TAX YEAR 2012

INCOME TAX GUIDE & CLIENT ORGANIZER

Gail Miller Anderson Tax & Financial Services 9326 Swinton Avenue

North Hills, CA 91343

Phone: (818) 891-8194

Fax: (818) 894-3234

Email: gail@gmataxes.com

Website: www.gmataxes.com

This questionnaire is provided to assist you in compiling the necessary information to prepare your tax

return accurately and to assure that all income, credits and allowable deductions are properly taken into

account. While every attempt has been taken to cover all cases, you may have additional information that

requires review. If so please note your questions and return them with this form.

Please include your last year’s return (only if you are a new client), all W-2, 1099 and K-1 forms.

Upon completing this Tax Organizer, please read and sign below.

I have gathered and submitted the information contained in this questionnaire and to the best of my

knowledge it is true, correct, and complete.

Signed: _______________________________________________________

PERSONAL INFORMATION

□ Check here if there are no changes from last year □Married during year (date______________) □ Lost a dependent

□Divorced during year (date______________) □ Gained a dependent

□ Spouse died during year (date______________) □ Legally blind? □ You □ Spouse

□ Moved during year (date________________) □ Disabled? □ You □ Spouse

Telephone: Home__________________ Office (H)_______________ Office (W)________________

Taxpayer: __________________ ___ __________________________________ First Name M.I. Last Name

Occupation _____________________ Social Security Number ________________

Street Address _______________________________________________________

City ________________________________ State ______ Zip Code __________

Spouse: ____________________ ___ __________________________________ First Name M.I. Last Name

Occupation _____________________ Social Security Number ________________

Street Address _______________________________________________________

City ________________________________ State ______ Zip Code __________

Dependents:

□Check here if no change from last year. You must provide a Social Security # for all dependents.

Children living at home: (Social Security Numbers are required for all dependents.)

Name (First M.I. Last) Social Security Number Birth date

1. ___________________________________________ _____________________ ___________

2. ___________________________________________ _____________________ ___________

3. ___________________________________________ _____________________ ___________

4. ___________________________________________ _____________________ ___________

Other dependents: (Social Security Numbers are required for all dependents.) Month % of

in Support Name (First M.I. Last) SSN DOB Relationship Home by you

1. _____________________________ ______________ _________ __________ ______ _______

2. _____________________________ ______________ _________ __________ ______ _______

3. _____________________________ ______________ _________ __________ ______ _______

If filing Head of House and qualifying person is your child but not your dependent above, enter child’s

name here: ________________________________________________________________________

INCOME

H* Withheld Taxes**

W Name of Employer Gross Earnings Federal State Local

__ ___________________________ _____________ ___________ ____________ ___________

__ ___________________________ _____________ ___________ ____________ ___________

__ ___________________________ _____________ ___________ ____________ ___________

__ ___________________________ _____________ ___________ ____________ ___________

__ ___________________________ _____________ ___________ ____________ ___________

* H=Husband, W=Wife ** Include all copies of W-2 wage statements.

INTEREST INCOME

T/S/J* Name of Payer Interest Amount Exempt

____ ______________________________________ ____________________ __________________

____ ______________________________________ ____________________ __________________

____ ______________________________________ ____________________ __________________

____ ______________________________________ ____________________ __________________

____ ______________________________________ ____________________ __________________

* T=Taxpayer, S=Spouse, J=Joint

DIVIDEND INCOME

Total Ordinary Qualified Capital

T/S/J* Name of Payer Dividends Dividends Gains Non-taxable

____ _____________________ _____________ _____________ _____________ _____________

____ _____________________ _____________ _____________ _____________ _____________

____ _____________________ _____________ _____________ _____________ _____________

____ _____________________ _____________ _____________ _____________ _____________

____ _____________________ _____________ _____________ _____________ _____________

* T=Taxpayer, S=Spouse, J=Joint

CAPITAL GAINS AND LOSSES

Date Date Sale Cost of

T/S/J* Description Acquired Sold Price Basis

____ _________________________________ __________ __________ __________ __________

____ _________________________________ __________ __________ __________ __________

____ _________________________________ __________ __________ __________ __________

____ _________________________________ __________ __________ __________ __________

____ _________________________________ __________ __________ __________ __________

* T=Taxpayer, S=Spouse, J=Joint

MISCELLANEOUS INCOME It is important to list the items below, even if not taxable. Show losses in brackets < >.

Amount Child Support payments/assistance ___________

Jury duty (or other public services) ___________

Tips/gratuities (not reported to IRS) ___________

Prizes/awards/lottery winnings (explain) ____________________________ ___________

Commissions/bonuses (not reported on W-2) ___________

Pensions/annuities (furnish Form 1099-R or details) ___________________ ___________

IRA/Keogh/SEP/SIMPLE Distribution ___________

Veteran’s benefits/disability income ___________

Business/self employment/farm/rental (furnish a schedule) ___________

Unemployment compensation ___________

Barter and exchanges ___________

Scholarship and fellowships ___________

Workers compensation/loss of time payments ___________

Other (explain) ________________________________________________ ___________

Other (explain) ________________________________________________ ___________

SOCIAL SECURITY

Use amount reported in box 5 of Social Security Benefit Statement (SSA-1099) and attach a copy.

Taxpayer ________________ Spouse________________

INCOME TAXES PAID OR REFUNDED

If someone else prepared your return last year please provide a copy.

Balance paid on last year’s tax return: Federal __________ State___________ Local ___________

Refunds received from last year’s return: Federal __________ State___________ Local ___________

Estimated Taxes Paid (if not paid by due date list actual date paid)

1st Qtr dated 4/15 Federal __________ State___________ Local ___________ Date ___________

2nd

Qtr dated 6/15 Federal __________ State___________ Local ___________ Date ___________

3rd

Qtr dated 9/15 Federal __________ State___________ Local ___________ Date ___________

4th Qtr dated 1/15 Federal __________ State___________ Local ___________ Date ___________

DEDUCTIONS AND CREDITS Check the following deductions and credit lists carefully. From your cancelled checks, paid invoices, or

other records, determine your deductions/expenditures during the past year. Enter the amount in the

space provided after each deduction item. Also enter items you think are deductible that do not appear on

the deduction list so it can be determined whether they are allowable. Keep all paid receipts, contracts,

and cancelled checks for these deductions at least three years after the due date for filing.

MEDICAL – Only the amount of un-reimbursed medical expenses in excess of 7.5% of Adjusted Gross

Income is allowed.

Prescription & Drugs (Doctor Prescribed only) ____________________

Insulin (General Drugs not allowed) ____________________

Eye Glasses/Contact Lenses ____________________

Hearing Aids & Supplies ____________________

X-Ray/Lab Fees ____________________

Ambulance/Paramedics ____________________

Nurses (Board & Fees) ____________________

Medical Aid Rental ____________________

Equipment (Prescribed) ____________________

Nursing Home Medical Care ____________________

Medical Part B Service Payments ____________________

Smoking Cessation Program ____________________

Medical Insurance Code: Pre-Tax ________________ After Tax ______________

Insurance-Paid by you ____________________

Group Health Plan (Deducted by Salary) ____________________

Medicare Premiums ____________________

Other Insurance ____________________

Other: _______________________________________ ____________________

Other: _______________________________________ ____________________

TAXES

Description of Tax State Amount

Real Estate Taxes (home) ______ ______________

Real Estate Taxes (other) ______ ______________

Property Tax rebates ______ ______________

Personal Property Tax ______ ______________

Auto License ______ ______________

State or Local Income Taxes ______ ______________

Sales Tax (other) ______ ______________

INTEREST Amounts, names and social security numbers must match Form 1098 issued by financial institution.

Amount

Primary Residence paid to financial institution _______________

Home mortgage paid to individuals _______________

Name _____________________________________________

Address ___________________________________________

SSN _________________________

Second Residence paid to financial institution _______________

Home mortgage paid to individuals _______________

Name _____________________________________________

Address ___________________________________________

SSN _________________________

Other: ____________________________________________________________________

Other Loans: Amount Home Improvement _______________

Interest on investments _______________

Points paid to acquire new mortgage _______________

Interest on school loans _______________

MOVING EXPENSES

If your residence has changed because you transferred to a new place of employment or because you

change employers, the cost of the move may be deductible. The information below is necessary to

determine amount allowable.

1. Distance from former residence to new business location _________ miles

2. Distance from former residence to former business location _________ miles

3. Subtract line 2 from 1 _________ miles

If line 3 is less than 50 miles stop here, you may not deduct moving expenses.

Date new employment began? ________________ Transportation of family: Amount

Expenses for train, bus, air travel, auto (include mileage), etc. ___________

Cost of lodging en route ___________

Cost of moving furniture & personal effects (date of move) ____/____/_______ ___________

Moving expenses paid by employer ___________

CASUALTY OR THEFT LOSSES From fire, storm, theft, etc. If more than one, provide similar details for each.

Kind of Property or item _______________________________ Date acquired ___/____/____

Cost or Basis _________________ Insurance reimbursement _____________________

Describe how or what happened ___________________________________________________

Fair market value-before _________________ Fair market value-after _______________

Kind of Property or item _______________________________ Date acquired ___/____/____

Cost or Basis _________________ Insurance reimbursement _____________________

Describe how or what happened ___________________________________________________

Fair market value-before _________________ Fair market value-after _______________

CONTRIBUTIONS Charitable contributions of $250.00 or more at one time require written acknowledge from the charitable

organization. This information must be obtained prior to filing your tax return. In addition, all cash

contributions require substantiation.

Church and religious organizations Amount

Church: Name _______________________________________ _______________

Other Religious: Name _________________________________ _______________

Other charitable organizations Amount

Name ______________________________________________ _______________

Name ______________________________________________ _______________

Name ______________________________________________ _______________

Name ______________________________________________ _______________

Name ______________________________________________ _______________

Non-cash contributions Name of organization Item(s) donated Date Value

_______________________ ________________________________ ___________ ___________

_______________________ ________________________________ ___________ ___________

_______________________ ________________________________ ___________ ___________

_______________________ ________________________________ ___________ ___________

Volunteer work - mileage (church, hospital, or non-profit organization) Name of organization Activity Performed Parking Miles Driven

_______________________ ________________________________ ___________ ___________

_______________________ ________________________________ ___________ ___________

_______________________ ________________________________ ___________ ___________

Meals, lodging, and other expenses may also be allowed-list full detail ________________________________________________________________________________ ________________________________________________________________________________

MISCELLANEOUS DEDUCTIONS Tax preparation fees ________________ Safe deposit box fees ________________

Union Dues ________________ Professional dues ________________

Dues/Subscriptions ________________ Tools/shoes/glasses ________________

Uniforms (cost & upkeep) ________________ Employment agency fees ________________

Second job mileage _______________ Job hunting expenses ________________

Handicapped job expenses _______________ Job related education ________________

Investment expenses _______________

Telephone _______________ Explain requirement ________________________________________

Alimony Paid _____________ Paid to ______________________________ SSN _______________

HOUSEHOLD EMPLOYEES Name of person Address ID# Amount paid _______________________ ____________________________ _________________ __________

_______________________ ____________________________ _________________ __________

_______________________ ____________________________ _________________ __________

_______________________ ____________________________ _________________ __________

CHILD AND DEPENDENT CARE

If you or your spouse paid someone to care for your child or other qualifying person so either of you

could work or look for work, you may be able to take a credit for child and dependent care expenses. A

qualifying person is any dependent child under age 13 or your disabled spouse who is not able to care for

himself or herself.

Childcare Provider Address Phone # ID# Amt Paid ____________________ ____________________________ ____________ ___________ ________

____________________ ____________________________ ____________ ___________ ________

____________________ ____________________________ ____________ ___________ ________

OFFICE IN HOME

Justified for business or professional use by: □ Taxpayer □ Spouse □ Both

Date acquired ____________ Cost of land ____________ Cost of home _____________

Cost of improvements _____________ Repair/maintenance _______________

Interest ____________ Utilities ____________ Taxes _____________ Insurance ___________

Other: Description ______________________________________________ Amount _____________

Square footage of living area ________________ Square Footage of office area _______________

EMPLOYEE BUSINESS EXPENSES

For outside salespersons or individuals not fully reimbursed by employer.

Vehicle Mileage (odometer reading) Vehicle 1 Vehicle 2 End of year ________________ __________________

Beginning of year ________________ __________________

Business Miles ________________ __________________

Commuting Miles ________________ __________________

Personal Miles ________________ __________________

Total Miles Driven ________________ __________________

Vehicle expenses (If both husband and wife have deductions use vehicle 1 for husband, 2 for wife)

Vehicle 1 Vehicle 2 Vehicle 1 Vehicle 2 Gas and Oil _________ _________ Parking and Tolls _________ _________

Washing and Lube _________ _________ Licenses _________ _________

Repair/maintenance _________ _________ Lease payments _________ _________

Tires/accessories _________ _________ Interest _________ _________

Insurance _________ _________ Garage rent _________ _________

Make Year Model Date acquired Cost or basis Vehicle 1 _________ _________ _________ _____________ __________________

Vehicle 2 _________ _________ _________ _____________ __________________

Travel Expenses: Number of nights away from home _____________

Taxpayer Spouse Taxpayer Spouse Transportation ___________ ___________ Auto Rentals ___________ __________

Lodging ___________ ___________ Cabs, Bus, etc ___________ ___________

Meals and tips ___________ ___________

Other business expenses: (must have supportive record for entertainment and gifts)

Taxpayer Spouse Taxpayer Spouse Entertainment ___________ ___________ Commissions ___________ ___________

Tickets/events ___________ ___________ Gifts/cars ___________ ___________

Postage/freight ___________ ___________ Office supplies ___________ ___________

Phone ___________ ___________ Dues/subscriptions ___________ ___________

Furniture/equipment ___________ ___________ Required education ___________ ___________

Total of above expenses reimbursed: Taxpayer ___________ Spouse _____________

Did you purchase any other business equipment during the year? □ Yes □ No

If yes, provide a list of dates bought, cost and description and trade-in deals. I have adequate records and

sufficient evidence to support the use of vehicles and deductions listed above.

Signed: __________________________________ ______________________________________

EARNED INCOME CREDIT

If you have more than three qualifying children, only list the three youngest children.

Child’s name DOB Relationship # of months lived full –time student (First, MI, Last) in your home under the age of 24

_________________________ ___________ ____________ ______________ □ Yes □ No

_________________________ ___________ ____________ ______________ □ Yes □ No

_________________________ ___________ ____________ ______________ □ Yes □ No

PARTNERSHIP, S-CORP, ESTATES AND TRUSTS

Enclose your copies of Schedules K-1, returns or other documents. Enter name, address, and Federal

Employer Identification Number from any partnership, joint venture, limited liability company, S

corporation, estate or trust, for which you do not have the Schedule K-1.

__________________________________________________________________________________

__________________________________________________________________________________

QUESTIONS

For “yes” answers, supply details.

1. Were you eligible to be claimed as a dependent on another tax return?

□ Yes □ No __________________________________________________________________

2. Were you notified by the IRS, State or City of any changes to any prior year’s tax return?

□ Yes □ No __________________________________________________________________

3. Did you make any gifts of over $13,000 in value to any individual?

□ Yes □ No __________________________________________________________________

4. Did you have living expenses in a foreign country as a result of income earned abroad?

□ Yes □ No __________________________________________________________________

5. Do you have any worthless stocks or uncollectible bad debts?

□ Yes □ No __________________________________________________________________

6. Did you receive any reimbursement (medical, insurance) for any expense claimed as a deduction on

a prior tax return? □ Yes □ No _________________________________________________

7. Do you expect any significant changes in income or tax liabilities in the coming year?

□ Yes □ No __________________________________________________________________

8. Did you receive any income from a source not listed in this booklet?

□ Yes □ No __________________________________________________________________

9. Do you wish to designate (at no cost to you) $3.00 of your taxes to the Presidential Campaign Fund?

□ Yes □ No _________________________________________________________________

OTHER CREDITS

Did you pay college tuition for yourself, spouse, or dependent?

□ Yes □ No (If “yes” attach Form 1098-T and the student account record for each student.)

Did you make any energy efficient improvements to your principal residence, such as insulation,

windows, doors, furnace, etc.?

□ Yes □ No (If “yes” please provide details on a separate sheet and include receipts.)

Did you purchase an electric vehicle or electric plug-in vehicle?

□ Yes □ No (If “yes” attach manufacturer’s certification and purchase statement.)

CHECK LIST AND CERTIFICATION

Review amounts and details listed in this tax booklet for completeness and include the following items (as

applicable to your return) when presenting your information for preparation of your tax returns:

□ 1. This completed Client Organizer

□ 2. All W-2 forms

□ 3. Estimated tax forms

□ 4. Partnership, limited liability companies, joint ventures, S corporation estates and trust documents

□ 5. Form(s) 1099 indicating dividend and interest income

□ 6. Buy/sell statements to cover stock sales, real estate transactions, and installment sales

□ 7. Copies of sales contracts to determine finance charges

□ 8. If you are a new client, provide copies of last year’s tax return

□ 9. Check if payroll reports were filed for household help

□ 10. Check if you have disability income

□ 11. Check if you were audited during the past year. Enclose results.

OTHER QUESTIONS OR COMMENTS Please note any other questions or comments on a separate piece of paper and keep it with this booklet.

I have reviewed the information contained in this booklet and to the best of my knowledge it is true, correct, and complete.

Signed: ____________________________________________________

When complete, print this form out and sign the appropriate boxes. Then mail it to the address below, fax it to (818) 894-3234, email to gandtanderson@yahoo.com or drop it off at my office:

Gail Miller Anderson Tax & Financial Services 9326 Swinton Avenue

North Hills, CA 91343

CALL FOR AN APPOINTMENT: (818) 891-8194