Income Tax Organizer - Section Two

Other Income
Interest - Attach 1099 Forms

Payor Amount
1 $
2 $
3 $
4 $

Dividends - Attach 1099 Forms

Payor Total Capital Gain Ordinary Dividend
1 $ $ $
2 $ $ $
3 $ $ $
4 $ $ $

State Tax Refund
 Amount Received $___________________

Check if you did not itemize on your federal tax return last year.

Capital Gains (stocks, bonds, other investment property)

Description Date Acquired Date Sold Sales Price Cost or Basis
1     $ $
2     $ $
3     $ $
4     $ $

Pensions/IRA Distributions - Attach Form 1099 / W-2s

Payor   Gross
Distribution
Taxable
Amount
1 $ $
2 $ $


Check box if Federal or State Tax was withheld

Alimony Received
Payor __________________________________________  Amount $___________

Payor's Social Security #____________________________

Unemployment Received
Taxpayer Amount $________________

Spouse Amount $_________________

Social Security Benefits 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 _________________


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Hickman & Associates, CPAs, P.C.
Certified Public Accountants
Mailing Address: P.O. Box 305140
Nashville, TN 37230
Street Address: 2451 Atrium Way
Nashville, TN 37214

(615) 391-2930 • Fax: (615) 316-5416
E-mail: kevin@kehcpa.biz

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