Are any dependent children married and filing a joint return with their spouse? -

April 28, 2016

Are any dependent children married and filing a joint return with their spouse?

				YES	NO
1.	Did any births, adoptions, marriages, divorces, or deaths occur in your family last year? If yes, provide details.			______	√

2.	Will the address on your current returns be different from that shown on your prior year returns? If yes, provide the new address and date moved.			______	√

3.	Were there any changes in dependents from the prior year? If yes, provide details.			______	√

4.	Are you entitled to a dependency exemption due to a divorce decree?			______	√

5.	Did any of your dependents have income of $1,000 or more ($400 if self-employed)?			______	√

6.	Did any of your children under age 19, age 24 if they are a full time student, have investment income over $2,000?			______	√
	If yes, do you want to include your child’s income on your return?			______	√

7.	Are any dependent children married and filing a joint return with their spouse?			______	√

8.	Did any dependent child 19-23 years of age attend school full-time for less than five months during the year?			______	√

9.	Did you receive income from any legal proceedings, cancellation of student loans or other indebtedness during the year? If yes, provide details.			______	√

10.	Did you make any gifts during the year directly or in trust exceeding $14,000 per person?			______	√

11.	Did you have any interest in, or signature, or other authority over a bank, securities, or other financial account in a foreign country?			______	√

12.	Were you the grantor, transferor or beneficiary of a foreign trust?			______	√

13.	Were you a resident of, or did you have income from, more than one state during the year?			______	√

14.	Do you wish to have $3 (or $6 on joint return) of your taxes applied to the Presidential Campaign Fund? (Current president unbearable)			______	√

15.	Do you wish to contribute to any state fund(s)? If yes, indicate amount(s) and which fund(s): ______________________________________________________________ ______________________________________________________________			______	√

16.	Do you want any overpayment of taxes applied to next year’s estimated taxes?			______	√

17.	Do you want any federal or state refund deposited directly into your bank account? If yes, enclose a voided check.			______	√
	1.	Do you want any balance due directly withdrawn from this same bank account on the due date?		______	√
	2.	Do you want next year’s estimated taxes withdrawn from this same bank account on the due dates?		______	√

18.	Do either you or your spouse have any outstanding child or spousal support payments or federal debt?			______	√

19.	If you owe federal or state tax upon completion of your return, are you able to pay the balance due?			√	______

20.	Do you expect a large fluctuation in your income, deductions or withholding next year? If yes, provide details.			______	√

21.	Did you receive any distribution from an IRA or other qualified plan that was partially or totally rolled over into another IRA or qualified plan within 60 days of the distribution (Form 1099R)?		______		√

22.	If you received an IRA distribution, which you did not roll over, provide details (Form 1099R).		______		√

23.	Did you “convert” IRA funds into a Roth IRA? If yes, provide details (Form 1099R).		______		√

24.	Did you receive any disability payments this year?		______		√

25.	Did you receive tip income not reported to your employer? Just Picnic baskets		______		√

26.	Did you sell or purchase a principal residence or other real estate? If yes, provide settlement sheet (HUD-1) and Form 1099-S.		______		√

27.	Did you collect on any installment contract during the year? Provide details.		______		√

28.	Did you receive tax-exempt interest or dividends not reported on Forms 1099-INT or 1099 -DIV?		______		√

29.	During this year, do you have any securities that became worthless or loans that became uncollectible?		______		√

30.	Did you receive unemployment compensation? If yes, provide Form 1099-G.		______		√

31.	Did you receive, or pay, any Alimony during the year? If yes, provide details.		______		√

32.	Did you have any casualty or theft losses during the year? If yes, provide details.		______		√

33.	Did you have foreign income, pay any foreign taxes, or file any foreign information reporting or tax return forms? Provide details.		______		√

34.	If there were dues paid to an association, was any portion not deductible due to political lobbying by the association or benefits received?		______		√

35.	Did you, or do you plan to contribute before April 15, 2015, to a traditional IRA, or Roth IRA for last calendar year? If yes, provide details. You tell me!		______		______

36.	Did you, or do you plan to contribute before April 15, 2015 to a health savings account (HSA) for last calendar year? If yes, provide details.		______		√

37.	Did you receive any distributions from an HSA? If so, provide details.		______		√

38.	Has the IRS, or any state or local taxing agency, notified you of changes to a prior year’s tax return? If yes, provide copies of all notices or correspondence received.		______		√

39.	Are you aware of any changes to your income, deductions and credits reported on any prior years’ returns?		______		√

40.	Did you purchase gasoline, oil, or special fuels, for non-highway use vehicles?		______		√

41.	Did you purchase an energy-efficient or other new vehicle? If yes, provide purchase invoice.		______		√

42.	If you, or your spouse, have self-employment income, did you pay any health insurance premiums or long-term care premiums?		______		√

43.	Were either you or your spouse eligible to participate in an employer’s health insurance or long-term care plan?		√		______

44.	If you, or your spouse, have self-employment income, do you want to make a retirement plan contribution?		______		√

45.	Did you acquire any “qualified small business stock”?		______		√

46.	Were you granted or did you exercise any stock options? If yes, provide details.		______		√

47.	Were you granted any restricted stock? If yes, provide details.		______		√

48.	Did you pay any household employee over age 18 wages of $1,800 or more?		______		√
	If yes, provide copy of Form W-2 issued to each household employee.		______		√
	If yes, did you pay total wages of $1,000 or more in any calendar quarter to all household employees?		______		______

49.	Did you surrender any U.S. savings bonds?		______		√

50.	Did you use the proceeds from Series EE U.S. savings bonds purchased after 1989 to pay for higher education expenses?		______		√

51.	Did you realize a gain on property which was taken from you by destruction, theft, seizure, or condemnation?		______		√

52.	Did you start a business?		______		√

53.	Did you purchase rental property? If yes, provide settlement sheet (HUD-1).		______		√

54.	Did you acquire any interests in partnerships, LLCs, S corporations, estates or trusts this year? If yes, provide Schedule K-1 that the Organization has issued to you.		______		√

55.	Do you have records to support travel, entertainment, or gift expenses? The law requires that adequate records be maintained for travel, entertainment, and gift expenses. The documentation should include amount, time and place, date, business purpose, description of gift(s) (if any), and business relationship of recipient(s).		√		______

56.	Has your will or trust been updated within the last three years? If yes provide copies.		______		√

57.	Did you incur expenses as an elementary or secondary educator? If so, how much?		_____		√

58.	Did you make any energy-efficient improvements (remodel or new construction) to your home?		______		√

59.	Can the Internal Revenue Service and state tax authority discuss questions about this return with the preparer?		√		______

60.	Did you make any large purchases or home improvements?		______		√

61.	Did you pay real estate taxes on your principal residence? If so, how much? $4500		√		______

ESTIMATED TAX PAYMENTS MADE

	FEDERAL		STATE (NAME):
	Date Paid	Amount Paid	Date Paid	Amount Paid
Prior year overpayment applied
1st Quarter
2nd Quarter
3rd Quarter
4th Quarter

WAGES, SALARIES, AND OTHER EMPLOYEE COMPENSATION

Enclose all Forms W-2.

Fed wages $97,400

State tax withheld $2,000

Fed Tax withheld $11,000

PENSION, IRA, AND ANNUITY INCOME

Enclose all Forms 1099-R.
	YES	NO

1.	Did you receive a Lump Sum distribution from your employer?	______	√

2.	Did you “convert” a Lump Sum distribution into another plan or IRA account?	______	√

3.	Did you transfer IRA funds to a Roth IRA this year?	______	√

joyce

Are any dependent children married and filing a joint return with their spouse?

YES

NO

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