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Missing Tax Information Sheet

Prepared by: __________________

Date:  ___________________

Name:  __________________

Email:___________________

Tax Year: __________

Home Phone: ________________________

Work Phone: _______________________

Fax: __________________________

Cell: ___________________________

The following information is required to complete your return:

W-2's

Pension/Social Security Income

__________________________________

__________________________________

__________________________________

__________________________________

__________________________________

__________________________________

Interest Income

Dividend Income

________________________

_________

________________________

________

________________________

_________

________________________

________

________________________

_________

________________________

________

K-1 Forms/Brokerage Statements:

______________________

__________________________

_______________________

______________________

__________________________

_______________________

Other Income:

______________________

_____________

_________________________

__________

Deductions

Medical:    ____________________

Real Estate Taxes:

Interest Paid:

______________________

______________

_______________________

___________

______________________

______________

_______________________

___________

______________________

______________

_______________________

___________

Personal Property Tax:

Charitable Contributions:

______________________

______________

_______________________

___________

______________________

______________

_______________________

___________

______________________

______________

_______________________

___________

Other Taxes:

Other Deductions:

______________________

______________

_______________________

___________

______________________

______________

_______________________

___________

______________________

______________

_______________________

___________

Other Items

Estimated Tax Payments:

Date

Amount

Date

Amount

Date

Amount

Date

Amount

Federal: ______________

____

_______

____

_______

____

_______

____

_______

State: _______________

____

_______

____

_______

____

_______

____

_______

Escrow Settlement/Closing Statement For:

______________________________________

Dependent Information

Name: _______________

DOB: ________

SSN:____________

Name: _______________

DOB: ________

SSN:____________

Name: _______________

DOB: ________

SSN:____________

Schedule C Information

________________________________________________________

 

________________________________________________________

 

________________________________________________________

 

________________________________________________________

Other Information

________________________________________________________

 

________________________________________________________

 

________________________________________________________

 

________________________________________________________

 

________________________________________________________