Federal Information Worksheet

 


              


Enter all the information that you currently have available.  If you have any additional information not covered on this worksheet please enter it in the Additional Tax Information or Suggestions box.
 

Taxpayer:

 

Spouse:

 
First Name First Name
Middle Initial Middle Initial
Last Name Last Name
Social Security Number Social Security Number
Date of Birth Date of Birth
Occupation Occupation
Work  Number Work  Number
Home  Number Home  Number
E-mail Address E-mail Address
Blind No     Yes Blind No     Yes
Address    
City    
State    
Zip Code    
Advanced Child Tax Credit  2003 No Yes  

              


Please choose 1 of the 5 Filing Status:
 
    1    Single
            2    Married Filing Jointly
    3    Married Filing Separately
                       Check the box if the taxpayer did not live with spouse at any time during the year
               Check this box if client is eligible to claim spouse's exemption ........................
                       Check this box if client is a Dual Status Alien..............................................
            4    Head of Household
                If the qualifying person is a child but not a dependent,
                        Child's Name: Child's Social Security Number:
    5   Qualifying widow (er)
                        Check the appropriate box for the year the spouse died................. 2001 2002
 

Go to Dependent Information

Go to W-2 Information

Go to Schedule A Information

Go back to Client Information

 


              


 

Did Dependent Live with Taxpayer?

First Name 

M

Last Name

Year of Birth

Dependent's Social Security Number

Relationship

No of Months in Home

Educ Expense

 

Go to Child and Dependent Care Information

Go to W-2 Information

Go to Schedule A Information

Go back to Client Information
 

              


 

Name

Street Address

City

State

Zip Code

EIN

Amount Paid

 

                      Go to W-2 Information                       Go to Schedule A Information

                      Go to 2106 Information                      Go back to Client Information
 

              


 

Employer Information:
a - Control no. (if any)    
b - Employer ID no.    
c - Employer's:      
Name    
Name (Continue)    
Street    
City  

 

State    
ZIP Code    
 
Boxes 1 thru 11:
1 - Wages    2 - Federal Tax W/H
3 - Soc. Sec. Wages     4 - Soc. Sec. Tax W/H
5 - Medicare Wages     6 - Medicare Tax W/H
7 - Soc. Sec. Tips     8 - Allocated Tips
9 - Advance EIC     10 - Dependent Care
11 - Nonqualified Plans        
 
Boxes 12 thru 14:
Box 12 - Letter Code (if any)

Amount

 

 

 

 
Box 13 - Check any boxes that are checked on your W-2
Retirement Plan   
Statutory Employee  
Third-Party Sick Pay  
Box 14 - Description (if any)

Amount

 

 

 

 
 
State and Local Taxes:
Box 15 - State Employer's State ID No. Box 16 - State Wages

Box 17 - State Income Tax

   
   
   

Box 18 - Local Wages

Box 19 - Local Income Tax

Box 20 - Locality Name

 
Add Another W-2

Go to Schedule A Information

Go to Payment Information

Go back to Client Information

 

Employer Information:
a - Control no. (if any)    
b - Employer ID no.    
c - Employer's:      
Name    
Name (Continue)    
Street    
City    
State    
ZIP Code    
 
Boxes 1 thru 11:
1 - Wages    2 - Federal Tax W/H
3 - Soc. Sec. Wages     4 - Soc. Sec. Tax W/H
5 - Medicare Wages     6 - Medicare Tax W/H
7 - Soc. Sec. Tips     8 - Allocated Tips
9 - Advance EIC     10 - Dependent Care
11 - Nonqualified Plans        
 
Boxes 12 thru 14:
Box 12 - Letter Code (if any)

Amount

 

 

 

 
Box 13 - Check any boxes that are checked on your W-2
Retirement Plan   
Statutory Employee  
Third-Party Sick Pay  
Box 14 - Description (if any)

Amount

 

 

 

 
 
State and Local Taxes:
Box 15 - State Employer's State ID No. Box 16 - State Wages

Box 17 - State Income Tax

   
   
   

Box 18 - Local Wages

Box 19 - Local Income Tax

Box 20 - Locality Name

 

Add Another W-2

Go to Schedule A Information

Go to Payment Information

Go back to Client Information
 
Employer Information:
a - Control no. (if any)    
b - Employer ID no.    
c - Employer's:      
Name    
Name (Continue)    
Street    
City  

 

State    
ZIP Code    
 
Boxes 1 thru 11:
1 - Wages    2 - Federal Tax W/H
3 - Soc. Sec. Wages     4 - Soc. Sec. Tax W/H
5 - Medicare Wages     6 - Medicare Tax W/H
7 - Soc. Sec. Tips     8 - Allocated Tips
9 - Advance EIC     10 - Dependent Care
11 - Nonqualified Plans        
 
Boxes 12 thru 14:
Box 12 - Letter Code (if any)

Amount

 

 

 

 
Box 13 - Check any boxes that are checked on your W-2
Retirement Plan   
Statutory Employee  
Third-Party Sick Pay  
Box 14 - Description (if any)

Amount

 

 

 

 
 
State and Local Taxes:
Box 15 - State Employer's State ID No. Box 16 - State Wages

Box 17 - State Income Tax

   
   
   

Box 18 - Local Wages

Box 19 - Local Income Tax

Box 20 - Locality Name

 

Add Another W-2

Go to Schedule A Information

Go to Payment Information

Go back to Client Information
 
Employer Information:
a - Control no. (if any)    
b - Employer ID no.    
c - Employer's:      
Name    
Name (Continue)    
Street    
City  

 

State    
ZIP Code    
 
Boxes 1 thru 11:
1 - Wages    2 - Federal Tax W/H
3 - Soc. Sec. Wages     4 - Soc. Sec. Tax W/H
5 - Medicare Wages     6 - Medicare Tax W/H
7 - Soc. Sec. Tips     8 - Allocated Tips
9 - Advance EIC     10 - Dependent Care
11 - Nonqualified Plans        
 
Boxes 12 thru 14:
Box 12 - Letter Code (if any)

Amount

 

 

 

 
Box 13 - Check any boxes that are checked on your W-2
Retirement Plan   
Statutory Employee  
Third-Party Sick Pay  
Box 14 - Description (if any)

Amount

 

 

 

 
 
State and Local Taxes:
Box 15 - State Employer's State ID No. Box 16 - State Wages

Box 17 - State Income Tax

   
   
   

Box 18 - Local Wages

Box 19 - Local Income Tax

Box 20 - Locality Name

 

Go to Schedule A Information

Go to Payment Information

Go back to Client Information

 

              


 

1 Medical and dental expenses
 
5 State and local income taxes in addition to withholdings
6 Real estate taxes
7 Personal property taxes
8 Other taxes
 
10 Home mortgage interests and points reported on Form 1098
11 Home mortgage interest not reported on Form 1098
12 Points not reported on Form 1098
13 Investment interest
 
15 Contributions by cash or check
  Total charitable mileage
16 Contributions other than cash or check
17 Carryover from prior year
 
19 Casualty or theft loss(es)
  Description of Property Fair Market Value Before Fair Market Value After Held Under 1 Year Trade or Business  
   
   
   
 
20 Unreimbursed employee expenses                    Go to Form 2106 Amount
 
 
 
 
21 Tax preparation fees
22 Other expenses  
  Investment expense
  Safe deposit box
  Other Limited Expenses Amount
 
 
 
 
 
27 Other Miscellaneous Deductions Amount
 
 
 
 
     

Go to Payment Information

Go back to Client Information

 
Job Travel Union and Professional Dues Job Education
Occupation Performing Artist  
Spouse Business Expense   Handicapped Employee   Dept Trans Employee  
Parking Fees, Tolls, ect
Travel Expenses Away:
Lodging
Car Rental
Other (not Entertainment)
Meals and Entertainment

Reimbursements from

Employer

Vehicle Mileage:
Date Placed in Service Total Miles Driven Business Miles
Other Miles Driven
Actual Vehicle Expenses: Vehicle 1 Vehicle 2
Gasoline
Oil
Repairs
Auto Insurance
Other Expenses
Cost Basis

              


 

Payment Type:  
Credit Card Type:  
Credit Card Number:  
Expiration Date: / (MM/YY)  
Card ID:  
***Required for American Express, Visa, or Master Card
 

Go to Account Information

Go back to Client Information
 

              


 

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         ↕       ↕      ↕

Routing/Transit    Check    Checking Account
(A 9-digit No.)     Number
 
Bank Name

City

State    
Routing/Transit Number:    
Checking                Savings                Other       
Account Number:    
 

Go back to Client Information

Add any Additional Information or Suggestions

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Last modified: 09/15/07