Above and Beyond Tax Service

Client Name

Tax Year

SSN

1040
INCOME
# of W-2
# of 1099-Misc(Misc. Income)
# of 1099-R (Retirement)
# of 1099-Div (Dividends)
# of 1099-Int (Interest)
# of 1099-G(Government Pymt)
Amount of State Refund from Prior Year $
Alimony Paid $
Other Income (Line 21 of 1040) $
Description of Line 21 Income $
Adjusted Gross Income (Prior Year) $
Alimony Received $
IRA Deduction $
Moving Expenses $
State Payments $
Federal Estimated Taxes (List date paid)
1 $
2 $
3 $
4 $
TAX AND CREDITS
Student Loan Interest Paid $
Education Tuition & Fees Paid $
Grants & Scholarships Received $
Year of Education:
Educators Expense $
Dependent Care Expenses
Dependent Name   
Expenses
Dependent Name   
Expenses
Dependent Care Provider
EIN/ SSN   
Address:   
Dependent Name:   
Expenses
Dependent Name:   
Expenses
Dependent Care Provider   
EIN/ SSN   
Address:   
CASUAL THEFT OR LOSS
Type :   
Type :   
Itemized Deduction
MEDICAL EXPENSES
Insurance Premiums $
Co-Payments $
Dentist $
Doctor $
Prescriptions $
Medical Mileage
$

OTHER
$
$
$
$
$
$
$
Spouse Name SSN
TAXES YOU PAID
Real Estate Taxes $
Personal Property $
Estimated State Taxes $
State Balance Paid from Previous $
General Sales Tax $
Ad Valorem Tax $
INTEREST YOU PAID
Mortgage Interest (1098) $
Mortgage Interest (1098) $
Mortgage Interest (Seller Financed) $
Points $
PMI (Private Mortgage Ins) $
$
GIFTS TO CHARITY
Cash Contribution $
To: $
To: $
Non-Cash Contribution $
To: $
To: $
To: $
Charitable Milege $
JOB EXPENSES/ MISC DEDUCTIONS
Unreimbursed Employee Expense $
Unreimbursed Employee Expense $
Tax Preparation Fees $
Safe Deposit Box $
OTHER EXPENSES (List Below)
$
$
$
$
$
Amount: $
Amount: $
NOTES



By my signature below, I acknowledge the information listed above is true and correct.


Client Signature :
Date :