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Priddy & Holfield, Certified Public Accountants
Priddy & Holfield, Certified Public Accountants
Priddy & Holfield, Certified Public Accountants




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.
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
W-2 Gr. Income Fed WH. FICA Medicare State WH SDI
1
2
3
4

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, No		 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:

BUSINESS INCOME
General Information:

Cash Basis Accrual Basis

First Year Taxpayer Spouse

Business/Profession:
Bus. Name:
Bus. Address:
City:
State, Zip:
Other Accounting Method:

 Expenses:

Advertising:
Car and Truck Expenses:
Commissions:
Employee Benefit Programs:
Insurance (other than health):
Health Ins. Premiums for Self:
Mortgage Int. (paid to banks, etc.):
Other Interest:
Legal and Professional:
Office Expense:
Pension & Profit Sharing Plans:
Rent-Vehicles, Machinery, & Equipment:

Rent - Other Business Property:
Repairs:
Supplies:
Taxes - Real Estate:
Taxes - Other:
Travel:
Total Meals and Entertainment:
Utilities:
Wages:

Income:

Gross Receipts or Sales:
Returns and Allowances:
Other Income:

Cost of Goods Sold: If Applicable

Inventory at Start of the Year:
Inventory at End of the Year:
Purchases:
Cost of Items for Personal Use:
Cost of Labor:
Materials and Supplies:
Other Costs:

Did you acquire or dispose of any business assets (including real estate) during the year?
Yes No		 Did you have a home office during the year?
Yes No

Rent:
Utilities:
Insurance:
Janitorial:
Misc:
% of exclusive business use :
RENTAL INCOME & EXPENSES
Was property purchased/converted to rental during the year?
Yes No

Property /Address
1:
2:
3:

Property 1 2 3
Income:
Rents Received
Expenses:
Advertising
Association Dues
Auto and Travel
Cleaning / Maintenance
Commissions
Gardening
Insurance
Labor
Professional Fees
Miscellaneous
Mortgage Interest
Other Interest
Repairs and Maintenance Supplies
Taxes
Telephone
Utilities
Improvements
Other

ADJUSTMENTS TO INCOME
Alimony Paid:

Payee:
Amount:
Payee's SSN#:

IRA Deduction:
Keogh/SEP Deduction:
SIMPLE Plan:
Penalty on early withdrawal of savings:
MISCELLANEOUS QUESTIONS
If any of the following items pertain to you or your spouse for the year, please check the appropriate box and include all pertinent details.

Yes / No
Y
N		 Were there any births, adoptions, marriages, divorces, or deaths in your immediate family during the year?
Y
N		 Are any of your unmarried children, who might be claimed as Dependents, 19 years of age or older?
Y
N		 Do you have any dependent children under age 24 with interest, dividend, and/or capital gain income in excess of $1,000?
Y
N		 Can you be claimed as a dependent on another person's tax return?
Y
N		 Did you or your spouse "rollover" a retirement plan distribution into another plan?
Y
N		 Did you or your spouse receive any disability income during the year?
Y
N		 Did you purchase, sell, or refinance your principal home or your second home, or obtain a home equity loan during the year? If yes, please send escrow papers and other relevant information.
Y
N		 Did you sell any stocks, bonds, or other investment property during the year? If yes, please list the description, date acquired, date sold, sales price, cost or basis, and expenses of sale.
Y
N		 Did you pay any one household employee cash wages of $1,500 or more; withhold federal income tax during at the request of any household employee; or pay total cash wages of $1,500 or more in any calendar quarter of the year to household employees?
Y
N		 Did you use your car on the job (other than to and from work)?
Y
N		 Does anyone owe you money which has become uncollectible?
Y
N		 Did you incur moving expenses during the year due to a change of employment?
Y
N		 Did you or your spouse work out of town for part of the year?
Y
N		 Did you incur a loss because of damaged or stolen property?
Y
N		 Do you or your spouse want to allocate $3 to the Presidential Election Campaign Fund?
Y
N		 Did you have an interest in or signature authority over a bank or brokerage account in a foreign country, or were you a grantor of or transferrer to a foreign trust?
Y
N		 Were you audited by either the Internal Revenue Service or the State taxing agency during the year?
Y
N		 Did you receive any K-1s from S corporations, partnerships, estates, trusts, or LLCs?

ESTIMATED TAX PAYMENTS
Federal:
Date Paid
Amt. Paid
Overpayment-Prior Year
1st Quarter
2nd Quarter
3rd Quarter
4th Quarter
State:
Date Paid
Amt. Paid
Overpayment-Prior Year
1st Quarter
2nd Quarter
3rd Quarter
4th Quarter

 

 
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