Tax Organizer Short

ORG02012 Tax Organizer

This Tax Organizer is designed to help you collect and report the information needed to prepare your 2012 income tax return. The attached worksheets cover income, deductions, and credits, and will help in the preparation of your tax return by focusing attention on your special needs.

Please enter your 2012 information in the designated areas on the worksheets. If you need to include additional information, you may use the back of a worksheet or an additional page.

When possible, 2011 information is included for your reference. You do not need to make any 2011 entries.

Note: The General Questions and Business/Investment Questions worksheets include a variety of questions designed to assist in completing your tax return. If you answer yes to any of the questions, be sure to provide the applicable details.

Please provide the following information:

A copy of your 2011 tax return (if not in our possession).

Original Form(s) W-2.

Schedule(s) K-1 showing income or loss from partnerships, S corporations or estates or trusts.

Copies of other compensation or pension documentation, such as Form 1099-MISC or Form 1099-R.

Form(s) 1099 or statements reporting dividend and interest income.

Brokerage statements showing transactions for stocks, bonds, etc.

Form(s) 1098 reporting interest paid, copies of real estate tax bills and other information relating to real property holdings.

Copies of closing statements regarding the sale or purchase of real property.

All other information notices you received, or any items you have questions about.

Thank you for taking the time to complete this Tax Organizer.

ORG0OGMW0101 07/09/12

ExactCPA14 S Pierson RoadMaplewood, NJ 07040Telephone: (973)996-2284 Fax: (646)929-5562E-mail: [email protected]

Table of Contents ORG1

OGMW8201 07/01/11 ORG1

Description Page

Cover Sheet ORG0

Topic Index ORG2

General Questions ORG3

Business/Investment Questions ORG4

Additional Information ORG5

Basic Taxpayer Information ORG6

W-2, W-2G, 1099-R Income ORG7

1099-MISC Income ORG8

Social Security Benefits/Form 1099-G/Other Income ORG10

Interest and Dividend Income ORG11

Seller Financed Interest/Child’s Interest and Dividends ORG12

Medical and Tax Expenses ORG13

Interest Paid and Cash Contributions ORG14

Non-Cash Charitable Contributions ORG14A

Miscellaneous Itemized Deductions ORG15

Moving Expenses ORG16

Employee Business Expenses ORG17

Employee Home Office Expense ORG17A

Car and Truck Expenses ORG18

Business Income and Expenses ORG19

Business Use of Home ORG20

Sales of Stocks and Securities ORG21

Sale of Your Home ORG22

Installment Sales Income ORG23

Sales of Business Property ORG24

Rental and Royalty Income and Expenses ORG25

Farm Rental Income and Expenses ORG26

Farm Income and Expenses ORG27

Adjustments to Income ORG28

Dependent Care Expenses ORG35

Education ORG36

Tax Payments ORG40

Household Employment Taxes ORG41

K-1 Partnership ' Partner’s Questions ORG45

K-1 S-Corporation ' Shareholder’s Questions ORG46

K-1 Estate & Trust ' Beneficiary’s Questions ORG47

K-1 Partnership Supplemental Business Expense ORG48

Transferred Assets ORG50

Additional Assets ORG51

Foreign Earned Income ORG52

State Information Worksheet ORG60

OGMW0201 07/01/11 ORG2

Topic Index ORG2

Alimony paid ORG28

Alimony received ORG10

Annuity payments received ORG7

Business income and expenses ORG19

Car and truck expenses ORG18

Casualties and thefts ORG3

Charitable contributions ORG14

Child and dependent care expenses ORG35

Dependent information ORG6

Depreciable property ' additions ORG51

Depreciable property ' deletions ORG50

Dividend income ORG11

Education ORG36

Employee business expense ORG17

Estate income ORG47

Estimated and other tax payments ORG40

Farm income and expenses ORG27

Farm rental income and expenses ORG26

Foreign earned income ORG52

Gambling and lottery winnings ORG7

Household employees ORG41

Installment sales ORG23

Interest income ORG11

Interest paid (mortgage, etc) ORG14

Investment interest expense ORG14

IRA contributions ORG28

IRA distributions and rollovers ORG7

Keogh plan contributions ORG28

Medical and dental expenses ORG13

Miscellaneous income reported on 1099-MISC ORG8

Miscellaneous income not from 1099-MISC ORG10

Miscellaneous itemized deductions ORG15

Moving expenses ORG16

Office in home expenses ORG20

Partnership income ORG45

Pension payments received ORG7

Personal information ORG6

Railroad retirement benefits ORG10

Rental income and expenses ORG25

Royalty income and expenses ORG25

S corporation income ORG46

Sale of home ORG22

Sales of business property ORG24

Sales of stock, securities ORG21

Self-employed health insurance ORG19

SEP plan contributions ORG28

SIMPLE plan contributions ORG28

Social security benefits ORG10

State and local tax refunds ORG10

Taxes paid ORG13

Trust income ORG47

Unemployment compensation ORG10

Wages and salaries ORG7

General Questions ORG3

PERSONAL INFORMATION

Yes No

Did your marital status change during 2012?1

If yes, explain

Do you want to allow your tax preparer to discuss this year’s return with the IRS?2

If no, enter another person (if desired) to be allowed to discuss this return with the IRS. Caution: Review any transferred information for accuracy.

GDesignee’s NameG GPhone Number Personal Identification Number (5 digit PIN)

Do you or your spouse plan to retire in 2013?3

Were you or your spouse permanently and totally disabled in 2012?4

Enter date of death for taxpayer or spouse (if during 2012 or 2013): Taxpayer: Spouse:5

Were you or your spouse a member of the U.S. Armed Forces during 2012?6

DEPENDENT INFORMATION

Yes No

Do you have dependents who must file?7 a

If yes, do you want us to prepare the return(s)?b

Do you have children who are under age 19 or a full time student under age 24 with investment income greater 8 athan $1,900?If yes, do you want to include your child’s income on your return?b

Are any of your dependents not U.S. citizens or residents?9

Did you provide over half the support for any other person during 2012?10

Did you incur adoption expenses during 2012?11

IRA, PENSION AND EDUCATION SAVINGS PLANS

Yes No

Did you receive payments from a pension or profit-sharing plan?12

Did you receive a total distribution from an IRA or other qualified plan that was partially or totally rolled over into another 13IRA or qualified plan within 60 days of the distribution?

Did you convert all or part of a regular IRA into a Roth IRA?14a

Did you roll over all or part of a qualified plan into a Roth IRA?b

Did you contribute to a Coverdell Education Savings Account?15

ITEMS RELATED TO INCOME/LOSSES

Yes No

Did you receive any disability payments in 2012?16

Did you receive tip income not reported to your employer?17

Did you buy, sell, refinance, or abandon a principal residence or other real property in 2012? 18a(Attach copies of any escrow statements or Forms 1099.)

If you sold or abandoned a home, did you claim the First-Time Homebuyer Credit when you purchased the home?b

Are you planning to purchase a home soon?c

Did you incur any casualty or theft losses during 2012?19

Did you incur any non-business bad debts?20

PRIOR YEAR TAX RETURNS

Yes No

Were you notified by the Internal Revenue Service or state taxing authority of changes to a prior year’s return?21

If yes, enclose agent’s report or notice of change.

Were there changes to a prior year’s income, deductions, credits, etc which would require filing an amended return?22

OGMW0312 07/10/12 ORG3

ORG3General Questions (continued)

FOREIGN BANK ACCOUNTS, FOREIGN ASSETS AND FOREIGN TAXESYes No

Did you have foreign income or pay any foreign taxes in 2012?23

a At any time during 2012, did you have an interest in or a signature or other authority over a bank account, or 24other financial account in a foreign country?

Did the aggregate value of all your foreign accounts exceed $10,000 at any time during 2012? Report all interest income bon Org 11Were you the grantor of or transferor to a foreign trust which existed during the tax year, whether or not you have any 25beneficial interest in the trust?Did you at any time during 2012, have an interest in or any authority over any foreign accounts or assets (i.e. stocks, 26bonds, mutual funds, partnership interests, etc.) held in foreign financial institutions that exceeded $50,000 in value at any time during the year?

HEALTH AND LIFE INSURANCEYes No

Did you or your spouse have self-employed health insurance?27If you or your spouse are self-employed, are either of you eligible to participate in an employer’s health plan at 28another job?Did your employer pay premiums on life insurance in excess of $50,000 where the proceeds are payable to beneficiaries 29named by you?

Did you contribute to or receive distributions from a Health Savings Account (HSA)?30

MISCELLANEOUSYes No

Did you make energy efficient improvements to your home or purchase any energy-saving property during 2012? If yes, 31please attach details

Did you start paying mortgage insurance premiums in 2012? If yes, please attach details32

Did you purchase a motor vehicle or boat during 2012?33If yes, attach documentation showing sales tax paid.Did you purchase a hybrid or electric vehicle in 2012?34If yes, enter year, make, model, and date purchased:Did you donate a vehicle in 2012? If yes, attach Form 1098C35

%What was the sales tax rate in your locality in 2012? State ID36

Did you or your spouse make gifts of over $13,000 to an individual or contribute to a prepaid tuition plan?37

Did you make gifts to a trust?38If there were dues paid to an association, was any portion required to be non-deductible due to political lobbying by 39the association?

If yes, please attach details.

Did you or your spouse participate in a medical savings account in 2012?40

If yes, please attach Form 1099-SA (Distributions from an HSA, Archer MSA or Medicare+Choice MSA.)

Did you make a loan at an interest rate below market rate?41

Did you pay any individual for domestic services in 2012?42Did you pay interest on a student loan for yourself, your spouse, or your dependents?43Did you, your spouse, or your dependents attend post-secondary school in 2012?44Did a lender cancel any of your debt in 2012? (Attach any Forms 1099-A or 1099-C)45Did you receive any income not included in this Tax Organizer?46

If yes, please attach information.

ELECTRONIC FILING AND DIRECT DEPOSIT OF REFUNDYes No

If your tax return is eligible for Electronic Filing, would you like to file electronically?D47

The Internal Revenue Service is able to deposit many refunds directly into taxpayers’ accounts. If you receive a refund, 48would you like direct deposit?

Caution: Review transferred information for accuracy.If yes, please provide the following information:49Name of your financial institutionaRouting Transit Number (must begin with 01 through 12 or 21 through 32)bAccount numbercWhat type of account is this? Checking Savingsd

GPlease attach a voided check (not a deposit slip) if your bank account information has changed.-

OGMW0312 09/07/12 ORG3

Business/Investment Questions ORG4

Yes No

Did you receive stock from a stock bonus plan with your employer?1

(Do not include stock sales included on your W-2.)

Did you buy or sell any stocks or bonds in 2012?2

If yes, attach broker’s information (such as Form 1099-Bs and broker annual statements) related to the transactions.

Did you surrender any U.S. savings bonds during 2012?3

Did you use the proceeds from Series EE or I U.S. savings bonds purchased after 1989 to pay for higher4

education expenses?

Did you realize a gain or loss on property which was taken from you by destruction, theft, seizure, or condemnation?5

Did you start a business, purchase a rental property or farm, or acquire interests in partnerships or S corporations?6

7 Do you have any investments for which you were not personally ’at risk’ (other than sole proprietorship or farm)?

Did you own an interest in a Real Estate Mortgage Investment Conduit (REMIC) during 2012?8

Did you sell property or equipment on installment in 2012?9

Did you have any business related educational expenses?10

Did you do a ’like-kind’ exchange of property in 2012?11

Do you have records, as described below, to support expenses?12

Tax law and IRS regulations allow deductions for travel and entertainment if adequate records can be presented.

Information must include: 1 Amount; 2 Time and place; 3 Date; 4 Business purpose; 5 Description of gift(s); and

6 Business relationship of recipient.

Did you purchase special fuels for non-highway use?13

If yes, please list the type of use and the number of gallons for each fuel.

Was Form 8903 (Domestic Production Activities Deduction) included in your 2011 federal income tax return?14

ORG4OGMW8601 07/10/12

Basic Taxpayer Information ORG6

PERSONAL INFORMATION

TAXPAYER SPOUSE

Last name

First name

Middle initial and suffix MI Suffix MI Suffix

Social security number

Occupation

Work phone/extension

Cell phone

E-mail address

MM/DD/YYYY MM/DD/YYYYBirthdate

Blind Yes No Yes No

Contribute to Presidential Election Yes No Yes NoCampaign Fund

Eligible to be claimed as a Yes No Yes Nodependent on another return

Street address Apartment number

City State ZIP code

Home phone Foreign country

Fax Foreign phone

FILING STATUS

Single1

Married filing jointly2

Married filing separately3GCheck this box if you did not live with spouse at any time during the yearGCheck this box if you are eligible to claim spouse’s exemptionGCheck this box if your spouse itemizes deductions

Head of household4

If the qualifying person is a child but not your dependent, enter

Child’s name Child’s social security number

Qualifying widow(er)5G 2010 2011Check the box for the year the spouse died

DEPENDENT INFORMATION2012 Child CareSocial Security Number **Code Date of BirthFull Name Expense

(first name, middle initial, last name, suffix) +Months 2011 Child CareRelationship *Not Citizenin U.S. Expense

** For the Dependent Code, enter the following: L = dependent child who lived with youN = dependent child who didn’t live with you due to divorce or separationO = other dependentQ = not a dependent (but is a person who qualifies your client for the earned income credit and/or the credit for

child and dependent care expenses)+ Enter the number of months dependent lived with you, and/or your spouse if married filing jointly, in the U.S.* Check this box if dependent child is not a U.S. citizen or resident alien

ORG6OGMW0501 08/9/12

Interest and Dividend Income ORG11

T = Taxpayer, S = Spouse, J = Joint

INTEREST INCOME

- Attach all copies of your Form 1099-INTs here.G**Type of Interest

MA1 = MA bank interest OK1 = OK bank interestblank = Regular taxable interestNH1 = NH nontaxable interest ' taxable federal TN1 = TN nontaxable interest ' taxable federalME1 = ME bond interest in federal income

MD1 = MD nontaxable interest ' taxable federal NJ1 = NJ nontaxable interest ' taxable federal WV1 = WV bond interest in federal income

2012 2012 2012 2011 Box Box 1 Box 3 Box 8 1 + 3

TSJ X* Payer Name Interest Tax Exempt StateUS/Treasury Type of InterestInterest**

X* Check if you did not receive income from this account in 2012.

DIVIDEND INCOME

- Attach all copies of your Form 1099-DIVs here.

G 2012 2012 2012 Box 1a Box 1b Box 2a 2011

Ordinary Qualified Capital TSJ X* Payer Name State Box 1a + 2aDividends Dividends Gains

X* Check if you did not receive income from this account in 2012.

OGMW1001 07/10/12 ORG11

Medical and Tax Expenses ORG13

MEDICAL AND DENTAL EXPENSES 2012 2011

Prescription medications1

Health insurance premiums (enter Medicare B on ORG10)2

Qualified long-term care premiums3

Taxpayer’s gross long-term care premiumsa

Spouse’s gross long-term care premiumsb

Dependent’s gross long-term care premiumsc

Enter self-employed health insurance premiums on ORG19, ORG27, ORG45A, or ORG46A 4for the appropriate activity

Insurance reimbursement5

Doctors, dentists, etc6

Hospitals, clinics, etc7

Lab and X-ray fees8

Expenses for qualified long-term care9

Eyeglasses and contact lenses10

Medical equipment and supplies11

Miles driven for medical purposes12

Ambulance fees and other medical transportation costs13

Lodging14

Other medical and dental expenses:15

a

b

c

d

e

f

g

h

i

j

TAXES 2012 2011

Enter state and local income taxes on ORG7, ORG8, ORG10, and ORG40.

Real estate taxes paid on principal residence16

Real estate taxes paid on additional homes or land17

Auto registration fees based on the value of the vehicle18

Other personal property taxes19

Other taxes:20

OMGW1101 10/03/12 ORG13

Interest Paid and Cash Contributions ORG14

HOME MORTGAGE INTEREST PAID

Check if NOT Lender’s Name 2012 2011on Form 1098

POINTS PAID ON LOAN TO BUY, BUILD, OR IMPROVE MAIN HOME

Check if NOT Lender’s Name 2012on Form 1098

SELLER FINANCED MORTGAGE

Identifying Individual’s Name AddressNumber

OTHER PERSON RECEIVING FORM 1098

Form 1098 Recipient’s Name Address

OTHER POINTS

Enter below any points paid on a home equity loan (other than to improve your main home), a loan for a second home, or a refinanced mortgage.

Loan Loan Length 2011 Points Lender’s Name Points Paid Date of LoanDeductedOver (years)

INVESTMENT INTEREST

2012 2011Investment interest (for example: margin interest, interest paid on loans used for property held for investment, etc)

OGMW4901 07/20/12 ORG14

Interest Paid and Cash Contributions (continued) ORG14

LIMITED HOME MORTGAGE DEDUCTIONIf your mortgage balance exceeded $1 million ($500,000 for married filing separately) or your home equity debt exceeded $100,000 ($50,000 for married filing separately) during 2012 complete the following:

Loan 1 Loan 2 Loan 3 Loan 4 Loan 51 Interest paid in 2012

Points paid in 2012Months loan outstanding

Principal pd on loan in 2012

2 Home acquisition debt:Beginning of year balanceAdditional borrowed in 2012

3 Home equity debt:Beginning of year balanceAdditional borrowed in 2012

4 Grandfathered debt: (before 10/14/1987)Beginning of year balanceAdditional borrowed in 2012

5 Fair market value of homes on date debt was last secured by home

6 Home acquisition and grandfathered debt on date last secured by home

CASH CONTRIBUTIONS

Check if Statement Name of Donee Organization 2012 2011

Exists for Gifts $250 or More

Charitable miles driven

Miles driven to deliver noncash contributions

Parking fees, tolls, and local transportation

OGMW4901 07/20/12 ORG14

Noncash Contributions ORG14A

OGMW1201 10/19/10 ORG14A

Name of Donee OrganizationCheck if

StatementExists for Giftsof $250 or More

Fair MarketValue

Prior Year FairMarket Value

A

B

C

D

E

F

G

H

I

Note: Complete sections below only if the total noncash contributions are more than $500.

Complete these columns only for each contribution over $500* Method for

Fair Market ValueDate of

Contribution Date Acquired(month, year)

HowAcquired***

YourCost

A

B

C

D

E

F

G

H

I

* Methods of determining FMV:Appraisal Capitalization of income Present value Thrift shopAverage share Comparative sales Replacement costCatalog Consignment shop Reproduction cost

** Type of Donated PropertyHousehold/clothing items Business equipment Intellectual propertyMotor vehicle, boat or airplane Business inventory Real property, conservation propertyArt, other than self-created Stock, publicly traded Real property, other than conservationArt, self-created Stock, other than publicly traded Other personal propertyCollectibles Securities, other than stock Other intangible property

***How Property was Acquired: Purchase, Gift, Inheritance, Exchange

Description of Donated Property Type** Address of Donee Organization

A

B

C

D

E

F

G

H

I

Copy 1

Miscellaneous Itemized Deductions ORG15

MISCELLANEOUS DEDUCTIONS (2% LIMITATION) 2012 2011

Employee Business ExpensesNote: If you have any travel, transportation, meals or entertainment expenses or your

employer reimbursed you for any of your job-related expenses, complete ORG17 for all your employee expenses.

Union and professional dues1

Professional subscriptions2

Uniforms and protective clothing3

Job search costs4

Other unreimbursed employee expenses:5

a

b

c

d

e

Other Expenses Subject to the 2% Limitation

Treat all MACRS assets for this activity as qualified Indian Yes Noreservation property?

Treat all assets acquired after August 27, 2005 as qualified GO Zone property? Regular Extension No

Treat all assets acquired after May 4, 2007 as qualified Kansas Yes NoDisaster Zone property?

Was this property located in a Qualified Disaster Area? Yes No

Check to code assets as Investment Expense

Use ORG50 to record dispositions.

Use ORG51A to enter additional assets.

Use ORG11a for investment expenses related to interest income.

Use ORG11b for investment interest related to dividend income.

Tax return preparation fees6

Investment counsel and advisory fees7

Certain attorney and accounting fees8

Safe deposit box rental9

IRA custodial fees10

Other expenses (list):11

a

b

c

d

e

OTHER MISCELLANEOUS DEDUCTIONS 2012 2011

Federal estate tax paid on income in respect of a decedent12

Amortizable bond premiums (acquired before 10/23/86)13

Gambling losses (to the extent of gambling income)14

Unrecovered investment in annuity15

Other miscellaneous deductions:16

OGMW1102 07/23/12 ORG15

Car And Truck Expenses ORG18(Employees use ORG17 ' Employee Business Expenses)

for:

GENERAL INFORMATION- Vehicle 1 Vehicle 2 Vehicle 3

Description of vehicle1

Date placed in service2

Enter detail on lines 3a and 3b, or total on line 3c:3

Ending mileage readinga

Beginning mileage readingb

c Total miles for the year (line 3a less line 3b)

Business miles4Total commuting miles5

STANDARD MILEAGE RATE Vehicle 1 Vehicle 2 Vehicle 3

6 Yes No Yes No Yes NoDo you qualify for standard mileage? (Preparer Use)

Is this a leased vehicle?7 Yes No Yes No Yes No

ACTUAL EXPENSES Vehicle 1 Vehicle 2 Vehicle 3

Gasoline, oil, repairs, insurance, etc8

Vehicle registration fee (excluding property tax)9

Vehicle lease or rental fee10

11 Inclusion amount (Preparer Use Only)

12 Depreciation (Preparer Use Only)

Parking fees, tolls, and local transportation13

Portion of vehicle registration fee based on value14

Interest on vehicle15

DEPRECIATION/DISPOSITIONS Vehicle 1 Vehicle 2 Vehicle 3

Cost or basis16

Is this an electric vehicle?17 Yes No Yes No Yes No

Is this qualified Indian reservation property?18 Yes No Yes No Yes No

19 Type of vehicle (Preparer Use)

20 Section 179 expense (Preparer Use)

21 Yes No Yes No Yes NoQualified Property for Economic Stimulus? (Preparer Use)

22 Yes No Yes No Yes NoQualified Property for Qualified Disaster Area? (Preparer Use)

23 Yes No Yes No Yes NoKansas Disaster Zone? (Preparer Use)

24 Reg Ext N/A Reg Ext N/A Reg Ext N/AQualified GO Zone Property (Preparer Use)100%/ 100%/ 100%/

30% No 30% No 30% No25 Percentage for SDA? (Preparer Use) 50% 50% 50%

26 Yes No Yes No Yes NoElect OUT of SDA? (Preparer Use)

27 Yes No Yes No Yes NoElect 30% in place of 50% SDA (Preparer Use)

Date sold28

Date acquired, if different from line 229

Sales price30

Expense of sale31

32 Gain/loss basis, if different (Preparer Use)

33 AMT gain/loss basis, if different (Preparer Use)

VEHICLE QUESTIONS Vehicle 1 Vehicle 2 Vehicle 3

Is another vehicle available for personal use?34 Yes No Yes No Yes No

Was vehicle available during off duty hours?35 Yes No Yes No Yes No

Was vehicle used primarily by a greater than 5% owner or 36related person? Yes No Yes No Yes No

Do you have evidence to support the business use claimed?37 Yes No

38 Yes NoIf yes, is the evidence written?

OGMW1601 07/10/12 ORG18

ORG19


for:






















Cost or basis16












Date sold28


Sales price30

Expense of sale31









OGMW1601 07/10/12 ORG18

ORG25


for:






















Cost or basis16












Date sold28


Sales price30

Expense of sale31









OGMW1601 07/10/12 ORG18

ORG27


for:






















Cost or basis16












Date sold28


Sales price30

Expense of sale31









OGMW1601 07/10/12 ORG18

ORG26


for:






















Cost or basis16












Date sold28


Sales price30

Expense of sale31









OGMW1601 07/10/12 ORG18

ORG48P

Business Income and Expenses ORG19

GENERAL INFORMATION

Check ownership1 Taxpayer Spouse Joint

Business name2

Business street address3a

b 1 City, State and Zip Code, or

Foreign country2

Principal business/profession4

Employer ID number5

6 Business code (Preparer Use Only)Yes No

Was this business fully disposed of in a fully taxable transaction during 2012?7

Accounting method:8

Cash Accrual Other (specify)

Method used to value closing inventory:9

Lower of Cost Other (explain)cost or market

Yes No

Was there a change in determining quantities, costs, or valuations between opening/closing inventory?10

(If yes, attach explanation)

Did you materially participate in the operation of this business during 2012?11

Did you start or acquire this business during 2012?12

Did you make any payments in 2012 that require you to file Forms 1099?13a

If yes, did you or will you file all the required Forms 1099?b

At-risk determination:14

Is all of the investment in this activity at risk?a

Is some of the investment in this activity not at risk?b

Did you have unallowed passive losses in 2011?15

Treat all MACRS assets for this activity as qualified Indian reservation property?16a

Treat all assets acquired after August 27, 2005 as qualified GO Zone property? Regular Extension Nob

Treat all assets acquired after May 4, 2007 as qualified Kansas Disaster Zone property?c

Was this business located in a Qualified Disaster Area?d

Complete ORG51 for Asset Acquisitions and ORG50 for Dispositions.

INCOME 2012 2011

Gross receipts or sales17

Returns and allowances plus other adjustments18

Other income (include federal/state gas tax credit/refund)19

2012 2011COST OF GOODS SOLD ' IF APPLICABLE

Inventory at beginning of year20

Purchases21

Items withdrawn for personal use22

Cost of labor (do not include your salary)23

Materials and supplies24

Other costs25

Inventory at end of year26

ORG19OGMW1712 07/09/12

Business Income and Expenses (continued) ORG19

EXPENSES 2012 2011

Business name

Advertising27

Car and truck expenses (complete ORG18)28

Commissions and fees29

Contract labor30

Depletion31

32 Depreciation and Section 179 deduction (Preparer Use Only)

Employee benefit programs:33

Employee health insurance premiumsa

Other employee benefit programsb

Insurance (other than health)34

Self-employed health insurance attributable to this business35

Interest:36

Mortgage paid to banks not reported to you on Form 1098a

Otherb

Legal and professional services37

Office expenses38

Pension and profit-sharing plans39

Rent or lease:40

Machinery and equipment (enter vehicle lease on ORG18)a

Other business propertyb

Repairs and maintenance41

Supplies (not included in cost of goods sold)42

Taxes and licenses not reported to you on Form 109843

Travel, meals, and entertainment:44

Travela

Meals and entertainment subject to 50% limitb

Meals subject to 80% limitc

Meals and entertainment not subject to limitd

Utilities45

Gross wages46

Other expenses:47

48 Expenses for business use of your home (Preparer Use Only)

Complete ORG20 for Business Use of Home.

Qualified pension plan start-up costs49

ORG19OGMW1712 07/09/12

Installment Sale Income ORG23

- Attach all closing documents if this is the year of sale.G

Was the property sold in this installment sale a rental or used in a trade or business? Yes No

Was the final installment received this year? Yes No

Description of property1Date acquired Date sold2 a 2 b

Check this box if ordinary gain from non-capital assetc

GROSS PROFIT INFORMATION(Complete for year of sale only.)

Selling price, including mortgages and other debts3Mortgages and other debts buyer assumed or took property subject to4Cost or other basis of property sold5Depreciation allowed or allowable6Commissions and other expenses of sale7

Was this property your main home?8 Yes No

CURRENT TAXABLE PORTION

Gross profit percentage9Payments received in current year10aInterest received in current yearb

Seller Financed Mortgage InformationPayer’s Name Address SSN or EIN11

Payments received in prior years (do not include interest)12

SALES TO RELATED PARTIES

Was the property sold to a related party after May 14, 1980?13a Yes No

b Yes NoIf yes, was the property a marketable security?

If yes, complete the rest of this form. If no, complete for year of sale and for 2 years after the sale.

If you received the final installment payment this year, do not complete the rest of this form.

Give the name, address, and taxpayer identification number of related party:cNameAddress

StateCity ZIP codeIdentifying number

Did the related party, during this tax year, resell or dispose of the property?14 Yes No

If no, do not complete the rest of this form.

Answer yes to no more than one of the following questions.

Was the second disposition more than two years after the first disposition (other than dispositions of15amarketable securities)? Yes No

If yes, give date of disposition

Was the first disposition a sale or exchange of stock to the issuing corporation?b Yes No

Was the second disposition an involuntary conversion where the threat of conversion occurred after thecfirst disposition? Yes No

Did the second disposition occur after the death of the original seller or buyer?d Yes No

Can it be established to the satisfaction of the IRS that tax avoidance was not a principal purpose foreeither disposition? Yes No

If yes, give explanation

If you answered no to all questions 15a through 15e, enter sales price of the property sold by related party16(attach Form 6252 for year of first sale)

OGMW2101 09/10/12 ORG23

Rent and Royalty Income and Expenses ORG25

BASIC PROPERTY INFORMATION

Property description:

If type is other, enter a description:Property type: *

Location (street address):

City: State: Zip:

If a foreign address: Foreign province or state:Foreign postal code: Foreign Country:

Check property owner1 Taxpayer Spouse Joint

Yes NoDid you make any payments that would require you to file Form(s) 1099?2 a

b If yes, did you or will you file all required Forms(s) 1099?

Enter the ownership percentage (if not 100%)3 a

If not 100%, are you reporting 100% of the income and expenses?b

4 Is this a rental property? (If yes, answer questions 5 through 11; if no, skip to question 12.)

Did you have personal use of this property or rent it for part of the year at less than fair rental value?56 For all rental properties, enter the number of days during 2012 that:

The property was rented at fair rental valueaThe property was used personally or rented at less than fair rental valuebYou owned the property, if not the entire yearc

Does this rental have multiple living units and you live in one of the units?7 a

b If yes, enter percentage of rental useDid you actively participate in this property’s management during 2012?8

Did you materially participate in this property’s management during 2012?9

Do you want to treat this property as non-passive?10Did this property have unallowed passive losses in 2011?11

Did you dispose of this property in a fully taxable transaction?1213 Check this box if some of this investment was not at-risk

Treat all MACRS assets for this activity as qualified Indian reservation property?14aTreat all assets acquired after August 27, 2005 as qualified GO Zone property?b Regular Extension No

Treat all assets acquired after May 4, 2007 as qualified Kansas Disaster Zone property?cWas this activity located in a Qualified Disaster Area?d


INCOME 2012 201115 Rents or royalties received

5 LandSingle family residence* Property Types: 16 RoyaltiesMulti-family residence27 Self-rentalVacation/short-term rental38 OtherCommercial4

ORG25OGMW2301 08/16/12

Rent and Royalty Income and Expenses (continued) ORG25

EXPENSES 2012 2011

Property location

Advertising16

Automobile (complete ORG18 for autos)a17

Travelb

Cleaning and maintenance18

Commissions19

Mortgage insurance premiums ' qualifieda20

Other insuranceb

Legal and professional fees21

Management fees22

Mortgage interest paid to banks ' qualifieda23

Mortgage interest paid to banks ' otherb

Other interest24

Repairs25

Supplies26

Real estate taxesa27

Other taxesb

Utilities28

Other expenses:29

a b c d e a30 Depreciation and Section 179 deduction (Preparer Use Only)

b Depletion (Preparer Use Only)

ORG25OGMW2301 08/16/12

Farm Rental Income and Expenses ORG26

GENERAL INFORMATION

Name of this activity

Check ownership1 Taxpayer Spouse Joint

Employer identification number2

Yes No

Was this farm fully disposed of in a fully taxable transaction during 2012?3

Did you actively participate in the operation of this business during 2012?4

Real estate professionals:5

Did you materially participate in the operation of this business during 2012?

At-risk determination:6

Is all of the investment in this activity at risk?a


Did you receive a subsidy in 2012?c


Treat all MACRS assets for this activity as qualified Indian reservation property?8 a

Treat all assets acquired after August 27, 2005 as qualified GO Zone property?b Regular Extension No


Was this farm rental located in a Qualified Disaster Area?d


2012 2011FARM RENTAL INCOME ' BASED ON PRODUCTION

Income from production of livestock, produce, grains and crops9

Total distributions received from cooperatives10

Taxable amount of distributions from cooperatives11

Total agricultural program payments12

Taxable amount of agricultural program payments13

Commodity Credit Corporation (CCC) loans under election14

CCC loans forfeited/repaid with certificates15

Taxable amount of CCC loans forfeited/repaid16

Crop insurance proceeds/federal crop disaster payments received in 201217

Taxable crop insurance proceeds/federal crop disaster payments18

Crop insurance proceeds/federal crop disaster deferred from 201119

Other income ' include federal/state gas tax credit/refund20

ORG26OGMW2412 08/03/12

Farm Rental Income and Expenses (continued) ORG26

2012 2011EXPENSES ' FARM RENTAL PROPERTY

Name of this activity

Car and truck expense (complete ORG18)21

Chemicals22

Conservation expenses23

Custom hire (machine work)24

25 Depreciation and Section 179 deduction (Preparer Use Only)

Employee benefit programs other than pension and profit-sharing plans26

Feed27

Fertilizers and lime28

Freight and trucking29

Gasoline, fuel, and oil30

Insurance (other than health)31

Interest:32

Mortgage (paid to banks, etc)a

Otherb

Labor hired33


Rent or lease:35

Machinery, equipment, etc (for vehicle rent or lease, see ORG18)a

Other (land, animals, etc)b


Seeds and plants37

Storage and warehousing38

Supplies39

Taxes40

Utilities41

Veterinary fees and medicine42

Other expenses (specify):43


ORG26OGMW2412 08/03/12

Farm Income and Expenses ORG27

GENERAL INFORMATION

Name of this farm

Check ownership Taxpayer Spouse Joint1Principal product2Employer identification number3Agricultural activity code (Preparer Use Only)4Accounting method Cash Accrual5

Yes No

Was this farm fully disposed of in a fully taxable transaction during 2012?6

Did you materially participate in the operation of this business during 2012?7

Did you make any payments in 2012 that would require you to file Form(s) 10998

If ’Yes,’ did you or will you file all required Forms 1099?9At-risk determination:10Is all of the investment in this activity at risk?a


Did you receive a subsidy in 2012?c


Treat all MACRS assets for this activity as qualified Indian reservation property?12a

Treat all assets acquired after August 27, 2005 as qualified GO Zone property?b Regular Extension No


Was this farm located in a Qualified Disaster Area?d

2012 2011FARM INCOME ' CASH METHOD

Sales of livestock, etc purchased for resale13

Cost/Basis of livestock, etc purchased for resale14Sales of livestock, produce, grains, etc raised15

16a Total distributions received from cooperativesTaxable amount of distributions from cooperativesbTotal agricultural program payments17aTaxable amount of agricultural program paymentsbIf you received social security retirement or disability benefits, enter any Conservation cReserve Program payments included on line 15Commodity Credit Corporation (CCC) loans under election18aCCC loans forfeited/repaid with certificatesbTaxable amount of CCC loans forfeited/repaidcCrop insurance proceeds/federal crop disaster payments received in 201219aTaxable crop insurance proceeds/federal crop disaster paymentsbCrop insurance proceeds/federal crop disaster payments deferred from 2011cCustom hire (machine work) income20

21 Other income ' include federal/state gas tax credit/refund

2012 2011FARM INCOME ' ACCRUAL METHOD

Sales ' livestock, produce, grain, other products22Total distributions received from cooperatives23aTaxable amount of distributions from cooperativesbTotal agricultural program payments24aTaxable amount of agricultural program paymentsbCommodity Credit Corporation (CCC) loans under election25aCCC loans forfeited/repaid with certificatesbTaxable amount of CCC loans forfeited/repaidcCrop insurance proceeds and certain disaster payments26

27 Custom hire (machine work) income

Other income include federal/state gas tax credit/refund28OGMW2512 09/07/12 ORG27

Farm Income and Expenses (continued) ORG27

2012 2011FARM INCOME ' ACCRUAL METHOD (continued)

Cost of Goods Sold:29

Beginning inventory ' livestock, produce, etca

Cost of livestock, produce, etc purchasedb

Ending inventory ' livestock, produce, etcc

Check if you used the unit-livestock price method or 30farm-price method to value inventory

Complete ORG51 for acquisitions and ORG50 for dispositions.

2012 2011FARM EXPENSES ' CASH AND ACCRUAL METHODS

Name of this farm

Car and truck expense (complete ORG18)31

Chemicals32

Conservation expenses33

Custom hire (machine work)34

Depreciation and Section 179 deduction (Preparer Use Only)35

Employee benefit programs other than pension and profit-sharing plans36

Feed37

Fertilizers and lime38

Freight and trucking39

Gasoline, fuel and oil40

Insurance (other than health)41a

Self-employed health insurance attributable to this farm businessb

Interest:42

Mortgage (paid to banks, etc)a

Otherb

Labor hired43


Rent or lease:45

Machinery, equipment, etc (for vehicle rent or lease, see ORG18)a

Other (land, animals, etc)b


Seeds and plants purchased47

Storage and warehousing48

Supplies purchased49

Taxes50

Utilities51

Veterinary, breeding and medicine52

Other expenses (specify):53


OGMW2512 09/07/12 ORG27

State Information Worksheet ORG60

GENERAL INFORMATION

Taxpayer Spouse

Enter your state of residence1

Check the appropriate box if:2 Taxpayer Spouse

Full year residenta

Part year resident Date of entry: Date of exit:b

Nonresidentc

Resident locality:3

County: School district: School district number:4

Taxpayer Spouse

Check if disabled5

STATE CREDITS

(for example, solar energy, carpool)6 Description/type of credit Code Amount

a

b

c

d

e

VOLUNTARY STATE CONTRIBUTIONS

(for example, wildlife, cancer)7 Description/type of contribution Code Amount

a

b

c

d

e

MISCELLANEOUS QUESTIONS

Yes No

Did you file a state return for 2011?8

Do you want state forms and instructions sent to you next year?9

Do you want any applicable penalty and interest calculated and added to the return?10

How do you want your state refund (if any) applied?11

Refunded Apply to 2013 estimates Apply to 2013 taxesa b c

Additional state information:12

ORG60OGMW8501 07/10/12

Tax Organizer Short

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