2016 Tax Return Organizer

Clemons and Associates, Inc.
Income Tax Professionals
2016 Income Tax Organizer

Use this handy checklist to organize your tax filing documents and include with
Fax or drop-off package

Name____________________________________      S.S. No._______________________     Birthdate_______________

Spouse___________________________________      S.S. No._______________________     Birthdate_______________

Address, City, State, Zip____________________________________________________________________________

E-mail Address ________________________________________________________________________________

Phone: Home_______________________Work______________________________Cell_____________________

Occupation: Taxpayer________________________________ Spouse____________________________________________

Check One:  ___Single   ___Divorced     ___Married, living with spouse    ___Married, separated from spouse
         ___ Surviving Widow/Widower  (Spouse’s year of death______________)

Dependents (Remember, this includes all related individuals living in your household for whom you provide more than 50% support.  Dependent parents need not live with you).  Attach an additional page if necessary.

Full Name                                        Soc. Sec. Number          Relationship         Date of Birth

___________________________                 ________________       ____________     ______________

___________________________                 ________________       ____________     ______________

___________________________                ________________        ____________     ______________

The following checklist could lead to helpful deductions.  Please check all that apply and provide supporting information.

__________ Did you have Health Insurance coverage for every member of your household for the entire year?

__________ Did you receive any notices from the IRS or the state taxing agency?  If yes, please attach.

__________ Do you or your spouse have any kind of pension, profit sharing, 401K, retirement, Keogh, IRA (Traditional, Roth or Educational), or  tax sheltered annuity plan?  If so, circle above which one(s). 

__________ Did you withdraw IRA or Pension funds during the year?  If so, please provide all forms 1099-R.
__________ Did you move more than 50 miles from your previous home because of a new workplace?

__________ Did you make payments on a student loan?

__________ Did you contribute to a State-Sponsored 529 Education Plan?

Members of your family (including yourself) attending college may be eligible for Education Credits. Students in grades
K through 12 may qualify for State of Illinois credits.  Number of Students - College________   (Provide form 1098-T for each student). K thru 12_________ (Provide statements of tuition and fees paid).


__________ Did you purchase a car, boat or motor home during the tax year? 

__________ Did you have any losses due to theft, fire, flood or any other casualty?  If so, attach an itemized list including original cost, value on date of loss and any insurance reimbursements.

__________ Did you have any large medical expenses not reimbursed by insurance, including physicians, hospitals, eyeglasses, dental care, medical transportation and insurance premiums?

__________ Did you make any cash or non-cash (clothing, furniture, automobile, etc.) contributions to churches or qualified charities?  Did you use your automobile to do volunteer work?

__________ Do you own a home?  If yes, please provide statements of mortgage interest and property taxes paid (Forms 1098).  Include 1st and 2nd mortgages as well as equity loans and/or any foreclosure related documents. 

__________ Did you buy or sell a home? Refinance your home?  If yes, please provide a copy of closing statements. 

__________ Did you make any energy efficient improvements to your home (windows, exterior doors, furnace, boiler, hot water heater, etc)?

__________ Are you a Teacher, Teacher Aide or Principal? 

__________ Did you pay for day care for child(ren) or other dependents?  Please provide caregiver’s name, address, Social Security or Employer ID Number and amount paid. 

__________ Did you have employee-related expenses not reimbursed by your employer?  (Including travel, use of home office and automobile).  Call us for a specialized organizer.

__________ Do you own rental property?  Please attach itemized list of rents received and expenses paid by you for each property owned or call us for a specialized organizer.

__________ Did you have income from a small business?  Please attach list of income received and expenses paid, including business use of home and automobile or call us for a specialized organizer.

__________ Did you sell any stocks, bonds or mutual funds?  If so, please provide all year-end document summaries provided by your broker.

__________ Did you receive unemployment benefits? 

__________ Did you have any gambling income or losses?  (Loss deductions limited to amount of winnings).


Be sure to bring all of the following documents that apply to you and your spouse.

__________ W-2 Forms.  Wage statements.  Be sure to include all W-2’s for yourself and your spouse.

__________ 1099-G Forms.  Unemployment Compensation.

__________ 1099-R and SSA-1099 Forms.  Retirement and Social Security benefits received.

__________ 1099-INT Forms.  Statements of interest paid to you from bank and credit union savings accounts.

__________ 1099-DIV Forms.  Statements of dividend income you received.

__________ 1095-A. Health Insurance Marketplace Statement.

__________ Other Benefits/Income Received.  Enclose all 1099’s, K-1’s and other Miscellaneous Forms.


If you need Organizers specifically for Business, Rental Property or employee related expenses, please give us a call at 773-783-4829. Or you can email us at rclemons@msn.com. We will be happy to send it to you.