Dear Taxpayer:

You are invited to use this organizer to help you organize your tax information and aid your memory of what happened in 2017 (and make sure you don't miss any important deductions).

DON'T WORRY ABOUT WHERE THE INFORMATION GOES. If you don't know where to put some information, just attach the relevant documents. This form is a memory aid and an organizational tool for your convenience.

Write in any questions you have, too!

TAXPAYER INFORMATION

First Name:___________________ Initial _______

Last Name_____________________________

Social Security # _____________________________

Occupation__________________________________

Date of Birth ________________________

Street Address __________________________________

City________________ State_________ Zip____________

Home Telephone ______________________________

Work Telephone______________________________

E-mail address______________________________

SPOUSE INFORMATION

First Name:___________________ Initial _______

Last Name_____________________________

Social Security # _____________________________

Occupation__________________________________

Date of Birth ________________________

Street Address __________________________________

City________________ State_________ Zip____________

Home Telephone ______________________________

Work Telephone______________________________

E-mail address______________________________


FILING STATUS (Circle one)

Single

Married

Head of Household

Married Filing Separate

SALARIES AND WAGES (List W-2's below and attach)

TAXPAYER

Employer #1 _____________________________

Employer #2 _____________________________

Employer #3 _____________________________

SPOUSE

Employer #1 _____________________________

Employer #2 _____________________________

Employer #3 _____________________________

DEPENDENTS

Name_______________________________________

Date of Birth_________________

Social Security #________________________

Relationship _____________________________

Months Lived at Home_________________

Name_______________________________________

Date of Birth_________________

Social Security #________________________

Relationship _____________________________

Months Lived at Home_________________

Name_______________________________________

Date of Birth_________________

Social Security #________________________

Relationship _____________________________

Months Lived at Home_________________

Name_______________________________________

Date of Birth_________________

Social Security #________________________

Relationship _____________________________

Months Lived at Home_________________

OTHER INCOME

INTEREST: List payor and attach 1099 Forms

Payor #1______________________________

Payor #2______________________________

Payor #3______________________________

Payor #4______________________________

DIVIDENDS - Attach 1099 Forms

Payor #1______________________________

Payor #2______________________________

Payor #3______________________________

Payor #4______________________________

State Tax Refund

Amount Received $___________________

CAPITAL GAINS

Property Sold::

Description__________________________________________

Date Acquired_______________________________

Date Sold___________________________________

Sales Price__________________________________

Cost or Basis________________________________

If there are more, attach list

Attach all 1099 B or S forms for property sold

PENSIONS/ IRA DISTRIBUTIONS

Attach Form 1099 / W-2s

Payor_____________________________

Payor_____________________________

Was Federal or State Income Tax withheld?

___________________________________


ALIMONY RECEIVED

Payor________________________ Amount $___________

Payor's Social Security #_______________________________

UNEMPLOYMENT RECEIVED

Taxpayer Amount $________________

Spouse Amount $_________________

SOCIAL SECURITY RECEIVED

Taxpayer Amount $_______________

Spouse Amount $_________________

MISCELLANEOUS INCOME

Description:________________________________

_________________________________________

__________________________________________

DEDUCTIONS

Medical and Dental Expenses

Insurance Premiums (Net) ___________________

Doctors, Dentists, etc.______________________

TAXES PAID

State & Local Income Tax____________________

Real Estate Taxes - Residence_________________

Real Estate Taxes - Other Property______________

Auto License:

No. of Cars Fees Paid _______________________

Personal Property Taxes____________________

Other Taxes_____________________________

INTEREST PAID - Attach 1098 Forms

Home Mortgage Interest Paid (1st)____________________

Home Mortgage Interest Paid (2nd)____________________

CONTRIBUTIONS - Attach Details

Contributions by Cash or Check____________________

Contributions by Other than Cash__________________

MISCELLANEOUS DEDUCTIONS

Unreimbursed Employee

Business Expenses____________________

Union /Professional Dues_______________

Investment Expense____________________

Tax Return Preparation Fees______________

Safe Deposit Box Rental_________________

BUSINESS INCOME

General Information:

Cash basis?

Accrual Basis?

First Year?

Taxpayer's business?

Spouse's business?

Principal Bus./Profession__________________________

Business Name__________________________________

Business Address________________________________

City, State, Zip__________________________________

Other Accounting Method___________________________

Income

Gross Receipts or Sales $___________________________

Returns and Allowances $___________________________

Other Income $___________________________________

Cost of Goods Sold - If Applicable

Inventory at Beginning of the Year $___________________________

Inventory at End of the Year $___________________________

Purchases $____________________________

Cost of Items for Personal Use $_______________________

Cost of Labor $_________________________

Materials and Supplies $__________________

Other Costs $___________________________

Expenses

Advertising $_____________________________

Car and Truck Expenses * $___________________

Commissions $____________________________

Employee Benefit Programs $_________________

Insurance (other than health) $________________

Health Insurance

Premiums for Self* $_______________________

Mortgage Interest

(paid to banks, etc.) $_______________________

Other Interest $___________________________

Legal and Professional $_____________________

Office Expense $___________________________

Pension and Profit Sharing Plans $_________________

Rent - Vehicles, Machinery, and Equipment $___________________________

Rent - Other Business Property $______________

Repairs $_________________________________

Supplies $_______________________________

Taxes - Real Estate $______________________

Taxes - Other $___________________________

Travel $________________________________

Total Meals and Entertainment $_______________________

Utilities $______________________________

Wages $________________________________

* Attach detailed schedule

Did you dispose of any business assets (including real estate)?

Yes

No

If yes, attach detailed schedule.

Did you have a home office during the year?

Yes

No

Rent $____________________ Utilities $________________

Insurance $________________ Janitorial $_______________

Misc._________________ % of exclusive business use_______

RENTAL INCOME & EXPENSES

Check if property was purchased/converted to rental in 2017.  ___

Property Address

1. ___________________________________________

2. ___________________________________________

3. ___________________________________________

ADJUSTMENTS TO INCOME

Alimony Paid

Payee___________________ Amount $_____________

Payee's Social Security #__________________________

IRA Deduction___________________________

Keogh/SEP Deduction_____________________

Penalty on Early Withdrawal of Savings____________________

ESTIMATED TAX PAYMENTS

04.15.17_______________

06.15.17_______________

09.15.17_______________

01.15.18_______________

If any of the following items pertain to you or your spouse for the year 2017, please indicate if applicable and include all pertinent details.

YES or NO

Were there any births, adoptions, marriages, divorces, or deaths in your immediate family during the year?

Are any of your unmarried children, who might be claimed as dependents, 19 years of age or older?

Do you have any children under age 14 with interest and dividend income?

Are any of your unmarried children, who might be claimed as dependents, 19 years of age or older?

Can you be claimed as a dependent on another persona's tax return?

Did you or your spouse "rollover" a profit-share or retirement plan distribution into another plan? If yes, enter amount $_________________, and attach Form 1099-R.

Did you or your spouse receive any disability income during the year? If yes, enter amount $__________________.

Did you purchase, sell, or refinance your principal home or your second home, or make a home equity loan during the year? If yes, please bring escrow papers and other relevant information.

Did you sell any stocks, bonds, or other investment property during the year? If yes, please list the description, date acquired, date sold, sales price, cost or basis, and expenses of sale.

Did you pay any one household employee cash wages in 2017?

Did you use your car on the job (other than to and from work)?

Does anyone owe you money which has become uncollectible?

Did you incur moving expenses during the year due to a change of employment?

Did you or your spouse work out of town for part of the year?

Did you incur a loss because of damaged or stolen property?

Did you have an interest in or signature over a bank or brokerage account in a foreign country, or were you a grantor of or transferor to a foreign trust?

Were you audited by either the Internal Revenue Service or the State taxing agency during the year?

Did you receive any K-1s from S corporations, partnerships estates, trusts, or LLCs? If so, please attach.

USE THIS SPACE TO LIST ANY QUESTIONS YOU MAY HAVE:

______________________________________

______________________________________

______________________________________

______________________________________

PLEASE PROVIDE PRIOR YEAR'S TAX RETURNS

Once you have completed the organizer form, call David Belzer at 206.288-5575 for an appointment, promptly scheduled to your convenience.

Or, if you prefer, you can email the completed form to David Belzer at davebelzer@gmail.com

Or you can mail the completed form to:  David Belzer, 1100 Dexter Ave. N, Suite 100, Seattle, WA 98109. Your return will be promptly prepared and delivered to you by your choice of delivery.

Thank you for the opportunity to be of service. 

Sincerely,

David C. Belzer

David C. Belzer

Link to belzertax.com, Dave Belzer's tax website

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