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This
will help you organize your tax information and make sure you
don’t miss any important deductions. There are lots of tax law
changes this year, so please review all sections of the "tax organizer"
carefully. Our fees are
competitive and we’ll gladly quote you a fee over the phone. We
run an efficient, friendly office, and we’re here all year round
to answer your questions. Please call us at 501-374-9241 or stop by our
office at 615 Main Street, North Little Rock to make an appointment.
Evening and weekend appointments are available.
This is PAGE 1 of a 3 page form. Please print this page and proceed to PAGE 2. Once you have completed this form, fax it to us at 501-374-9042.
Or you can fill out this form on-line by clicking here.
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THE BASICS
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Your Name: |
E-mail: |
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TAXPAYER INFORMATION
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SPOUSE INFORMATION
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First Name: Initial: 
Last Name: 
Social Security #: 
Occupation: 
Date of Birth: 
Street Address: 
City: 
State, Zip: 
Home Telephone: 
Work Telephone: 
Fax Number:  |
First Name: Initial: 
Last Name: 
Social Security #: 
Occupation: 
Date of Birth: 
Street Address: 
City: 
State, Zip: 
Home Telephone: 
Work Telephone: 
Fax Number:  |
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FILING STATUS
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Single:  |
Married:  |
Head of Household:  |
Married Filing Separate:  |
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SALARIES AND WAGES
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| W-2 |
Gr. Income |
Fed WH. |
FICA |
Medicare |
State WH |
SDI |
| 1 |
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| 2 |
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| 3 |
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| 4 |
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DEPENDENTS
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Name: 
Date of birth: 
Social Security #: 
Relationship: 
Months Lived at Home:  |
Name: 
Date of birth: 
Social Security #: 
Relationship: 
Months Lived at Home:  |
Name: 
Date of birth: 
Social Security #: 
Relationship: 
Months Lived at Home:  |
Name: 
Date of birth: 
Social Security #: 
Relationship: 
Months Lived at Home:  |
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DEDUCTIONS
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Medical And Dental Expenses:
Insurance Premiums (Net): 
Doctors, Dentists, etc.:  |
Taxes Paid:
State & Local Income Tax: 
Real Estate Taxes - Residence: 
Real Estate Taxes - Other: 
Personal Property Taxes : 
Other Taxes:  |
Interest Paid:
Home Mortgage Int. Pd. (1st): 
Home Mortgage Int. Pd. (2nd): 
Home Mortgage (Equity Line):  |
Contributions:
By Cash Or Check: 
By Other Than Cash : |
Miscellaneous Deductions:
Unreimbursed Employee Business: Expenses: Description: 
Union /Professional Dues: 
Investment Expense: 
Tax Return Preparation Fees: 
Safe Deposit Box Rental: |
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END - PAGE 1
Please Proceed to PAGE 2
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