1040 Tax Return

REGISTRATION

First Name:
Last Name:
Occupation:
Date of Birth:
#SSN/ITIN:
Phone:
Type of Return:
Address:
City:
ZIP:
E-mail:

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SPOUSE? YesNo
First Name:
Last Name:
Occupation:
Date of Birth:
#SSN/ITIN:

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DEPENDENTS? YesNo
Number of Legal Dependents:

Dependant 1
First Name:
Last Name:
Date of Birth:
ITIN/SSN:

Dependant 2
First Name:
Last Name:
Date of Birth:
ITIN/SSN:

Dependant 3
First Name:
Last Name:
Date of Birth:
ITIN/SSN:

Dependant 4
First Name:
Last Name:
Date of Birth:
ITIN/SSN:

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HEALTH INSURANCE?

Did you have Health Insurance? YesNo
Type:

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REAL ESTATE?

Do you own a Home? YesNo
If yes, do you pay Mortgage? YesNo

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RENDIMENTOS:

Possui veículo em nome da empresa?*
Quantos?
Possui imóvel em nome da empresa?*
Quantos?

Receitas
Do you have W-2 form? YesNo
How many?
Do you have 1099 form? YesNo
How many?

Income Sources:

Professional Services:
Rent of Property:
Dividends:
Bank interest:
Capital Gains:
Others:
Description:
Sub-total of earnings
Sub-total de despesas:

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EXPENSES:

Schedule A (Personal Expenses, deductible on "full form")

Donations:
Medical Expenses:
Mortgage Interests (1098):
Property Tax:
Other Expenses:
Sub-total of expenses:

HOME-OFFICE Expenses*

*Dear Client, Home Office expense deductions are only valid if you are self employed and operate in licensed environment.

House Size (sqft):
Room Size (sqft):
Water:
Rent:
Internet/TV:
Property Taxes:
Energy:
Phone:
Sub-total of expenses:
Deductible Amount:

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Schedule C (Self-emplyment Expenses)

Lawyers/Accountant:
Meals / Entertainment:
Gas:
Paid Commission:
Mail and Deliveries:
Medical Expenses:
Licences and Permits:
Marketing and Advertising:
Office Expenses:
Mileage:
Other expenses:
Sub-total of expenses:

CHECK LIST OF DOCUMENTS

Driver's License/IDPassaportW-21099PrincipalDependents10981095AMarraigeNaturalizationPermanent ResidencyWater, energy or phone billBank StatementHome InsuranceCar InsuranceLease AgreementDeed (purchase of property)Birth CertificateProof of School Enrollment

NOTES

I accept under penalty of perjury the above mentioned items.
Signature: