| YES |
NO |
|
| |
|
Were there
any births, adoptions, marriages, divorces, or deaths in your
immediate family during the year? |
| |
|
Are any of your unmarried children, who
might be claimed as dependents, 19 years of age or older? |
| |
|
Can you be claimed as a dependent on
another person's tax return? |
| |
|
Did you or your spouse receive any
disability income during the year? If yes, enter amount $__________________. |
| |
|
Did you sell any stocks, bonds, or other
investment property during the year? If yes, have you listed the description, date
acquired, date sold, sales price, cost or other basis in Section Two of this organizer? |
| |
|
Did you receive any K-1s from
partnerships, estates, trusts, LLCs? If so, please attach. |
| |
|
Did you purchase, sell, or refinance your
principal home or your second home, or get a home equity loan during the year? If yes,
please attach escrow papers and other relevant information. |
| |
|
Did you or your spouse "roll
over" a profit sharing or retirement plan distribution into another plan? If yes,
enter amount $_________________, and attach Form 1099-R. |
| |
|
Does anyone owe you money which has
become uncollectable? |
| |
|
Did you incur a loss because of damaged
or stolen property? |
| |
|
Did you incur moving expenses during the
year due to a change of employment? |
| |
|
Did you use your car on the job (other
than to and from work)? |
| |
|
Did you or your spouse work out of town
for part of the year? |
| |
|
Did you have an interest in or signature
over a bank or brokerage account in a foreign country, or were you a grantor of or
transferor to a foreign trust? |
| |
|
Do you or your spouse want to allocate $3
to the Presidential Election Campaign Fund? |
| |
|
Were you audited by either the Internal
Revenue Service or a state taxing agency during the year? |