2001 Tax Checklist and General Questions
	Following is a checklist to help you collect and report the information needed to prepare your
2001 income tax return.  Please print and attach your tax documents to the checklist.
	Also attached is a list of general questions and business/investment questions designed to assist
us in completing your tax return.  If you answer yes to any of the questions, be sure to provide the
applicable details.
	Thank you in advance for taking the time to use this checklist and answering the questions.  We
look forward to serving you with your tax needs for tax year 2001.  If you should have any questions,
please don't hesitate to give us a call.
Checklist
		A copy of your 2000 tax return (if not in our possession).
		Original Form(s) W-2.
		Schedule(s) K-1 showing income or loss from partnerships, S corporations or estates or trusts.
		Copies of other compensation or pension documentation, such as Form 1099-MISC or Form 1099-R.
		Form(s) 1099 or statements reporting dividend and interest income.
		Brokerage statements showing transactions for stocks, bonds, etc.
		Form(s) 1098 reporting interest paid, copies of real estate tax bills and other information relating to
			real property holdings.
		Copies of closing statements regarding the sale or purchase of real property.
		All other information notices you received, or any items you have questions about.
General Questions
		PERSONAL INFORMATION
Yes	No
		1	Did your marital status change during 2001?
				If yes, explain ____________________________________
		2	Do you or your spouse plan to retire in 2002?
		3	Were you or your spouse permanently and totally disabled in 2001?
		4	Enter date of death for taxpayer or spouse (if during 2001 or 2002):
				Taxpayer: __________			Spouse: __________
		DEPENDENT INFORMATION
		1 a	Do you have dependents who must file?
		b	Do you want us to prepare the return(s)?
		2 a	Do you have children under age 14 with investment income greater than $1,400?
		b	If yes, do you want to include your child’s income on your return?
		3	Are any of your dependents not U.S. citizens or residents?
		4	Did you provide over half the support for any other person during the year?
		5	Did you incur adoption expenses during the year?
		IRA AND PENSION PLAN
		1	Did you receive payments from a pension or profit-sharing plan?
		2	Did you receive a total distribution from an IRA or other qualified plan that was partially or
				totally rolled over into another IRA or qualified plan within 60 days of the distribution?
		3	Did you convert all or part of a regular IRA into a Roth IRA?
		4	Did you contribute to an Education IRA?
		ITEMS RELATED TO INCOME/LOSSES
		1	Did you receive any disability payments this year?
		2	Did you receive tip income not reported to your employer?
		3	Did you sell and/or purchase a principal residence in 2001?
		4	Did you have any installment sale amounts from relatives?
		5	Did you incur any casualty or theft losses during the year?
		6	Did you incur any non-business bad debts?
		PRIOR YEAR TAX RETURNS
		1	Were you notified by the Internal Revenue Service or state taxing authority of changes to a
				prior year’s return?
			If yes, enclose agent’s report or notice of change.
		2	Were there changes to a prior year’s income, deductions, credits, etc which would require
				filing an amended return?
		FOREIGN BANK ACCOUNTS AND TAXES
		1	Did you have foreign income or pay any foreign taxes in 2001?
		2	At any time during the tax year, did you have an interest in or a signature or other authority
				over a bank account, or other financial account in a foreign country?
			If yes, enter the name of the foreign country:  _____________________________
		3	Were you the grantor of or transferor to a foreign trust which existed during the tax year,
				whether or not you have any beneficial interest in the trust?
		HEALTH AND LIFE INSURANCE
		1	Did you or your spouse have self-employed health insurance?
		2	If you or your spouse are self-employed, are either of you covered under an employer's
				health plan at another job?
		3	Did your employer pay premiums on life insurance in excess of $50,000 where the proceeds
				are payable to beneficiaries named by you?
		GIFTS TO TRUSTS OR TUITION PLANS
		1	Did you or your spouse make gifts of over $10,000 to an individual or contribute to a prepaid
				tuition plan?
		2	Did you make gifts to a trust?
		MISCELLANEOUS
		1	If there were dues paid to an association, was any portion required to be non-deductible due
				to political lobbying by the association?
			If yes, please attach details.
		2	Did you or your spouse participate in a medical savings account during the year?
			If yes, please attach Form 1099-MSA (Distributions from Medical Savings Accounts).
		3	Did you make a loan at an interest rate below market value?
		4	Did you pay any individual during 2001 for domestic services?
		5	Did you pay interest on a student loan for yourself, your spouse, or your dependents?
		6	Did you, your spouse, or your dependents attend college or a vocational school in 2001?
		7	Did you receive any income not included on this checklist?
			If yes, please attach information.
		DIRECT DEPOSIT OF REFUND
		1	The Internal Revenue Service is able to deposit many refunds directly into taxpayers’ accounts.
			If you receive a refund, would you like direct deposit?
		2	If yes, please provide the following information:
		a	Name of your financial institution
				_____________________________________________________
		b	Routing Transit Number (must begin with 01 through 12 or 21 through 32)
				_____________________________________________________
		c	Account number
				____________________________________________________
		d	What type of account is this?				Checking		Savings
		e	Please attach a voided check or deposit slip.
		BUSINESS/INVESTMENT QUESTIONS
		1	Did you receive stock from a stock bonus plan with your employer?
			(Do not include stock sales included on your W-2.)
		2	Did you buy or sell any stocks or bonds during the year?
			If yes, attach broker’s information (such as Form 1099-Bs and broker annual statements)
				related to the transactions.
		3	Did you surrender any U.S. savings bonds during 2001?
		4	Did you use the proceeds from Series EE U.S. savings bonds purchased after 1989 to pay
				for higher education expenses?
		5	Did you realize a gain or loss on property which was taken from you by destruction, theft,
				seizure, or condemnation?
		6	Did you start a business, purchase a rental property or farm, or acquire interests in partnerships
				or S corporations?
		7	Do you have any investments for which you were not personally ’at risk’ (other than sole
				proprietorship or farm)?
		8	Did you own an interest in a Real Estate Mortgage Investment Conduit (REMIC) during 2001?
		9	Did you sell property or equipment on installment in 2001?
		10	Did you have any business related educational expenses?
		11	Do you have records, as described below, to support expenses?
				Tax law and IRS regulations allow deductions for travel and entertainment if adequate
				records can be presented.
				Information must include: 1 Amount; 2 Time and place; 3 Date; 4 Business purpose;
				5 Description of gift(s); and 6 Business relationship of recipient.
		12	Did you purchase special fuels for non-highway use?
			If yes, please list the type of use and the number of gallons for each fuel.
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