheld from the pay. (**Please refer to Reason Codes located at the bottom)

Firm name

Firm's federal Reason identification number Code **

Date of IRS determination or Mark if Total wages received correspondence 1099‐MISC with no social security received received or Medicare tax withheld

Taxpayer information [6]

Spouse information [7]

** Reason Codes A = I filed Form SS‐8 and received a determination letter stating that I am an employee of this firm. C = I received other correspondence from the IRS that states I am an employee. G = I filed Form SS‐8 with the IRS and have not received a reply. H = I received a Form W‐2 and a Form 1099‐MISC from this firm for 2015. The amount on Form 1099‐MISC should have been included as wages on Form W‐2.

Form ID: OtherTax

Form ID: Clergy

73

Minister, Clergy, Religious Workers Taxpayer

State postal code

Spouse [2]

[1]

Taxpayer Spouse If you received a parsonage provided by the church, please complete the following information: [5] + Fair rental value of parsonage provided by church + [11] + Actual parsonage utilities expense +

Prior Year Information [6] [12]

If you received a rental or parsonage allowance provided by the church, please complete the following information: Utilities allowance, [17] + [18] if separate from parsonage allowance + [20] [21] Actual parsonage expense + + [24] [23] Fair rental value of home + + [26] + [27] Actual utilities expense + Mark if you have claimed exemption from self‐employment tax by filing Form 4361 with the IRS If you are a self‐employed minister, enter any tax‐deductible contributions to a 403(b) retirement plan +

[29] [31]

[32]

+

[34]

NOTES/QUESTIONS:

Control Totals+

Form ID: Clergy

Form ID: 8615

Tax for Children with Unearned Income

74

Enter parent's information for children under age 19 on 1/1/16 or a full‐time student under age 24 with unearned income of more than $2,1 Parent's social security number (Enter the name and social security number of the parent listed first on the return) Parent's first name Parent's last name Parent's filing status (1 = Single, 2 = Married/filing jointly, 3 = Married separately, 4 = Head of household, 5 = Qualifying widow(er))

[2] [3] [4] [5]

All Other Children's Information Enter information for each child with unearned income of more than $2,100. Preparer ‐ Enter on Screen 8615Sib Child #1 social security number Child #1 first name Child #1 last name Child #1 date of birth (mm/dd/yyyy)

[1]

Child #3 social security number Child #3 first name Child #3 last name Child #3 date of birth (mm/dd/yyyy)

[1]


[1]


[1]


[1]


[1]

[2] [3] [4]

[2] [3] [4]

[2] [3] [4]

[2] [3] [4]

[2] [3] [4]

[2] [3] [4]


[1]


[1]


[1]


[1]


[1]


[1]

[2] [3] [4]

[2] [3] [4]

[2] [3] [4]

[2] [3] [4]

[2] [3] [4]

[2] [3] [4]

NOTES/QUESTIONS:

Form ID: 8615

Form ID: 8814

75

Children's Interest Income

Please provide copies of all Form 1099‐INT or other statements reporting child's interest income. *Whole numbers will be treated as $ amounts. Enter percentages in the XXX.XX format. For example, enter 100% as 100.00 or 75.5% as 75.50. Complete a separate Organizer Form ID: 8814 for each child. Child's social security number [1] Child's date of birth [2] [4] Child's name Taxpayer/Spouse/Joint (T, S, J) [5] Type Interest [6] Prior Year Tax Exempt U.S. Obligations*Tax Exempt* Code (**See codes below) Payer Income Income $ or % $ or % Information + + + + + +

Blank = Regular Interest 3 = Nominee Distribution

**Interest Codes 4 = Accrued Interest

5 = OID Adjustment

6 = ABP Adjustment

Children's Dividend Income Type Ordinary[8] Code (** See codes below) Dividends 1 Payer Amounts + 2 Payer Amounts + 3 Payer Amounts + 4 Payer Amounts + 5 Payer Amounts + 6 Payer Amounts +

Please provide copies of all Form 1099‐DIV or other statements reporting child's dividend income. Qualified Total Capital Gain 28% Tax Exempt U.S. Obligations* Tax Exempt* Dividends Distributions Section 1250 Section 1202 Capital Gain Dividends $ or % $ or %


**Dividend Codes Blank = Other 3 = Nominee 2015 Information[10]


Alaska Permanent Fund dividends: + +

Control Totals +

Form ID: 8814

Household Employment Tax

Form ID: H

76

Complete if you paid cash wages of $1,000 or more to any household employee. Taxpayer/Spouse (T, S) Employer identification number

[1] [2]

Total cash wages subject to social security taxes Total cash wages subject to Medicare taxes Total cash wages subject to Additional Medicare Tax withholding Federal income tax withheld State disability plan social security & Medicare withheld

+ + + + +

[4] [5] [6] [7] [8]

Did you: (A) pay any household employee cash wages of $1900 or more in 2015? (Y, N) (B) withhold Federal income tax for any household employee? (Y, N) (C) pay household employees cash wages equal to or greater than $1,000 in any quarter of 2014 or 2015? (Y, N)

[9] [10] [11]

Federal Unemployment (FUTA) Tax If you answered "Yes" to question (C) above, complete the following information. Complete only items marked with an asterisk (*) if total cash wages subject to FUTA tax amount is also taxable as defined by your State act and unemployment contributions are paid to only one State. Total cash wages subject to FUTA tax

+

State #1 information State postal code where you have to pay unemployment contributions * State reporting number as shown on state unemployment tax return Taxable wages (as defined in state act) State experience rate period: From To State experience rate (xxx.xx) Contributions paid to state unemployment fund * Contributions for 2015 paid after 04/18/16 State #2 information State postal code where you have to pay unemployment contributions State reporting number as shown on state unemployment tax return Taxable wages (as defined in state act) State experience rate period: From To State experience rate (xxx.xx) Contributions paid to state unemployment fund Contributions for 2015 paid after 04/18/16

[12]

[14] [15]

+

[16] [17] [18] [19]

+

[20]

+

[21]

[22] [23]

+

[24] [25] [26] [27]

+

[28]

+

[29]

NOTES/QUESTIONS:

Control Totals +

Form ID: H

Form ID: 5405

77

First‐Time Homebuyer Credit Repayment

You are required to repay the First‐Time Homebuyer credit if you claimed the credit in 2008. If the credit was claimed in 2009, 2010, or 2011, and the home is no longer used as your main residence, you may have to repay the credit. Principal residence address, if different from home address on Organizer Form ID: 1040 Address City/State/Zip code Date home acquired (After 4/8/08 and before 5/1/10) (For service members after 12/31/08 and before 5/1/11) Purchase price of the home Date the home was sold or ceased being used as principal residence If you sold your home, enter the selling price If you sold your home, enter the expense of sale Were you and your spouse married on the purchase date? (Y, N) If your home was transferred to your ex‐spouse due to a divorce settlement, enter his or her full name If you own the principal residence with another person enter their name and allocation percentage Other owner name Allocation percentage

[1] [2]

[3]

[4] [5] [6] [13] [14] [15] [18] [19] [22]

NOTES/QUESTIONS:

Form ID: 5405

Form ID: 2441

78

Child and Dependent Care Expenses

Please enter all amounts paid in 2015 for the care of one or more dependents which enables you to work or attend school. Enter the amount of dependent care expenses paid for each qualifying dependent on Organizer Form ID:1040 Taxpayer 2014 employer‐provided dependent care benefits used during 2015 grace period + Employer‐provided dependent care benefits that were forfeited in 2015 + Total qualified expenses incurred in 2015 Were you or your spouse a full time student or disabled? (Yes or No) Did you provide care expenses for any person(s) who is not listed as a dependent? (Y, N)

Spouse [3] [5]

+ +

[4] [6] [9]

[10]

[11] [12]

Business name of provider First and last name of provider Street address of provider City, State and Zip code Social security number OR Employer identification number Tax Exempt / LAFCP / Due Diligence (1 = Tax Exempt, 2 = Living Abroad Foreign Care Provider, 3 = Provider moved and unable to get TIN, 4 = Provider refuses to give TIN) Amount paid to care provider in 2015 + [7] Foreign province or state of provider Foreign country and Foreign postal code of provider Business name of provider First and last name of provider Street address of provider City, State and Zip code Social security number OR Employer identification number Tax Exempt / LAFCP / Due Diligence (1 = Tax Exempt, 2 = Living Abroad Foreign Care Provider, 3 = Provider moved and unable to get TIN, 4 = Provider refuses to give TIN) + Amount paid to care provider in 2015 Foreign province or state of provider Foreign country and Foreign postal code of provider Business name of provider First and last name of provider Street address of provider City, State and Zip code Social security number OR Employer identification number Tax Exempt / LAFCP / Due Diligence (1 = Tax Exempt, 2 = Living Abroad Foreign Care Provider, 3 = Provider moved and unable to get TIN, 4 = Provider refuses to give TIN) + Amount paid to care provider in 2015 Foreign province or state of provider Foreign country and Foreign postal code of provider Business name of provider First and last name of provider Street address of provider City, State and Zip code Social security number OR Employer identification number Tax Exempt / LAFCP / Due Diligence (1 = Tax Exempt, 2 = Living Abroad Foreign Care Provider, 3 = Provider moved and unable to get TIN, 4 = Provider refuses to give TIN) + Amount paid to care provider in 2015 Foreign province or state of provider Foreign country and Foreign postal code of provider Business name of provider First and last name of provider Street address of provider City, State and Zip code Social security number OR Employer identification number Tax Exempt / LAFCP / Due Diligence (1 = Tax Exempt, 2 = Living Abroad Foreign Care Provider, 3 = Provider moved and unable to get TIN, 4 = Provider refuses to give TIN) + Amount paid to care provider in 2015 Foreign province or state of provider Foreign country and Foreign postal code of provider Control Totals+ Form ID: 2441

Form ID: R

79

Credit For The Elderly or Disabled

Please complete if you were age 65 or older at the end of 2015, OR you were under age 65 and retired under total and permanent disability, and you received taxable disability income. Taxpayer Spouse Nontaxable disability/pension income received in 2015 + [7] + Taxable disability income received in 2015 + + [9]

NOTES/QUESTIONS:

Control Totals+

Form ID: R

[8] [10]

Form ID: 5695

Residential Energy Credit

80

The American Tax Relief Act of 2012 provides credits for energy efficient improvements made to personal residences. There are certain restrictions and limits but some of the home improvements that may qualify include exterior windows and doors, metal roofs, solar electric, or solar heating property. Please provide copies of any prior year Forms 5695 not prepared by this office. Taxpayer/Spouse/Joint (T, S, J) Were the costs incurred made to your main home located in the United States? (Y, N) Were the costs incurred related to the construction of your main home located in the United States? (Y, N) Enter the total amount of costs for insulation material or system to reduce heat loss or gain + Enter the total amount of costs for exterior windows + Enter the total amount of costs for exterior doors + Enter the total amount of costs for qualified metal roofs + + Enter the total amount of costs for energy‐efficient building property Enter the total amount of costs for qualified natural gas, propane, or oil furnace or hot water boilers + Enter the total amount of costs for advanced main circulating fan used in a natural gas, propane, or oil furnace + + Enter the total amount of costs for qualified solar electric property + Enter the total amount of costs for qualified solar water heating property Enter the total amount of costs for qualified small wind energy property + Enter the total amount of costs for qualified geothermal heat pump property + + Enter the total amount of costs for qualified fuel cell property Enter the total amount of kilowatt capacity of the qualified fuel cell property

[1] [2] [3] [5] [7] [9] [11] [6] [8] [10] [12] [14] [16] [13] [15] [17]

NOTES/QUESTIONS:

Control Totals+

Form ID: 5695

Form ID: 1116

81

Foreign Tax Credit Complete if you paid or accrued foreign taxes to a foreign country or U.S. possession in 2015. Preparer use only

Description Taxpayer/Spouse (T, S) Category of income* Description of income

[3] [8] [10] [11]

*Category of Income A = Passive category income D = Certain income re‐sourced by treaty B = General category income E = Lump‐sum distributions C = Section 901(j) income

Foreign Income or Loss Country code Country name

[18] [19]

Regular Foreign gross income Definitely related expenses:

Foreign source losses

AMT, if different

+

[22]

+

[23]

+ + + + + +

[30]

+ + + + + +

[31]

[44]

[45]

Foreign Taxes Paid or Accrued Foreign taxes paid or accrued: Date paid or accrued In foreign currency ‐ taxes withheld on: Dividends Rents & royalties Interest Other foreign taxes In US dollars ‐ taxes withheld on: Dividends Rents & Royalties Interest Other foreign taxes

[46]

+ + + +

[47]

+ + + +

[52]

[48] [49] [50]

[53] [54] [55]

NOTES/QUESTIONS:

Control Totals+

Form ID: 1116

Form ID: 8839

Adoption Credit

82

Complete this form if you paid qualified adoption expenses in 2015. Indicate if the adoption was final in or before 2015. Qualified adoption expenses include adoption fees, attorney fees, court costs, and travel expenses while away from home. Please provide copies of legal documents approving the adoption. Child 1 [1]

Child 2

Child 3

Child 4

Child 5

Child 6

Taxpayer/Spouse/Joint (T, S, J) First name Last name Child's date of birth Mark if this child was: born before '98 and was disabled a child with special needs a foreign child Child's identifying number Total adoption credit received in prior years for this child Total qualified adoption expenses paid in 2014 for this child Employer‐provided benefits received in 2014 for this child Total qualified adoption expenses paid in 2015 for this child Employer‐provided benefits received in 2015 for this child Adoption final in (1 = '15, 2 = Pre '15)

Taxpayer/Spouse/Joint (T, S, J) First name Last name Child's date of birth Mark if this child was: born before '98 and was disabled a child with special needs a foreign child Child's identifying number Total adoption credit received in prior years for this child Total qualified adoption expenses paid in 2014 for this child Employer‐provided benefits received in 2014 for this child Total qualified adoption expenses paid in 2015 for this child Employer‐provided benefits received in 2015 for this child Adoption final in (1 = '15, 2 = Pre '15) If the adoption was incomplete or unsuccessful please provide information below: [7] [8] [9]

NOTES/QUESTIONS:

Form ID: 8839

Form ID: 4136

83

Fuel Tax Credit *Select the Type of Use codes from the chart below Type of Use*

Nontaxable use of gasoline ‐ Off‐highway business use Use on a farm Other nontaxable use Exported Nontaxable use of aviation gasoline ‐ Commercial aviation Other nontaxable use Exported Leaking underground storage tank (LUST) tax Nontaxable use of undyed diesel fuel ‐ Explanation of evidence of dyes:

[3]

[7]

Rate

Gallons

$0.183 0.183 0.183 0.184

+ + + +

[1]

0.15 0.193 0.194 0.001

+ + + +

[6]

[2] [4] [5]

[8] [9] [10]

[11]

[12] Other nontaxable use Use on a farm Trains Intercity / local bus Exported Nontaxable use of undyed kerosene (other than aviation) ‐ Explanation of evidence of dyes:

0.243 0.243 0.243 0.17 0.244

+ + + + +

[13] [14] [15] [16] [17]

[18]

Other nontaxable use Use on a farm Intercity / local buses Exported Other nontaxable use taxed at $.044 Other nontaxable use taxed at $.219 Kerosene used in aviation ‐ Kerosene taxed at $.244 Kerosene taxed at $.219 Other nontaxable use taxed at $.244 Other nontaxable use taxed at $.219/.044 Leaking underground storage tank (LUST) tax

[19]

[24] [26]

[30] [32]

1 = Farming purposes 2 = Off highway business use 3 = Export 4 = Commercial fishing 5 = Intercity/local bus 6 = In a qualified local bus 7 = School bus

0.243 0.243 0.17 0.244 0.043 0.218

+ + + + + +

[20]

0.200 0.175 0.243 0.218 0.001

+ + + + +

[28]

[21] [22] [23] [25] [27]

[29] [31] [33] [34]

*Type of Use 8 = Diesel & Kerosene fuel other than train or highway vehicle 9 = Foreign trade 10 = Certain helicopter and fixed wing air ambulance uses 11 = Aviation fuel other than propulsion engines 13 = Exclusive use by a nonprofit educational organization 14 = Exclusive use by a state, political subdivision or DC 15 = In an aircraft or vehicle owned by an aircraft museum

NOTES/QUESTIONS:

Control Totals +

Form ID: 4136

Form ID: 4136‐2

84

Fuel Tax Credit *Select the Type of Use codes from the chart below

Type of Use* Sales by registered ultimate vendors of undyed diesel fuel ‐ Registration Number Explanation of evidence of dyes:

Rate

Gallons [1] [2]

State / local government Intercity / local buses

0.243 0.17

+ +

[3] [4]

Sales by registered ultimate vendors of undyed kerosene ‐ Registration Number Explanation of evidence of dyes:

[5] [6]

Use by state/local government Sales from a blocked pump Intercity / local buses Sales by registered ultimate vendors of kerosene in aviation ‐ Registration Number Commercial aviation taxed at $.219 (Other than foreign trade) Commercial aviation taxed at $.244 (Other than foreign trade) Nonexempt use in noncommercial aviation Other nontaxable uses taxed at $.244 [14] Other nontaxable uses taxed at $.219/.044 [16] Leaking underground storage tank (LUST) tax


0.243 0.243 0.17

+ + +

0.175 0.200 0.025 0.243 0.218 0.001

+ + + + + +

[7] [8] [9] [10] [11] [12] [13] [15] [17] [18]


NOTES/QUESTIONS:

Control Totals +

Form ID: 4136‐2

Form ID: 4136‐3

85

Fuel Tax Credit *Select the Type of Use codes from the chart below

Type of Use*

Rate

Nontaxable use of alternative fuel ‐ Liquefied petroleum gas (LPG) [1] "P Series" fuels [3] Compressed natural gas (CNG) [5] Liquefied hydrogen [7] Any liquid fuel derived from coal through the Fischer‐Tropsch process [9] [11] Liquid hydrocarbons derived from biomass Liquefied natural gas (LNG) [13] Liquefied gas derived from biomass [15] Alternative fuel credit and alternative fuel mixture credit ‐ Registration Number Liquefied hydrogen Registered credit card users ‐ Registration Number Diesel for state / local government Kerosene for state / local government Kerosene for aviation use by state / local gov't taxed at $.219/.044 Nontaxable use of a diesel‐water fuel emulsion ‐ [23] Other nontaxable use Exported Diesel‐water fuel emulsion blending ‐ Registration Number Blender credit Exported dyed fuels ‐ Exported dyed diesel fuel Exported dyed kerosene


Gallons

0.183 0.183 0.183 0.183

+ + + +

[2]

0.243 0.243 0.243 0.183

+ + + +

[10]

0.50

+

0.243 0.243 0.218

+ + +

0.197 0.198

+ +

0.046

+

[27]

0.001 0.001

+ +

[28]

[4] [6] [8]

[12] [14] [16] [17] [18] [19] [20] [21] [22] [24] [25] [26]

[29]


NOTES/QUESTIONS:

Control Totals +

Form ID: 4136‐3

Carryover Information ‐ Preparer Use Only

Form ID: CO

86

Indefinite Carryovers Instructions Enter carryovers from prior year(s) as positive numbers. Enter utilizations from prior year(s) as negative numbers.

2014 to 2015 Amounts

Excess section 179 for Sch A + Excess section 179 for Sch A ‐ AMT + Minimum tax credit + Investment interest + Investment interest ‐ AMT + Short‐term capital loss + Short‐term capital loss ‐ AMT + Long‐term capital loss + Long‐term capital loss ‐ AMT + Residential energy credit + D.C. first‐time homebuyer credit + Tax credit bonds +

[1] [2] [3] [4] [5] [6] [7] [8] [9] [10] [11] [12]

Charitable Contribution Carryover Items Prior C/O Year 2006 2007 2008 2009 2010 2011 2012 2013 2014

50% Contributions

+ + + + +

30% Contributions

+ [14] + [15] + [16] + [17] + [13]

[18] [19] [20] [21] [22]

50/30% Cap Gain Prop

+ + + + +

+ [24] + [25] + [26] + [27] + [23]

20% Contributions

50% Qualified Conservation Contributions

+ + + + [28] + [29] + [30] + [31] + [32] +

100% Qualified Conservation Contributions + + [65] + [66] + [67] + [68] + [69] + [70] + [71] + [63]

[81]

[64]

[82] [83] [84] [85] [86] [87] [88] [89]

AMT Charitable Contribution Carryover Items Prior C/O Year 2006 2007 2008 2009 2010 2011 2012 2013 2014

50% AMT Contributions

+ + + + +

30% AMT Contributions

+ [34] + [35] + [36] + [37] + [33]

[38] [39] [40] [41] [42]

50/30% AMT Cap Gain Prop

+ [44] + [45] + [46] + [47] +

+ + + + +

[43]

20% AMT Contributions + + + + [48] + [49] + [50] + [51] + [52] +

50% AMT Qual Conservation Contributions

100% AMT Qual Conservation Contributions + + [74] + [75] + [76] + [77] + [78] + [79] + [80] + [72]

[90]

[73]

[91] [92] [93] [94] [95] [96] [97] [98]

Section 1231 Nonrecaptured Losses Section 1231 Nonrecaptured Losses 2010 2011 2012 2013 2014

+ + + + +

[53] [54] [55] [56] [57]

AMT Section 1231 Nonrecaptured Losses + + + + +

[58] [59] [60] [61] [62]

Control Totals+

Form ID: CO

Business Credit Carryover Information ‐ Preparer Use Only

Form ID: COGBCr

87

Description A B C D

Prior C/O Year 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014

[2] [2] [2] [2]

A

B [1]

+ + + + + + + + + + + + + + + + +

C [1]

[3] [4] [5] [6] [7] [8] [9] [10] [11] [12] [13] [14] [15] [16] [17] [18] [22]

+ + + + + + + + + + + + + + + + +

D [1]

[3] [4] [5] [6] [7] [8] [9] [10] [11] [12] [13] [14] [15] [16] [17] [18] [22]

+ + + + + + + + + + + + + + + + +

[1] [3] [4] [5] [6] [7] [8] [9] [10] [11] [12] [13] [14] [15] [16] [17] [18] [22]

+ + + + + + + + + + + + + + + + +

[3] [4] [5] [6] [7] [8] [9] [10] [11] [12] [13] [14] [15] [16] [17] [18] [22]

NOTES/QUESTIONS:

Control Totals+

Form ID: COGBCr

Form ID: FarmLoss

Excess Farm Loss Limitation Information ‐ Preparer Use Only

Schedule F ‐ Farm income/‐loss: 2014 2013 2012 2011 2010 Schedule C ‐ Farm commodity processing income/‐loss: 2014 2013 2012 2011 2010 Schedule E ‐ Partnership/S corporation farm income/‐loss: 2014 2013 2012 2011 2010 Form 4835 ‐ Farm rent income/‐loss: 2014 2013 2012 2011 2010 Gain/‐loss on sale of farming property: 2014 2013 2012 2011 2010 AMT Gain/‐loss on sale of farming property: 2014 2013 2012 2011 2010 AMT Adjustments/Preferences to farm income/‐loss: 2014 2013 2012 2011 2010

88

+ + + + +

[1]

+ + + + +

[6]

+ + + + +

[11]

+ + + + +

[16]

+ + + + +

[21]

+ + + + +

[26]

+ + + + +

[31]

[2] [3] [4] [5]

[7] [8] [9] [10]

[12] [13] [14] [15]

[17] [18] [19] [20]

[22] [23] [24] [25]

[27] [28] [29] [30]

[32] [33] [34] [35]

NOTES/QUESTIONS:

Control Totals+

Form ID: FarmLoss

Form ID: NOLCO

Net Operating Loss Carryover Information ‐ Preparer Use Only

Prior C/O Year

Net Operating Loss + + + + + + + + + + + + + + + + +

1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014

89

AMT NOL [1] [2] [3] [4] [5] [6] [7] [8] [9] [10] [11] [12] [13] [14] [15] [16] [17]

+ + + + + + + + + + + + + + + + +

[18] [19] [20] [21] [22] [23] [24] [25] [26] [27] [28] [29] [30] [31] [32] [33] [34]

NOTES/QUESTIONS:

Control Totals+

Form ID: NOLCO

Form ID: History

90

Tax Return History

This page has been prepared to present the details of prior year income tax returns and is provided for informational purposes only. 2011 Amounts

2012 Amounts

2013 Amounts

2014 Amounts

% %

% %

% %

% %

Filing Status (1 = Single, 2 = MFJ, 3 = MFS, 4 = HOH, 5 = QW)

Salaries and wages Interest income Tax‐exempt interest Dividend income Qualified dividends Business income/loss Capital gains and losses Other gains and losses IRA distributions, pensions, annuities Rent, royalty, farm rental income Partnership/S corp income Estate or trust income Farm income/loss Other income/loss Total income ‐ Total adjustments to income Adjusted gross income ‐ Medical expenses State and local taxes Interest expenses Charitable contributions Other itemized deductions Allowable itemized deductions Standard deduction Standard or itemized deduction taken ‐ Exemptions Taxable income ‐ Tax on taxable income Alternative minimum tax Total credits Net tax liability ‐ Self‐employment taxes Other taxes Total tax ‐ Income tax withheld Estimated tax payments Other payments Total payments ‐ Tax due/‐refund ‐ Penalties and interest Net tax due/‐refund ‐ Refund applied to estimated tax payments Refund received Marginal tax rate ‐ Effective tax rate ‐

NOTES/QUESTIONS:

Form ID: History

GENERAL INFORMATION General: 1040

Personal Information

Filing (Marital) status code (1 = Single, 2 = Married filing joint, 3 = Married filing separate, 4 = Head of household, 5 = Qualifying widow(er)) Mark if you were married but living apart all year Mark if your nonresident alien spouse does not have an ITIN Taxpayer Spouse Social security number First name Last name Occupation Designate $3.00 to the presidential election campaign fund? (1 = Yes, 2 = No, 3=Blank) Mark if legally blind Mark if dependent of another taxpayer Taxpayer between 19 and 23, full‐time student, with income less than 1/2 support? (Y, N) Date of birth Date of death Work/daytime telephone number/ext number Do you authorize us to discuss your return with the IRS (Y, N) General: 1040, Contact

Present Mailing Address

Address Apartment number City/State postal code/Zip code Foreign country name Home/evening telephone number Taxpayer email address Spouse email address General: 1040

Dependent Information

First Name

Credits: 2441

Last Name

Date of Birth

Social Security No.

Relationship

Care Months expenses in paid for home dependent

Child and Dependent Care Expenses

Provider information: Business name First and Last name Street address City, state, and zip code Social security number OR Employer identification number Tax Exempt or Living Abroad Foreign Care Provider (1 = TE, 2 = LAFCP) Amount paid to care provider in 2015

Taxpayer

Spouse

Employer‐provided dependent care benefits that were forfeited General: Info

Direct Deposit/Electronic Funds Withdrawal Information If you would like to have a refund deposited directly or a balance due debited directly into/from your bank account, please enter the following information:

Financial institution: Routing transit number Name Your account number Type of account (1 = Savings, 2 = Checking, 3 = IRA*) If you would like to use a refund to purchase U.S. Series I Savings bonds (in increments of $50), enter a maximum amount (up to $5,000).** *Refunds may only be direct deposited to established traditional, Roth or SEP‐IRA accounts. Make sure direct deposits will be accepted by the bank or financial institution. **To purchase U.S. Series I Savings bonds in someone else's name, please contact our office.

Lite‐1

GENERAL INFORMATION

W‐2/1099‐R/K‐1/W‐2G/1099‐Q Income: W2

Salary and Wages

Please provide all copies of Form W‐2 that you receive. Below is a list of the Form(s) W‐2 as reported in last year's tax return. If a particular W‐2 no longer applies, mark the not applicable box. T/S

Income: 1099R


Description

Mark if no longer applicable

Pension, IRA, and Annuity Distributions

Please provide all copies of Form 1099‐R that you receive. Below is a list of the Form(s) 1099‐R as reported in last year's tax return. If a particular 1099‐R no longer applies, mark the not applicable bo T/S


Description

Income: K1, K1T


Schedules K‐1

Please provide all copies of Schedule K‐1 that you receive. Below is a list of the Schedule(s) K‐1 as reported in last year's tax return. If a particular K‐1 no longer applies, mark the not applicable box T/S/J

Description

Income: W2G


Form

Gambling Income

Please provide all copies of Form W‐2G that you receive. Below is a list of the Form(s) W‐2G as reported in last year's tax return. If a particular W‐2G no longer applies, mark the not applicable box T/S

Educate: 1099Q

Description



Qualified Education Plan Distributions

Please provide all copies of Form 1099‐Q that you receive. Below is a list of the Form(s) 1099‐Q as reported in last year's tax return. If a particular 1099‐Q no longer applies, mark the not applicable b T/S

Description


Lite‐2


W‐2/1099‐R/K‐1/W‐2G/1099‐Q

INCOME SUMMARY

Income Summary Below is a list of the forms as reported in last year's tax return. Please provide copies of all of the forms you received. To indicate which forms are attached, enter a "1" for attached in the field provided next to the Description. To indicate which forms are not applicable, enter a "2" for not applicable (N/A) in the field provided next to the Description. Otherwise, leave this field blank. Form

T/S/J

1 = Attached 2 = N/A

Description

Lite‐2

INCOME SUMMARY

INTEREST/DIVIDENDS/CAPITAL GAINS/OTHER INCOME Income: B1

Interest Income Please provide all copies of Form 1099‐INT or other statements reporting interest income. Interest Prior Year Income Information Payer Name

T/S/J

Income: B3

Seller Financed Mortgage Interest

T, S, J Payer's name Payer's address, city, state, zip code Amount received in 2015

Payer's social security number Amount received in 2014

Income: B2

Dividend Income Please provide copies of all Form 1099‐DIV or other statements reporting dividend income.

T/S/J

Ordinary Dividends

Payer Name

Income: D

Qualified Dividends


Sales of Stocks, Securities, and Other Investment Property Please provide copies of all Forms 1099‐B and 1099‐S.

T/S/J

Description of Property

Income: Income

Date Acquired

Date Sold

Gross Sales Price (Less expenses of sale)

Cost or Other Basis

Other Income Please provide copies of all supporting documentation. 2015 Information

State and local income tax refunds

Taxpayer

Spouse

Prior Year Information Prior Year Information

Alimony received Unemployment compensation Unemployment compensation repaid Social security benefits Medicare premiums to be reported on Schedule A Railroad retirement benefits

T/S/J

2015 Information


Other Income:

Lite‐3

INTEREST/DIVIDENDS/CAPITAL GAINS/OTHER INCOME

ADJUSTMENTS/EDUCATE 1040 Adj: IRA

Adjustments to Income ‐ IRA Contributions

Please provide year end statements for each account and any Form 8606 not prepared by this office. Taxpayer Spouse Traditional IRA Contributions for 2015 ‐ If you want to contribute the maximum allowable traditional IRA contribution amount, enter the applicable code: (1 = Deductible only, 2 = Both deductible and nondeductible) Enter the total traditional IRA contributions made for use in 2015 Roth IRA Contributions for 2015 ‐ Mark if you want to contribute the maximum Roth IRA contribution Enter the total Roth IRA contributions made for use in 2015 Educate: Educate2

Higher Education Deductions and/or Credits

Complete this section if you paid interest on a qualified student loan in 2015 for qualified higher education expenses for you, your spouse, or a person who was your dependent when you took out the loan. T/S

Qualified student loan interest paid

2015 Information


Complete this section if you paid qualified education expenses for higher education costs in 2015. Qualified education expenses include tuition and fees required for enrollment or attendance at an eligible educational institution. Please provide all copies of Form 1098‐T. Ed Exp Prior Year T/S Code* Student's SSN Student's First Name Student's Last Name Qualified Expenses Information

*Education Expense Code: 1 = American opportunity credit; 2 = Lifetime learning credit; 3 = Tuition and fees deduction The student qualifies for the American opportunity credit when enrolled at least half‐time in a program leading to a degree, certificate, or recognized credential; has not completed the first 4 years of post‐secondary education; has no felony drug convictions on student's record. 1040 Adj: 3903

Job Related Moving Expenses

Complete this section if you moved to a new home because of a new principal work place. Description of move Taxpayer/Spouse/Joint (T, S, J) Mark if the move was due to service in the armed forces Number of miles from old home to new workplace Number of miles from old home to old workplace Mark if move is outside United States or its possessions Transportation and storage expenses Travel and lodging (not including meals) Total amount reimbursed for moving expenses 1040 Adj: OtherAdj

Alimony Paid: T/S

Other Adjustments to Income Recipient name

Recipient SSN

2015 Information


Street address City, State and Zip code

Taxpayer

Spouse


Educator expenses:

Other adjustments:

Lite‐4

ADJUSTMENTS/EDUCATE

ITEMIZED DEDUCTIONS Itemized: A1

Medical and Dental Expenses

T/S/J

2015 Information


Medical and dental expenses Medical insurance premiums you paid*** Long‐term care premiums you paid*** Prescription medicines and drugs Miles driven for medical items ***Do not include pre‐tax amounts paid by an employer‐sponsored plan, amounts paid for your self‐employed business, or Medicare premiums entered on Form Lite‐3 Itemized: A1

Tax Expenses

T/S/J

2015 Information


2015 Information


State/local income taxes paid 2014 state and local income taxes paid in 2015 Sales tax paid on actual expenses Real estate taxes paid Personal property taxes Other taxes Itemized: A2

Interest Expenses

T/S/J Home mortgage interest From Form 1098

T/S/J

Other home mortgage interest paid to individuals: Payee's Name

SSN or EIN

Address

2015 Information City

T/S/J

Prior Year Information State

2015 Information

Zip Code


Investment interest expense, other than on Sch K‐1s: Refinancing Information: T/S/J Recipient/Lender name Total points paid at time of refinance Date of refinance Term of new loan (in months) Reported on Form 1098 in 2015

Refinance #1

Itemized: A3

Refinance #2


T/S/J

2015 Information


2015 Information


Lite‐5

ITEMIZED DEDUCTIONS

Contributions made by cash or check Volunteer miles driven Noncash items, such as: Goodwill, Salvation Army Itemized: A3

Miscellaneous Deductions

T/S/J Unreimbursed expenses Union dues Tax preparation fees Other expenses, subject to 2% AGI limitation:

Safe deposit box rental Investment expenses, other than on Schedule(s) K‐1 or Form(s) 1099‐DIV/INT Other expenses, not subject to the 2% AGI limitation: Gambling losses (enter only if you have gambling income)

Form ID: OrgDp

91

Depreciation ‐ Asset List Preparer use only

Activity name

HOW TO REPORT DISPOSALS: Use the blank line directly below the asset information to indicate any asset disposals. Enter the date of the disposal and/or sale proceeds, if applicable. Enter additional information regarding the asset disposal in the comments section, such as if the asset was sold on installment, traded for other asset(s), disposed of due to casualty, or sold to a related party. See the EXAMPLE asset below. Asset No.

EXAMPLE

Description of Property Comments Machinery and equipment (EXAMPLE ASSET) Collected in 5 equal payments over 2 yrs

Date in Service Date Sold/Disposed

11/21/09 03/09/15

Cost or Basis Sales Price

42,500 20,000

Form ID: OrgDp

Form ID: OrgDp2

92

Depreciation ‐ Asset Acquisitions Preparer use only

Activity name

Use the comments section to provide additional information about the asset. Enter information such as vehicle mileage (total, commuting and business), the total and business square footage of home, home expenses (total and business portion). See the EXAMPLE asset below.

EXAMPLE 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25

Comments:

Description of Asset Acquired 2015 Model T ‐ (EXAMPLE ASSET) 22,500 job‐related miles, 25,000 total miles

Date Acquired 03/09/15

Cost or Basis 25,750

Comments: Comments: Comments: Comments: Comments: Comments: Comments: Comments: Comments: Comments: Comments: Comments: Comments: Comments: Comments: Comments: Comments: Comments: Comments: Comments: Comments: Comments: Comments: Comments: Comments:

Form ID: OrgDp2

Form ID: AL

Alabama General Information

If you moved during the tax year, name of Alabama city moved to If divorced during the tax year, enter former spouse's social security number If you did not file a prior year Alabama tax return, enter reason:

[1]

Zip code

[2] [3] [4]

Contributions Enter the amount of contributions you wish to make:

Political Contributions Taxpayer Election campaign fund contribution ($1.00) (1 = Democratic party fund, 2 = Republican party fund)

Spouse [6]

[5]

Charitable Contributions Senior Services Trust Fund Arts Development Fund Nongame Wildlife Fund Child Abuse Trust Fund Veterans Program Historic Preservation Fund Archives Services Fund Foster Care Trust Fund Mental Health

[14]

Firefighters Benefit Fund Breast and Cervical Cancer Program Victims of Violence Assistance Military Support Foundation Spay‐Neuter Program Cancer Research Institute Association of Rescue Squads USS Alabama Battleship Commission

[15]

Children First Trust Fund

[7] [8] [9] [10] [11] [12] [13]

[16] [17] [18] [19] [20] [21] [22] [23] [24]

Part‐year Resident and Nonresident Information If you were a part‐year resident during the tax year, enter the dates you lived in Alabama Part‐year residency dates: From To If a nonresident of Alabama, enter state of legal residence

[25] [26] [27]

Credits Basic Skills Education Credit: Dept of Education certification number Name of sponsoring employer or firm Name of approved provider Location of provider Total expenses Rural Physician Credit: Hospital where services provided Community where services provided

[28] [29] [30] [31] [32] [33] [34]

NOTES/QUESTIONS:

Form ID: AL

Form ID: AZ

Arizona General Information

Last name on prior returns, if different

[1]

If you were a part‐year resident during the tax year, enter the dates you lived in Arizona Part‐year residency dates: From To Other state(s) of residency (Part‐year residents only) [4] [5] Mark if on active military assignment in Arizona during the year (Part‐year residents and Nonresidents only)

[2] [3] [6]

[7] [8]

Contributions Amount of political and charitable contributions you wish to make to:

Political Contributions Political gift Name of party (1 = American Electorate, 2 = Arizona Green Party, 3 = Democratic, 4 = Libertarian, 5 = Republican)

[9] [10]

Charitable Contributions Solutions Teams Assigned to Schools Arizona Wildlife Fund Child Abuse Prevention Fund Domestic Violence Shelter Fund Neighbors Helping Neighbors Fund Special Olympics Fund Veterans Donation Fund I Didn't Pay Enough Fund Sustainable State Parks and Road Fund

[11] [12] [13] [14] [15] [16] [17] [18] [19]

Property Tax Credit Information Full Year Residents Only Homestead status on December 31 (1 = Rent, 2 = Own) Mark if you: Received Title 16, SSI payments Lived alone Property taxes paid through rent payments If claimed as a dependent on another's return, enter claimant's information: Name Social security number [26] Address City [28] State [29] Zip code Income earned by other household residents

[20] [21] [22] [23] [24] [25]

Apartment number

[27]

[30] [31]

NOTES/QUESTIONS:

Form ID: AZ

Form ID: AR

Arkansas General Information

Taxpayer deaf Spouse deaf Early childhood program ‐ certificate number State political contribution

[1] [2] [3] [4]

Taxpayer Contributions to a long‐term intergenerational trust

Spouse [5]

[6]

Contributions Amount of charitable contributions you wish to make to: Disaster Relief Program Game and Fish Foundation School for the Blind and Deaf Baby Sharon's Children Catastrophic Illness Program Organ Donor Awareness Education Program Area Agency on Aging Military Family Relief Newborn Umbilical Cord Blood Initiative

[7] [8] [9] [10] [11] [12] [13] [14]

Part‐year Resident and Nonresident Information If you were a part‐year resident during the tax year, enter the dates you lived in Arkansas Part‐year residency dates: From To State of residency if nonresident of Arkansas

[15] [16] [17]

NOTES/QUESTIONS:

Form ID: AR

Form ID: CA

California General Information

Prior year last name Taxpayer Spouse Mark if different from prior year return: Social security number(s) Address Filing status

[1] [2] [3] [4] [5]

Use Tax Item purchased

Purchase price

County (City)

Sales Tax paid [6]

Contributions Amount of contributions you wish to make to: School Supplies for Homeless Children Fund Seniors Special Fund [7] Parks Pass Purchase ($195) Alzheimer's Disease/Related Disorders Fund [8] State Parks Protection Fund Rare and Endangered Species Preservation Program [9] Breast Cancer Research Fund [10] Protect Our Coast and Oceans Fund [11] Keep Arts in Schools Fund Firefighters' Memorial Fund . . . . . . . . . . . . . . . . . . . . . . . . Emergency Food for Families Fund [12] California Senior Legislature Fund Peace Officer Memorial Foundation Fund [13] Habitat for Humanity Fund Sea Otter Fund [14] California Sexual Violence Victim Services Cancer Research Fund [15] Children's Trust Fund ‐ Prevent Child Abuse Child Victims of Human Trafficking Fund [16] Prevention Animal Homelessness & Cruelty

[17] [18] [19] [21] [22] [23] [24] [25] [26] [27]

Renter Information Number of months rented principal residence in California in 2015 Lived with person claiming dependency exemption for more than 6 months (Dependent of another only) Property rented was exempt from property tax in 2015 Taxpayer claimed homeowner's property tax exemption in 2015 Spouse claimed homeowner's property tax exemption during 2015 Maintained separate residencies for the entire year Addresses if more than one or different from mailing address Address City State Zip Code Date Rented From Date Rented To

[28] [29] [30] [31] [32] [33] [34]

Landlord information Name Address City State Zip Code Telephone

[35]

NOTES/QUESTIONS: Form ID: CA

Form ID: CA2

California Residency Information Part‐year, Nonresident Taxpayer

Spouse [1]

[2]

[3]

[4]

[5]

[6]

Date moved into California Prior state of residence

[7]

[9]

[8]

[10]

Date moved out of California New state of residence

[11]

[13]

[12]

[14]

[15]

[16]

State of domicile Number of days spent in California Owned California home or property Part‐year resident:

Nonresident or full‐year resident for entire year: State of residence

Prior Year Residency Information Taxpayer Prior residency information: From To

Spouse [17]

[19]

[18]

[20]

Military Personnel Part‐year, Nonresident Taxpayer

Spouse [21]

State in which stationed

[22]

Electronic Filing Information for Military Taxpayer Date deployed overseas or entered combat zone/QHDA Date returned from overseas or combat zone/QHDA Duty (A = Military overseas, B = Combat Zone/QHDA, C = NAT Guard) Combat Zone/QHDA Operation/Area served Taxpayer Spouse

Spouse [23]

[26]

[24]

[27]

[25]

[28] [29] [30]

NOTES/QUESTIONS:

Form ID: CA2

Form ID: CO

Colorado Contributions

Amount of charitable contributions you wish to make to: Nongame and Endangered Wildlife Fund Domestic Abuse Fund Homeless Prevention Activities Fund Western Slope Military Veterans Cemetery Fund Pet Overpopulation Fund Colorado for Healthy Landscapes Fund American Red Cross Colorado Disaster Response, Readiness, and Preparedness Fund Military Family Relief Fund Habitat for Humanity of Colorado Fund Special Olympics of Colorado 9Health Fair Fund Round Up River Ranch Fund Colorado Youth Corps Association Fund Public Education Fund

[1] [2] [3] [4] [5] [6] [8] [9] [10] [11] [12] [13] [14] [15]

Part‐year Resident and Nonresident Information If you were a part‐year resident during the tax year, enter the dates you lived in Colorado Taxpayer Spouse Residency status (If taxpayer and spouse are different): Resident Nonresident Part‐year resident Military nonresident Part‐year residency dates: From To

[16]

[17]

[18]

[19]

[20]

[21]

[22]

[23]

[24]

[26]

[25]

[27]

NOTES/QUESTIONS:

Form ID: CO

Form ID: CT

Connecticut Charitable Contributions

AIDS Research Organ Transplant Endangered Species/Wildlife Fund Breast Cancer Research

Amount of contributions you wish to make to: [1] Safety Net Services [2] Military Relief [3] CHET Baby Scholar

[5] [6] [7]

[4]

Use Tax Information Use Tax‐Enter any out‐of‐state purchases made on which sales tax was not paid to the seller: Purchase 1 Description Date of purchase Retailer/Service Provider: Purchase price Type Code: Out of state tax paid Purchase 2 Description Date of purchase Retailer/Service Provider: Purchase price Type Code: Out of state tax paid

[8]

Use Tax Type Codes 1 = Computer & data processing services 2 = General sales tax

3 = Luxury items

Property Tax Information Enter property taxes paid on primary residence and/or motor vehicle: Primary Residence Description (Enter street address)(Resident only) Auto 1 Description (Enter year, make and model)(Resident only) Auto 2 Description (Enter year, make and model)(MFJ Resident only) Name of CT Tax Town or District Primary Residence (Resident only) Auto 1 (Resident only) Auto 2 (MFJ Resident only)

[9] [10] [11]

Date Paid

Date Paid

Amount Paid

[12]

[13]

[14]

[15]

[16]

[17]

[18]

[19]

[20]

[21]

[22]

Part‐year Resident Information If you were a part‐year resident during the tax year, enter the dates you lived in Connecticut: Taxpayer Spouse Enter residency dates: From To Indicate type of move (1 = Moved into Connecticut, 2 = Moved out of Connecticut) Did you earn income from Connecticut sources during nonresident period? (Y, N) State of prior or new residence

[23]

[25]

[24]

[26]

[27]

[30]

[28]

[31]

[29]

[32]

Enter the following amounts only if you do NOT know the exact amount of your Connecticut source information Basis for calculating apportionment (1 = Working days, 2 = Sales, 3 = Mileage) Working days (or other basis) outside Connecticut Working days (or other basis) inside Connecticut Nonworking days (holidays, weekends, etc) Total income being apportioned

[33] [34] [35] [36] [37]

NOTES/QUESTIONS:

Form ID: CT

Form ID: DE

Delaware General Information Taxpayer

Mark if totally disabled Volunteer firefighter Fire Company number (Resident only)

Spouse [1]

[2]

[3]

[4]

Contributions Amount of contributions you wish to make to: Taxpayer Non‐Game Wildlife US Olympics Emergency Housing Breast Cancer Education Organ Donations Diabetes Education Veteran's Home Delaware National Guard Juvenile Diabetes Fund Multiple Sclerosis Society Ovarian Cancer Fund 21st Fund for Children White Clay Creek Home of the Brave Senior Trust Fund Veteran's Trust Fund Protecting Delaware's Children Fund

Spouse [5]

[6]

[7]

[8]

[9]

[10]

[11]

[12]

[13]

[14]

[15]

[16]

[17]

[18]

[19]

[20]

[21]

[22]

[23]

[24]

[25]

[26]

[27]

[28]

[29]

[30]

[31]

[32]

[33]

[34]

[35]

[36]

[37]

[38]

Part‐year Resident Information If you were a part‐year resident during the tax year, enter the dates you lived in Delaware Taxpayer Part‐year residency dates: [39] From [40] To

Spouse [41] [42]

NOTES/QUESTIONS:

Form ID: DE

Form ID: DC

District of Columbia Property Tax Credit Information

If renting, enter rental information below (Residents only) Type of property (1 = Private home, 2 = Apartment, 3 = Rooming house, 4 = condominium) Landlord's name Landlord's address (Number and street)

[1] [2] [3] [4]

Apartment number City State Zip code Landlord's telephone number Rent paid Rent supplements received

[5] [6] [7] [8] [9] [10] [11]

If property owner, enter real property information below Square number Suffix number Lot number

[12] [13] [14]

Use Tax Purchases subject to use tax Merchandise, services and rentals Alcoholic beverages Catered food or drink or rental of non‐commercial vehicles Not applicable

[15] [16] [17] [18]

Contribution Amount of contribution you wish to make to: DC Statehood Delegation Fund (Political Contribution) Public Trust for Drug Prevention and Children at Risk (Charitable Contribution) Anacostia River Cleanup and Prevention Fund (Charitable Contribution)

[19] [20] [21]

Part‐year Resident Information If you were a part‐year resident during the tax year, enter the dates you lived in the District of Columbia Part‐year residency dates: From

[22] [23]

To

Disability Information Name of Employer Taxpayer Spouse Mark if physician's certification previously filed Otherwise, enter: Physician's name Address, apartment number City, state, zip code Telephone number

Payer, if other than employer

No. of Weeks

[24]

[25]

[26]

[27]

[28]

[29] [30]

[31]

[32]

[33] [34] [36]

[37]

[35] [38] [39]

NOTES/QUESTIONS:

Form ID: DC

Form ID: GA

Georgia General Information Taxpayer

If disabled, enter the following: Type of disability Date of disability

Spouse [1]

[2]

[3]

[4]

Contributions Amount of contributions you wish to make to: [5]

Wildlife Conservation Fund Fund for Children and Elderly Cancer Research Fund Land Conservation Program National Guard Foundation Dog and Cat Sterilization Fund Save the Cure Fund Realizing Educational Achievement Can Happen Program

[6] [7] [8] [9] [10] [11] [12]

Part‐year Resident Information If you were a part‐year resident during the tax year, enter the dates you lived in Georgia Taxpayer Part‐year residency dates: From To

Spouse

[13]

[15]

[14]

[16]

NOTES/QUESTIONS:

Form ID: GA

Form ID: HI

Hawaii General Information

Mark if first time filer Mark if address has changed from prior year If you (or spouse) are blind, deaf or totally disabled, has impairment been certified? (Special disability exemption: T = Taxpayer, S = Spouse, B = Both) Current year distributions from an individual housing account not used for home purchase Reservist or National Guard pay included in W‐2 income Payments to an individual housing account

[1] [2] [3] [4] [5] [6]

Contributions Amount of contributions you wish to make to: Election campaign fund ‐ taxpayer (Y, N) Election campaign fund ‐ spouse (Y, N) $2 School‐Level Minor Repairs and Maintenance Special Fund (T = Taxpayer, S = Spouse, B = Both) $2 Public Libraries Special Fund (T = Taxpayer, S = Spouse, B = Both) $5 Children's Trust, Domestic Violence, and Abuse Special Accounts (T = Taxpayer, S = Spouse, B = Both)

[7] [8] [9] [10] [11]

Rental Credit Information Rental credits can only be claimed by persons with Hawaii residence of 9 or more months during the calendar year [12] Residence Information: Starting Month of Occupancy Ending Month of Occupancy Address City State Zip Owner Information: Name Business Name Address City State Zip Foreign Providence/State Foreign Country Code Foreign Country Foreign Postal Code Tax ID # Total rents received for this unit

Part‐year Resident Information If you were a part‐year resident during the tax year, enter the dates you lived in Hawaii Part‐year residency dates: From To

[13] [14]

NOTES/QUESTIONS:

Form ID: HI

Form ID: ID

Idaho General Information

Mark if: Tax forms, instructions and booklet needed Taxpayer or spouse is a disabled veteran Receiving Idaho Public Assistance

[1] [2] [3]

Taxpayer

Spouse

[4]

[5]

Number of days eligible for grocery credit if less than full year or total time spent as part year resident

Use Tax Purchases subject to use tax

[6]

Contributions Amount of charitable contributions you wish to make to: Nongame Wildlife Conservation Fund Children's Trust Fund and Child Abuse Prevention Special Olympics Idaho Idaho Guard and Reserve Family Support Fund American Red Cross of Greater Idaho Fund Veterans Support Fund Idaho Food Bank Opportunity Scholarship Program Fund Donate grocery credit to the Cooperative Welfare Fund

[7] [8] [9] [10] [11] [12] [13] [14] [15]

Part‐year Resident and Nonresident Information If you were a part‐year resident during the tax year, enter the dates you lived in Idaho Taxpayer Residency status (1 = Resident, 2 = Resident on active military, 3 = Nonresident, 4 = Part‐year resident, 5 = Military nonresident) Part‐year residency dates: From To State of residence

Spouse

[16]

[17]

[18]

[20]

[19]

[21]

[22]

[23]

Adjustments and Credits Energy efficiency upgrades Adoption expenses Mark if taxpayer or spouse has a developmental disability (T = Taxpayer, S = Spouse, B = Both)

[24] [25] [26]

NOTES/QUESTIONS:

Form ID: ID

Form ID: IL

Illinois General Information Use Tax

General merchandise purchases Qualifying food, non‐prescription drugs and medical appliances purchases Sales tax already paid to another state

[1] [2] [3]

Contributions Wildlife Preservation Child Abuse Prevention Alzheimer's Disease Research Assistance to the Homeless

Amount of contributions you wish to make to: Cancer Research [4] [5] Military Family Relief Diabetes Research Fund [6]

[8] [9] [10]

[7]

Credits Qualified Education Expenses Child's Name

Grade

School Name

Total Tuition, Books, Lab fees

School City

[11]

[12]

[13]

[14]

[16]

[17]

[18]

[19]

[15] [20]

[21]

[22]

[23]

[24]

[25]

[26]

[27]

[28]

[29]

[30]

[31]

[32]

[33]

[34]

[35]

[36]

[37]

[38]

[39]

[40]

[41]

[42]

[43]

[44]

[45]

[46]

[47]

[48]

[49]

[50]

Property Taxes Description

Property Index Number [51]

Part‐year Resident and Nonresident Information If you were a part‐year resident during the tax year, enter the dates you lived in Illinois Taxpayer Part‐year residency dates: From To Mark if you were a resident of any of the following states during the tax year:

IA

[56]

In what states other than above did you reside and/or file a tax return during the tax year? State postal code State postal code State postal code State postal code State postal code State postal code State postal code State postal code State postal code State postal code State postal code State postal code

KY

[57]

Spouse [52]

[54]

[53]

[55]

MI

[58]

WI

[60]

NOTES/QUESTIONS:

Form ID: IL

[59]

Form ID: IN

Indiana General Information

School corporation name (as of January 1 of tax year) School corporation code (as of January 1 of tax year)

[1] [2]

Taxpayer County of residence (as of January 1 of tax year) County of employment (as of January 1 of tax year) Household employment taxes: Employee Name Income County Tax Withheld

Spouse

[3]

[4]

[5]

[6]

Employee SSN State Tax Withheld County Code

[7]

Contributions Amount of contribution you wish to make to: Nongame Wildlife Fund Public K‐12 Education Fund

[8] [9]

Credit for Donation to an Indiana College or University Mark this field if you made a cash or noncash contribution to an Indiana college or university

[10]

Renter's Information Taxpayer, Spouse, Joint (T,S,J) Number of months rented

Principal address City, state, zip code Total rent paid

[11]

Landlord name Landlord address Landlord city, state, zip code

[12]

Part‐year Resident and Nonresident Information Enter the dates you lived in Indiana or in other states. Taxpayer State of residency (Use these fields if you or your spouse had only one state of residency) States of residency (Use these fields if you or your spouse had more than one state of residency) Taxpayer, Spouse(T,S) State Postal Code

Spouse

[13]

From Date

[14]

To Date [15]

NOTES/QUESTIONS:

Form ID: IN

Form ID: IA

Iowa General Information [1]

County of residence as of December 31st School district

[2]


Political Contribution Political checkoff (D = Democratic Party, R = Republican Party, C = Campaign Fund)

Spouse

Taxpayer

[3]

[4]

Charitable Contributions [5]

Fish and Wildlife Fund State Fairgrounds Renovation Firefighters Fund and Veterans Trust Fund Child Abuse Prevention

[6] [7] [8]

Residency Information [9]

Residency code

Residency Code Blank = Both spouses have the same residency status 4 = Taxpayer nonresident, spouse part‐year resident 1 = Taxpayer nonresident, spouse resident 5 = Taxpayer resident, spouse part‐year resident 2 = Taxpayer resident, spouse nonresident 6 = Taxpayer part‐year resident, spouse resident 3 = Taxpayer part‐year resident, spouse nonresident

Part‐year Resident Information If you were a part‐year resident during the tax year, enter the dates you lived in Iowa Spouse Part‐year residency dates: Moved into Iowa Moved out of Iowa

Taxpayer

[10]

[12]

[11]

[13]

Nonresident Information Illinois residents: Iowa wages or salary only Wages or salary and other Iowa source income

[14] [15]

NOTES/QUESTIONS:

Form ID: IA

Form ID: KS

Kansas General Information [1]

County of residence School district number Mark if name or address has changed

[2] [3]

Use Tax [4]

Use Tax due but receipts or records not available Purchases Subject to Use Tax, receipts or records are available

City/county

Amount [5]

Contributions Enter the amount of charitable contributions you wish to make to: Chickadee Checkoff Senior Citizens Meals On Wheels Contribution Program Breast Cancer Research Fund Military Emergency Relief Fund Kansas Hometown Heroes Fund Kansas Creative Arts Industry Fund

[6] [7] [8] [9] [10] [11]

Part‐year Resident Information If you were a part‐year resident during the tax year, enter the dates you lived in Kansas Part‐year residency dates: From To

[12] [13]

NOTES/QUESTIONS:

Form ID: KS

Form ID: KY

Kentucky General Information [1]

National Guard member ‐ taxpayer National Guard member ‐ spouse Enter your state of residency at the end of the tax year (Part‐year and Nonresident only)

[2] [3]

Use Tax Description

Date of Purchase

Amount

Enter any out‐of‐state purchases made on which sales tax was not paid to the seller

[4]


Political Contributions Political Party Fund (1 = Democratic, 2 = Republican, 3 = No Designation)

Spouse

Taxpayer

[5]

[6]


Nature and Wildlife Fund Child Victims' Trust Fund Veterans' Program Trust Fund Breast Cancer Research and Education Trust Fund Farms to Food Banks Trust Fund Local History Trust Fund

[8] [9] [10] [11] [12]

Part‐year Resident Information If you were a part‐year resident during the tax year, enter the dates you lived in Kentucky Part‐year residency dates: From To State moved from State moved to

[13] [14] [15] [16]

Nonresident Information Spouse Kentucky prior year income tax return was filed (Y, N) Mark if: Commuted daily to Kentucky employment (VA resident) All Kentucky wage income earned while a resident of a reciprocal state (indicate state(s) below) Resident of state(s) [23] [24] MI [25] OH Taxpayer IL IN [30] [31] [32] Spouse IL IN MI OH

[26] [33]

VA VA

Taxpayer

[17]

[18]

[19]

[20]

[21]

[22]

[27] WV [34] WV

[28]

WI

[29]

[35]

WI

[36]

NOTES/QUESTIONS:

Form ID: KY

Form ID: LA

Louisiana General Information

Mark if name has changed Credit for certain disabilities (B = Blind, D = Deaf, L = Loss of limb, M = Mentally incapacitated): Taxpayer Spouse Dependents: Code Disability First Name

[1] [2] [3]

SSN

Last Name

[4]

Value of computer or other technological equipment donated

[5]

Use Tax Enter the amount of any out‐of‐state purchases on which sales tax was not paid

[6]

Contributions Military Family Assistance Fund Coastal Protection and Restoration Fund SNAP Fraud and Abuse Detection/Prevention Wildlife Habitat and Natural Heritage Fund Louisiana Cancer Trust Fund Animal Welfare Commission Louisiana Food Bank Association Make‐A‐Wish of Texas Gulf Coast/Louisiana Louisiana Association of United Ways / 2‐1‐1 American Red Cross Dreams Come True START savings program:

[7] [8] [9] [10] [11] [12] [13] [14] [15] [16] [17]

Louisiana Coalition Against Domestic Violence Decorative Lighting ‐ Crescent City Connection Operations / Maintenance New Orleans Ferry National Guard Honor Guard for Military Funerals Bastion Community of Resilience Louisiana Youth Leadership Seminar Corporation Lighthouse for the Blind in New Orleans, Inc Louisiana Association for the Blind Louisiana Center for the Blind Affiliated Blind of Louisiana, Inc Louisiana State Troopers Charities, Inc

Account Description

[18] [19] [20] [21] [22] [23] [24] [25] [26] [27] [28]

Amount [29]

Part‐year Resident Information Taxpayer

Part‐year residency dates: From To

Spouse [30]

[32]

[31]

[33]

Retirement Information Taxpayer Date retired as a: Louisiana state employee Louisiana teacher Federal employee

Retirement System Name Other retirement information:

Spouse [34]

[35]

[36]

[37]

[38]

[39]

Taxpayer Spouse Date Retired [40]

Form ID: LA

Form ID: ME

Maine Use Tax

Calculate use tax using table (For purchases $999 if using table) Use tax already paid to another jurisdiction Casual rental income

[1] [2] [3] [4]

Contributions Political Contributions Contribute $3 ($6 if joint) to the Maine Clean Election Fund (1 = Taxpayer, 2 = Spouse, 3 = Joint)

[5]


Endangered and Nongame Wildlife Fund "Chickadee Check‐off" Maine Children's Trust Companion Animal Sterilization Fund Maine Military Family Relief Fund Maine Veterans' Memorial Cemetery Maintenance Fund Maine Public Library Fund

[7] [8] [9] [10] [11]

State Park Passes Number of individual park passes Number of vehicle passes

[12] [13]

Property Tax Fairness Credit Not required to file federal or Maine tax return (Filing for Property Tax Fairness only) Married filing separate but claiming credit of same homestead Physical street address if different from mailing address City, state, zip code [18] Property tax paid during 2015 (For home up to 10 acres less portion related to business use and special assessments) Rent paid for 2015 Social security disability / supplemental security income (If part‐year resident, enter portion received during residency) Does rent includes heat, utilities, furniture, snow plowing, etc. [24] Amount related to heat, etc. Landlord #1 name Landlord #1 phone number Landlord #2 name Landlord #2 phone number

[14] [15] [16]

[17] [20]

[19]

[21] [22] [23] [25] [26]

Part‐year Resident Information Taxpayer Part‐year residency dates: From To State where stationed State of prior residency Nonresident state of residence Number of days in Maine for any reason Maine property owners only: Municipality where owned, taxpayer Municipality where owned, spouse

Spouse [27]

[29]

[28]

[30]

[31]

[32]

[33]

[34]

[35]

[36]

[37]

[38] [39] [40]

NOTES/QUESTIONS:

Form ID: ME

Form ID: MD

Maryland General Information Taxpayer

County of residence City of residence

Spouse, if different [1]

[3]

[2]

[4]

Contributions Amount of charitable contributions you wish to make to: Chesapeake Bay and Endangered Species Fund Developmental Disabilities Waiting List Equity Fund Maryland Cancer Fund

[5] [6] [7]

Part‐year Resident and Nonresident Information If you were a part‐year resident during the tax year, enter the dates you lived in Maryland Part‐year residency dates: From To

[9]

State of legal residence (Other than Maryland)

[10]

If Maryland return filed for previous year, indicate type (Nonresident only) (1 = Resident, 2 = Nonresident) Mark if taxpayer or spouse in military (Nonresident only)

[11]

[8]

[12]

NOTES/QUESTIONS:

Form ID: MD

Form ID: MA

Massachusetts General Information

Mark if name and address have changed since last year Mark if noncustodial parent In care of address or address of legal residence or domicile: Street City, state, zip code

[1] [2] [3] [5]

[4]

[6]

Use Tax Estimate use tax for out of state purchases less than $1,000 Out of state purchases

[7] [8]

Sales tax paid to other state

[9]

Contributions Amount of political and charitable contributions you wish to make to: Taxpayer Mark to contribute to the State Election Campaign Fund Organ Transplant Fund Endangered Wildlife Conservation AIDS Fund

Spouse

[10] [12] [13] [14]

United States Olympic Fund Military Family Relief Fund Homeless Animal Prevention and Care Fund

[11] [15] [16] [17]

Adjustments and Deductions Rental Deduction Residence #1 rented address Landlord's name and address Date from

Date to

Rent paid

Residence #2 rented address Landlord's name and address Date from

Date to

Rent paid

[18]

Health Insurance Information Taxpayer Enrolled in Minimum Creditable Coverage (MCC) health insurance plan for entire year Federal identification number Subscriber number Name of insurance company (Taxpayer) Name of insurance company (Spouse)

Spouse [19]

[20]

[21]

[22]

[23]

[24] [25] [26]

Commuter Deduction Tolls paid through Fastlane

MBTA Transit/commuter passes

Taxpayer Spouse

[27] [28]

Part‐year Resident Information If you were a part‐year resident during the tax year, enter the dates you lived in Massachusetts Part‐year residency dates: From To

[29] [30]

NOTES/QUESTIONS: Form ID: MA

Form ID: MI

Michigan General Information

School district name School district code Mark if 2/3 income from seafaring

[1] [2] [3]

Taxpayer

Spouse

[4]

[5]

[6]

[7]

[8]

[9]

Do you want $3.00 to go to the state campaign fund? (Y, N) Mark the applicable boxes if the following conditions apply to you and/or your spouse: Paraplegic, quadriplegic or hemiplegic Totally and permanently disabled Deaf Qualified disabled veteran

[10]

[11]

[12]

[13]

Use Tax Purchases up $1000 per purchase subject to use tax Purchases exceeding $1000 per purchase subject to use tax

[14] [15]

Contributions Amount of charitable contribution you wish to make to: Contributions must be a minimum of $5, $10 or any amount greater than $10 [16] Children's Trust Fund ALS of Michigan Fund [17] Military Family Relief Fund Alzheimer's Association of Michigan Animal Welfare Fund [18] Special Olympics Michigan Children of Veterans Tuition Grant Program [19] United Way Fund

[20] [21] [22] [23]

Part‐year Resident Information If you were a part‐year resident during the tax year, enter the dates you lived in Michigan Taxpayer

Spouse

From

[24]

[26]

To Residency status of spouse (If different from taxpayer)(1 = Resident, 2 = Nonresident, 3 = Part‐year resident)

[25]

[27] [28]

NOTES/QUESTIONS:

Form ID: MI

Form ID: MI2

Michigan Credits ‐ Homestead Property Tax Credit Information Homeowner

[1] Homestead occupied entire tax year:Taxable value Special Assessments Homestead property taxes levied, if different from that entered on Organizer Form ID: A1 (or Lite‐5) TSJ Description

[3]

Amount [4]

Address at end of tax year, if different from that entered on Organizer Form ID: 1040 (or Lite‐1): Street address [5] Taxable value City Number of days occupied [6] State Zip code Property taxes levied for the year [7] [8] Address of homestead sold during tax year: Street address City State Zip code [14]

[12] [13] [19]

[9] [10] [11]

Taxable value Number of days occupied Property taxes levied for the year

[16] [17] [18]

Rental Information Rental #1 Address City

[19]

No. months Monthly rent

Mobile home

Zip code

Landlord #1 Name Address

City

Rental #2 Address City

State Zip Code No. months Monthly rent

Mobile home

Zip code

Landlord #2 Name Address

City

State Zip Code

Household Income

Enter amounts of nontaxable income received during the tax year by any member of your household Child support and foster parent payments Worker's compensation and Veteran's benefits Family Independence Agency and other public assistance payments Gifts or expenses paid on your behalf Other nontaxable income (inheritances, etc):

[20] [21] [22] [23] [24]

NOTES/QUESTIONS:

Form ID: MI2

Form ID: MI3

Michigan Cities General Information Taxpayer Spouse

Mark the applicable boxes if the following conditions apply to you and/or your spouse: Disabled Deaf

[1]

[2]

[3]

[4]

NOTES/QUESTIONS:

Form ID: MI3

Form ID: MN

Minnesota General Information

Mark if you or your spouse are disabled Welfare amounts received

[1] [2]


Political Contributions Taxpayer

Spouse

[3]

[4]

State campaign fund (Enter the appropriate code for the $5 political party contribution on Form M1 or Form M1PR from the list below)

Political Parties 11 = Republican 14 = Grassroots‐Legalize Cannabis Party 17 = Legalize Marijuana Now Party 12 = Democratic Farmer‐Labor 15 = Green Party of Minnesota 99 = General Campaign Fund 13 = Independent 16 = Libertarian

Charitable Contribution Nongame Wildlife Fund

[5]

Credits and Subtractions Long Term Care Insurance Credit Name of insurance company (Taxpayer) Name of insurance company (Spouse) Policy Number (Taxpayer) Policy Number (Spouse)

[6] [7] [8] [9]

K‐12 Education Expenses Child's Name

Grade

Class Fees

Textbook Material

Indiv Fees

Transport Costs

Hardware Software

Qualified Tuition

[10]

[11]

[12]

[13]

[14]

[15]

[16]

[17]

[18]

[19]

[20]

[21]

[22]

[23]

[24]

[25]

[26]

[27]

[28]

[29]

[30]

[31]

[32]

[33]

Child One Class name Class type Ind. instr name Ind. instr type Music ins type Musical ins cost Type of school attended Transp provider

Child Two

Child Three

[34]

[35]

[36]

[37]

[38]

[39]

[40]

[41]

[42]

[43]

[44]

[45]

[46]

[47]

[48]

[49]

[50]

[51]

[52]

[53]

[54]

[55]

[56]

[57]

M1PR Property Tax Credit Note: Please attach copies of your tax year CRP's and/or current year Property Tax Statements

Part‐year Resident and Nonresident Information If you were a part‐year resident during the tax year, enter the dates you lived in Minnesota Taxpayer Part‐year residency dates: From [58] To [59] Other state of residence (State/Foreign country required for other nonresidents) [62]

Spouse [60] [61] [63]

NOTES/QUESTIONS: Form ID: MN

Form ID: MS

Mississippi General Information

County of residence

[1]

Contributions Amount of contributions you wish to make to: Military Family Relief Fund Commission for Volunteer Service Fund Wildlife Heritage Fund Educational Trust Fund Wildlife Fisheries and Parks Foundation Bicentennial Celebration Fund Burn Care Fund

[2] [3] [4] [5] [6] [7] [8]

NOTES/QUESTIONS:

Form ID: MS

Form ID: MO

Missouri General Information

County of residence name County of residence

[1] [2]

Contributions Amount of contributions you wish to make to: Children's Trust Fund Veterans Trust Fund Elderly Home Delivered Meals Trust Fund Missouri National Guard Trust Fund Workers' Memorial Trust Fund Childhood Lead Testing Trust Fund Missouri Military Family Relief Trust Fund General Revenue Trust Fund Organ Donor Program Trust Fund Trust Fund Trust Fund

[3] [4] [5] [6] [7] [8] [9] [10] [11] [12]

[13]

[14]

[15]

Trust Fund Codes 15 = American Red Cross Trust Fund 01 = American Cancer Society 08 = March of Dimes 16 = Developmental Disabilities Waiting List Fund 02 = American Diabetes Association 09 = National Arthritis Foundation 03 = American Heart Association 10 = National Multiple Sclerosis Society17 = Puppy Projection Trust Fund 04 = American Lung Association 12 = Cervical Cancer Fund 18 = Pediatric Cancer Trust 05 = ALS (Lou Gehrig's Disease) 19 = Missouri National Guard Foundation Fund 13 = Breast Cancer Awareness 07 = Muscular Dystrophy Association 14 = Adoptive Parent's Recruitment and Retention

Part‐year Resident and Nonresident Information If you were a part‐year resident during the tax year, enter the dates you lived in Missouri Taxpayer Missouri residency dates: From To Other state residency dates: From To Other state of residency If your reason for residence in Missouri was to serve in the military, enter Missouri place of station: Taxpayer Spouse

Spouse

[16]

[17]

[18]

[19]

[20]

[21]

[22]

[23]

[24]

[25]

[26] [27]

Property Tax Information Residents only Mark if you are a 100% disabled veteran Mark if you are disabled per section 135.010(2), RSMo Mark if surviving spouse social security benefits were received during the tax year

[28] [29] [30]

NOTES/QUESTIONS:

Form ID: MO

Form ID: MT

Montana Contributions Amount of contributions you wish to make to: Taxpayer

Nongame Wildlife Program Child Abuse and Neglect Prevention Program Agriculture in Montana Schools Program Montana Military Family Relief Fund Political Contributions

Spouse [1]

[2]

[3]

[4]

[5]

[6]

[7]

[8]

[9]

[10]

Part‐year Resident Information If you were a part‐year resident during the tax year, enter the dates you lived in Montana Part‐year residency dates: From To

[11] [12]

State moved to State moved from

[13] [14]

Elderly Homeowner or Renter Credit Please provide copies of property tax bills Mark if owned or rented a Montana residence for 6 months or more during the current tax year Taxpayer, Spouse, Joint Rent paid

[15] [16] [17]

NOTES/QUESTIONS:

Form ID: MT

Form ID: NE

Nebraska General Information

County of residence Public school district

[1] [2]

Contributions Amount of charitable contributions you wish to make to: Wildlife Conservation Fund

[3]

Part‐year Resident Information If you were a part‐year resident during the tax year, enter the dates you lived in Nebraska Part‐year residency dates: From To

[4] [5]

NOTES/QUESTIONS:

Form ID: NE

Form ID: NH

New Hampshire General Information Taxpayer

Mark if disabled on the last day of the tax year

[1]

Spouse [2]

DP‐10 Name change since last filing

[3]

Part‐year Resident Information If you were a part‐year resident during the tax year, enter the dates you lived in New Hampshire From To

[4] [5]

Business Tax Summary Mark to indicate final return

[6]

NOTES/QUESTIONS:

Form ID: NH

Form ID: NJ

New Jersey General Information

County or Municipality code In care of address Mark if: Tax forms, instructions and booklet are not needed You are not eligible for the property tax deduction or credit You maintain the same residence as your spouse (Married filing separate returns ONLY)

[1] [2] [3] [4] [5]

Taxpayer Mark if: Contributed to the Social Security Fund (Eligible to receive benefits) You want to designate $1 to the gubernatorial election campaign fund Use tax due on out‐of‐state purchases (Resident and part‐year residents)

Spouse

[6]

[7]

[8]

[9] [10]

Contributions Amount of contribution you wish to make to: Endangered Wildlife Fund Breast Cancer Research Fund [11] Children's Trust Fund to prevent child abuse USS New Jersey Educational Museum Fund [12] New Jersey Vietnam Veterans' Memorial Fund Other (see codes below) [13]

01 = Drug Abuse Ed 02 = Korean Veterans' 03 = Organ Donor 04 = AIDS Services 05 = Literacy Vol 06 = Prostate Cancer

[14] [15] [16]

[17]

Other Funds 13 = NJ National Guard State Family19 = NJ Farm to School / School Garden 07 = World Trade Center 20 = Local Library Support 14 = American Red Cross NJ 08 = Veterans Haven Support 15 = Girl Scouts Council in NJ 21 = ALS Association Support 09 = Community Food Pantry 10 = Cat and Dog Spay and Neuter16 = Homeless Veterans Grant 17 = The Leukemia and Lymphoma ‐ NJ 11 = Lung Cancer Research 18 = Northern NJ Veterans Memorial Cemetery Development 12 = Boys and Girls Club

Property Information For principal residences owned or rented in New Jersey during the tax year, enter address information

Homeowner Information: Street City Block number Qualifier number (Condos) Your share of property owned Total property taxes paid (mobile home site fees) Co‐op or continuing care retirement facility resident

[18] [19] [20]

[21] [24] [26] [28] [30]

Lot number Mobile home park site # Number of days as an owner Share used as principal residence Your share of property taxes

[22]

[23] [25] [27] [29] [31]

Renter Information: Street Apt # Days as a tenant Total rent paid

[32] [33] [35] [37]

City Total number of tenants Your share of rent paid

[34] [36] [38]

Tenant Information: First name of other tenant Last name of other tenant

[39]

Middle initial of other tenant SSN of other tenant

Part‐year Resident and Nonresident Information If you were a part‐year resident during the tax year, enter the dates you lived in New Jersey Part‐year residency dates: From To State of residency (Nonresidents only)

[40] [41] [42]

Form ID: NJ

Form ID: NM

New Mexico General Information If you were a part‐year resident during the tax year, enter the dates you lived in New Mexico

First year resident

[1]

From Part‐year residency dates: Taxpayer Spouse Do NOT have a commercial domicile in New Mexico

To [2]

[3]

[4]

[5] [6]


Political Contributions Political party (1 = Democratic, 2 = Republican, 3 = Libertarian, 4 = Independent American, 5 = Constitution Party, 6 = Green Party)

Taxpayer [7]

Spouse [8]

Charitable Contributions Share with Wildlife Veteran's National Cemetery Fund Substance Abuse Education Fund Forest Re‐Leaf Program National Guard Member and Family Assistance Kids in Parks Education Program Amyotrophic Lateral Sclerosis Research Fund Vietnam Veterans' Memorial State Park Veterans' Enterprise Fund Lottery Tuition Fund Horse Shelter Rescue Fund Animal Care and Facility Fund Supplemental Senior Services

[9] [10] [11] [12] [13] [14] [15] [16] [17] [18] [19] [20] [21]

Additions and Deductions Income of an Indian Name of the taxpayer's Indian nation, tribe, or pueblo Name of the spouse's Indian nation, tribe, or pueblo Contributions refunded from the New Mexico approved Section 529 College Savings Plan

[22] [23] [24] [25]

Rebate and Credit Schedule Public assistance, AFDC, welfare benefits Supplemental security income (SSI) Amount of rent paid during the tax year on principal place of residence Mark if rent includes amount paid on your behalf by a government entity Resident county (1 = Los Alamos, 2 = Santa Fe)

[26] [27] [28] [29] [30]

NOTES/QUESTIONS:

Form ID: NM

New York General Information

Form ID: NY

Taxpayer Mark if you were a resident of New York City at any time during the current tax year Mark if you were a resident of Yonkers at any time during the current tax year County of residence School district

Spouse

[1]

[2]

[3]

[4] [5] [6]

Use Tax [7]

Use tax due but receipts or records not available

Contributions Amount of contributions you wish to make to: Volunteer Firefighting and EMS Recruitment Fund Return a Gift to Wildlife [8] Missing or Exploited Children Fund Teen Health Education [9] Breast Cancer Research Fund [10] Veterans Remembrance Alzheimer's Fund [11] Homeless Veterans [12] Mental illness anti‐stigma fund Olympic Fund (Maximum $2 per filer) Prostate and testicular cancer research and education fund [13] Women's cancer education and prevention fund 9/11 Memorial [14]

[15] [16] [17] [18] [19] [20]

Property Tax Credit Information Resident who lived six or more months in same taxable residence with market value $85,000 or less Mark if you lived in a nursing home and qualify for credit Enter amounts received for cash public assistance and relief Enter any other income not reported elsewhere Homeowners: Enter the amount of special assessments you and all qualified household members paid during the current tax year Enter the amount of taxes not paid due to the exemption for persons 65 or older under section 467 Tenants: Enter the total rent you and all members of your household paid during current tax year Rent includes charges for (Specify) 4 = Heat, gas, electricity, furnishings and board 3 = Heat, gas, electricity and furnishings

[21] [22] [23] [24] [25] [26] [27] [28]

2 = Heat, gas and electricity 1 = Heat or heat and gas

Part‐year Resident and Nonresident Information New York State

Taxpayer New York City Yonkers

Spouse New York City Yonkers

Part‐year residency dates: From [29] To [30] County of residence while a nonresident of New York City

[31]

[33]

[35]

[37]

[32]

[34]

[36]

[38] [40]

[39]

Nonresident Information for Apartment or Living Quarters Maintained in the State/City

Address #1 Mark if this address is still maintained by or for you Number of days in NYC Street address City, State and Zip code Is this address within city limits? Specify city (YON = Yonkers) Address #2 Mark if this address is still maintained by or for you Number of days in NYC Street address City, State and Zip code Is this address within city limits? Specify city (YON = Yonkers)

[41]

Form ID: NY

Form ID: NC

North Carolina General Information

County of residence

[1]

Contributions Amount of charitable contributions you wish to make to: Endangered Wildlife Fund Education Endowment Fund

[2] [3]

Part‐year Resident Information If you were a part‐year resident during the tax year, enter the dates you lived in North Carolina Taxpayer Spouse Part‐year residency dates: From [4] To [5]

[6] [7]

NOTES/QUESTIONS:

Form ID: NC

Form ID: ND

North Dakota General Information

School district code Income source code

[1] [2]

Income source code 1 = Farming, ranching 4 = Public, private education 7 = Manufacturing 10 = Finance, banking, insur 2 = Retail, wholesale trade5 = Personal, business services 8 = Communication, trnspn, utilities 11 = Military 3 = Government service 6 = Construction 9 = Gas, oil, coal 12 = Retirement

Contributions Amount of contributions you wish to make to: Watchable Wildlife Fund Trees for North Dakota Fund

[3] [4]

Part‐year Resident and Nonresident Information If you were a part‐year resident during the tax year, enter the dates you lived in North Dakota Taxpayer Spouse Part‐year residency dates: From [5] To [6] Other state of residency [9]

[7] [8] [10]

NOTES/QUESTIONS:

Form ID: ND

Form ID: OH

Ohio General Information

Enter your current Ohio county of residence School district number

[1] [2]

Use Tax Mark this field to certify no sales or use tax is due Purchases subject to use tax

[3] [4]


Political Taxpayer Contribution to Ohio political party fund?

Spouse [6]

[5]

Charitable Contributions Military injury relief fund Natural areas and endangered species fund Wildlife species and endangered wildlife Ohio Historical Society Breast and cervical cancer project

[7] [8] [9] [10] [11]

Credits Taxpayer

Spouse

Displaced worker training expenses for 12‐month period since loss of job Amount contributed to Ohio political campaigns

[12]

[13]

[14]

[15]

Part‐year Resident and Nonresident Information If you were a part‐year resident during the tax year, enter the dates you lived in Ohio Taxpayer Part‐year residency dates: From To

Spouse [16]

[18]

[17]

[19]

Taxpayer Residency status (If taxpayer and spouse are different) (R = Resident, P = Part‐year resident, N = Nonresident) If nonresident, enter state of residency If foreign, enter country of residency

Spouse

[20]

[21]

[22]

[23]

[24]

[25]

NOTES/QUESTIONS:

Form ID: OH

Form ID: OK

Oklahoma Use Tax

Mark if not subject to Use Tax

[1]

Contributions Amount of charitable contributions you wish to make to: Court Appointed Advocates [2] Lupus Revolving Fund National Guard Sports Eye Safety Program [3] Regional Food Banks Historic Greenwood District Music Festival Fund [4] [5] Domestic Violence and Sexual Assault Services Public School Classroom Support Fund Volunteer Fire Departments [6]

[7] [8] [9] [10]

Part‐year Resident and Nonresident Information If you were a part‐year resident during the tax year, enter the dates you lived in Oklahoma Part‐year residency dates: From To Nonresident state of residence [13] Nonresident country of residence Resident and part‐year or nonresident spouse: Taxpayer's residence Spouse's residence State postal code State postal code State postal code State postal code

[15]

Country code Country code Country code Country code

[16]

State postal code State postal code State postal code State postal code

[17]

Country code Country code Country code Country code

[11] [12] [14]

[18]

Property Tax and Sales Tax Credits Mark if you were not an Oklahoma resident for the entire tax year Mark if you (or spouse) were disabled for the entire tax year Home real estate tax Workmen's compensation/loss of time insurance Support money Cash public assistance

[19] [20] [21] [22] [23] [24]

NOTES/QUESTIONS:

Form ID: OK

Form ID: OR

Oregon General Information

Indicate if severely disabled (T = Taxpayer, S = Spouse, B = Both)

[1]

Taxpayer Number of months of federal service before 10/01/1991 (Federal employees) Total number of months of federal service (Federal employees) Prior year child care expenses paid in current year

Spouse

[2]

[3]

[4]

[5] [6]

Contributions Amount of charitable contributions you wish to make to: Mark to donate surplus credit (kicker) to the State School Fund Planned Parenthood Lions Sight & Hearing Foundation Shriners Hospitals for Children Special Olympics Susan G. Komen for the Cure Military Assistance Program Historical Society Food Bank Albertina Kerr Kid's Crisis Care American Red Cross Cascade AIDS Project Veterans Suicide Prevention Oregon Non‐game Wildlife Prevent Child Abuse Alzheimer's Disease Research

[7] [8] [9] [10] [11] [12] [13] [14] [15] [16] [17] [18] [19] [20] [21]

Stop Domestic and Sexual Violence Habitat for Humanity Head Start Association American Diabetes Association SMART ‐ Start Making A Reader Today Oregon Coast Aquarium SOLV ‐ Stop Oregon Litter and Vandalism The Nature Conservancy St. Vincent DePaul Society of Oregon Oregon Humane Society The Salvation Army Doernbecher Children's Hospital Oregon Veteran's Home ALS Association

[23] [24] [25] [26] [27] [28] [29] [30] [31] [32] [33] [34] [35] [36]

[22]

Political party you wish to make contributions to: Taxpayer Political Party

Spouse

[37]

[38]

Political Party Contributions 500 = Constitution Party of Oregon 501 = Democratic Party of Oregon 502 = Independent Party of Oregon

503 = Libertarian Party of Oregon 504 = Oregon Republican Party 505 = Pacific Green Party of Oregon

506 = Progressive Party 507 = Working Families Party of Oregon

Part‐year Resident and Nonresident Information If you were a part‐year resident during the tax year, enter the dates you lived in Oregon Taxpayer Dates of residency: From To

Spouse

[39]

[41]

[40]

[42]

Credit for Home Care of an Elderly Person Name Birth date, social security number Expenses you incurred or paid for home care of an elderly person: Food [46] Clothing [47]

[43] [44]

Medical care Transportation

[45] [48] [49]

NOTES/QUESTIONS: Form ID: OR

Form ID: PA

Pennsylvania General Information

County of residence School district name

[1] [2]

Taxpayer Final return

Spouse

[3]

[4]

Contributions Amount of contributions you wish to make to: Taxpayer Breast and Cervical Cancer Wild Resource Conservation Fund Military Family Relief Assistance Governor Robert P. Casey Memorial Organ/Tissue Trust Fund Juvenile (Type 1) Diabetes Cure Research Fund Children's Trust Fund American Red Cross

Spouse [5]

[6]

[7]

[8]

[9]

[10]

[11]

[12]

[13]

[14]

[15]

[16]

[17]

[18]

Part‐year Resident Information If you were a part‐year resident during the tax year, enter the dates you lived in Pennsylvania Taxpayer Spouse Part‐year residency dates: From [19] To [20]

[21] [22]

NOTES/QUESTIONS:

Form ID: PA

Form ID: RI

Rhode Island General Information

Enter city or town of legal residence if different from that entered on Organizer Form ID:1040

[1]

Use Tax Purchases subject to use tax Total sales tax paid to other states Purchases subject to use tax is unknown except purchases over $1000 (Use tax table based on federal AGI) Purchases subject to use tax over $1000:

Description

[2] [3] [4]

Sales Tax Paid to Other State

Purchases Subject to Use or sales Tax [5]


Political Contributions Mark to make an electoral system contribution (NOTE: This will NOT increase your tax or decrease your refund) If you wish for a portion of your electoral contribution to be paid to a political party, enter name of party

[6] [7]

Charitable Contributions Drug Program Account Mark if you wish to make an Olympic Contribution Organ Transplant Fund Council on the Arts Nongame Wildlife Fund Childhood Disease Victims' Fund Military Family Relief Fund

[8] [9] [10] [11] [12] [13] [14]

Part‐year Resident Information Part‐year residency dates: From To

[15] [16]

Property Tax Relief Claim Mark if disabled and received social security disability payments during the tax year Live in household or rent dwelling subject to property tax? (Y, N) Current for property taxes and rent due for 2015 and all prior years (Y, N) Rent paid (Enter 100%) If renting, Landlord name: Landlord Address: Landlord city, state and zip code Landlord phone number:

[17] [18] [19] [20] [21] [22] [23]

[24]

[25] [26]

NOTES/QUESTIONS:

Form ID: RI

Form ID: SC

South Carolina General Information

County code number, if known Authorize discussion with Department of Revenue (Y, N) Purchases subject to use tax If not using direct deposit for refund, select alternative method of receiving refund

[1] [2] [3] [4]

1 = SCDOR Income Tax Refund Prepaid Debit Card issued by Bank of America 2 = Paper Check

Additions and Subtractions Expenses related to reserve income National guard reserve pay Law enforcement subsistence (Number of days) Volunteer deduction code Taxpayer Spouse

[5] [6] [7] [8] [9]

Volunteer Deduction Codes 1 = Volunteer Firefighter 5 = Reserve Police officer 2 = HAZMAT team member 6 = State Guard member 3 = Rescue Squad worker 7 = State Constable 4 = DNR officer

Part‐year Resident and Nonresident Information If you were a part‐year resident during the tax year, enter the dates you lived in South Carolina Part‐year residency dates: From To

[10] [11]

Contributions Amount of contributions you wish to make to: Endangered Wildlife Fund Children's Trust Fund Eldercare Trust Fund Veterans' Trust Fund Donate Life South Carolina First Steps to School Readiness Fund War Between States Heritage Trust Fund Litter Control Enforcement Program Law Enforcement Assistance Program K‐12 Public Education Fund State Parks Fund Military Family Relief Fund Conservation Bank Trust Fund Financial Literacy Trust Fund State Forests Fund Department of Natural Resources Fund

[12] [13] [14] [15] [16] [17] [18] [19] [20] [21] [22] [23] [24] [25] [26] [27]

NOTES/QUESTIONS:

Form ID: SC

Form ID: TN

Tennessee General Information

County City Account number

[1] [2] [3]

Taxpayer Mark if quadriplegic

[4]

Spouse [5]

NOTES/QUESTIONS:

Form ID: TN

Form ID: UT

Utah General Information If you were a part‐year resident during the tax year, enter the dates you lived in Utah

Part‐year residency dates: From To State of residency (Nonresidents)

[1] [2] [3]

Use Tax County/City

Purchases [4]

Use tax


Political Contributions Taxpayer

Election campaign fund

Spouse

[5]

[6]

Enter the appropriate code for the political party from the list below:

Political Party L = Libertarian C = Constitution D = Democratic R = Republican M = Independent AmericanN = No Contribution Making a selection from this list will designate $2 to the party of your choice. Your refund or amount of tax due will not be affected


Pamela Atkinson Homeless Trust Account Kurt Oscarson Children's Organ Transplant Account School district code School District and Nonprofit School District Foundation

01 = Alpine 07 = Davis 13 = Iron 02 = Beaver 08 = Duchesne14 = Jordan 03 = Box Elder09 = Emery 15 = Juab 04 = Cache 10 = Garfield 16 = Kane 05 = Carbon 11 = Grand 17 = Logan 06 = Daggett 12 = Granite 18 = Millard

School district code 19 = Morgan 25 = Park City 20 = Murray 26 = Piute 21 = Nebo 27 = Provo 22 = North Sanpete 28 = Rich 23 = North Summit 29 = Salt Lake City 24 = Ogden 30 = San Juan

Cat and Dog Community Spay and Neuter Program Canine Body Armor Account Invest More for Education Account Youth Development Organization Account Youth Character Organization Account

[7] [8] [9] [10]

31 = Sevier 37 = Wasatch 32 = S. Sanpete 38 = Washington 33 = S. Summit 39 = Wayne 34 = Tintic 40 = Weber 35 = Tooele 41 = Utah Assistive Technology 36 = Uintah 42 = Canyons [11] [12] [13] [14] [15]

NOTES/QUESTIONS:

Form ID: UT

Form ID: VT

Vermont General Information

School district name School district code

[1] [2]

Contributions and Use Tax Use Tax Total out‐of‐state purchases

[3]

Contributions Amount of charitable contributions you wish to make to: Nongame Wildlife Fund Children's Trust Fund Vermont Veterans' Fund Green Up Day Vermont

[4] [5] [6] [7]

Part‐year Resident and Nonresident Information If you were a part‐year resident during the tax year, enter the dates you lived in Vermont Part‐year residency dates: From To

[9]

Other state of residency

[10]

[8]

Property Tax Information Homeowners Anticipate selling Vermont housesite on or before April 1 SPAN number from 2015/2016 property tax bill Housesite value Housesite education tax Housesite municipal tax Ownership percentage of property Mobile home lot rent

[11] [12] [13] [14] [15] [16] [17]

Renters Rent paid

[18]

NOTES/QUESTIONS:

Form ID: VT

Form ID: VA

Virginia General Information

Virginia city or county of residence on January 1, 2016; last lived in or business location Mark to indicate name has changed from last year (Resident and nonresident only) Mark to indicate filing status has changed from last year (Resident only) Mark to indicate address has changed from last year (Resident and nonresident only) Mark to indicate that a Virginia return was not filed last year (Resident only) Last five digits of taxpayer's Virginia driver's license Last five digits of spouse's Virginia driver's license

[1] [2] [3] [4] [5] [6] [7]

Use Tax Consumer's Use Tax

[8]

Contributions Amount of contributions you wish to make to:

Political Contributions Virginia Democratic Party

[9]

Virginia Republican Party

[10]

Charitable Contributions If you contributed to a public school foundation, provide the supporting information to your accountant [11] Virginia Tuition Assistance Grant Fund Virginia Nongame Wildlife Fund [12] Spay and Neuter Fund US Olympic Committee [13] Cancer Centers in the Commonwealth Virginia Housing Program [14] Martin Luther King, Jr. Fund Department for Aging and Rehabilitative Services [15] Celebrating Special Children Community Policing Fund Virginia Arts Foundation [16] Chesapeake Bay Restoration Fund [17] Family and Children's Trust Fund (FACT) Open Space Recreation and Conservation [18] Virginia State Forests Fund Historic Resources Fund [19] Virginia Uninsured Medical Catastrophe Fund Children of America Finding Hope Virginia War Memorial and National D‐Day Memorial [20] Home Energy Assistance [21] Virginia Military Family Relief Fund Virginia Federation of Humane Societies

[22] [23] [24] [25] [26] [27] [28] [29] [30] [31] [32]

Part‐year Resident Information If you were a part‐year resident during the tax year, enter the dates you lived in Virginia Spouse Part‐year residency dates: From To

Taxpayer [33]

[35]

[34]

[36]

Nonresident Information State of residence (Nonresidents only)

[37]

NOTES/QUESTIONS:

Form ID: VA

Form ID: WV

West Virginia General Information

County of residence

[1]

Use Tax Purchases

[2]

Municipality

Purchases

Municipality purchases Municipality purchases

[3]

Contributions Amount of contributions you wish to make to: West Virginia Children's Trust Fund

[4]

Part‐year Resident and Nonresident Information Part‐year residency status

[5]

1 = Moved into West Virginia 2 = Moved out of West Virginia with West Virginia source income during period of nonresidency 3 = Moved out of West Virginia with no West Virginia source income during period of nonresidency

If you were a part‐year resident during the tax year, enter the dates you lived in West Virginia Part‐year residency dates: From To State of residence If state of residence is Virginia or Pennsylvania, enter number of days in West Virginia (Nonresidents only)

[6] [7] [8] [9]

NOTES/QUESTIONS:

Form ID: WV

Form ID: WI

Wisconsin General Information

City of residence Village of residence Town of residence County of residence School district Mark if divorce decree Enter rent paid: Heat included Heat not included

[1] [2] [3] [4] [5] [6] [7] [8]

Use Tax Mark if not subject to Use Tax

[9]

County

Purchases

Sales and use tax on out‐of‐state purchases Sales and use tax on out‐of‐state purchases Sales and use tax on out‐of‐state purchases

[10]

Contributions Cancer research Endangered resources Military family relief Multiple sclerosis

Amount of charitable contributions you wish to make to: Red Cross WI disaster relief [11] Second Harvest / Feeding America [12] [13] Special Olympics Wisconsin Veterans trust fund [14]

[15] [16] [17] [18]

Part‐year Resident and Nonresident Information Residency code

[19]

Residency code Blank = Both spouses have the same residency status (Default) 4 = Taxpayer nonresident, spouse part‐year 1 = Taxpayer nonresident, spouse resident 5 = Taxpayer resident, spouse part‐year 2 = Taxpayer resident, spouse nonresident 6 = Taxpayer part‐year, spouse resident 3 = Taxpayer part‐year, spouse nonresident If you were a part‐year resident during the tax year, enter the dates you lived in Wisconsin Taxpayer Part‐year residency dates: From [20] To [21] State of residency (Nonresidents only) [24] Country of residency (Nonresidents only) [26] Nonresident aliens: Taxpayer or Spouse is a U.S. citizen or a resident alien Resident of: IL IN KY [29] [30] [31]

Spouse [22] [23] [25] [27] [28]

MI

[32]

NOTES/QUESTIONS:

Form ID: WI