Priddy & Holifield, CPAs - Tax Organizer Page 1

Gr. Income

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. To encourage you to file your taxes early, we’re offering a 10% discount off the regular fee to new clients if you send us your tax information before the end of February. 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.

THE BASICS
Your Name:	E-mail:

TAXPAYER INFORMATION	SPOUSE INFORMATION
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:

FILING STATUS

Single:

Married:

Head of Household:

Married Filing Separate:

SALARIES AND WAGES

DEPENDENTS
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:

OTHER INCOME

Interest:
Payor / Amount

Dividends:
Payor / Total / Capital Gain / Ordinary Dividend

State Tax Refund:
Amount Received:

Did you itemize in prior years:

Yes,

Capital Gains:

Desc./

Date
Acquired/

Date
Sold/

Sales
Price/

Cost or
Basis

Pensions/IRA Distributions:
Payor / Gross Distribution / Taxable Amount

Was Federal Or State Tax withheld? Yes, No

Alimony Received:
Payor:

Amount:

Payor's SSN#:

Unemployment Received:

Taxpayer Amount:

Spouse Amount:

Social Security Received:
Taxpayer Amount:

Spouse Amount:

Miscellaneous Income:
Description / Amount

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:

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:

ADJUSTMENTS TO INCOME
Alimony Paid: Payee: Amount: Payee's SSN#:	IRA Deduction: Keogh/SEP Deduction: SIMPLE Plan:	Roth IRA Contribution: Penalty on early withdrawal of savings:

END - PAGE 1

Please Proceed to PAGE 2

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