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Itemized Personal Information

 

 

Name:    Tax Year:

                                

            Medical and Dental             Charity and Donations
Pre-Tax Health Insurance.... Donations - Money.............
Post-Tax Health Insurance.. Donations - Material...........
Long Term Premiums.......... Charity Mileage..................
Doctors.............................. How To Determine Value IRS    Goodwill Guide    Salv Army Guide
Prescriptions.......................               Interest Paid
Dentists..............................

Home Mortgage................

Optical...............................

Second Mortgage..............

Medical Mileage.................

Loan Points.......................

               Other Medical and Dental Qualified Mtg Insurance.....
Investment Interest.............
                                          ____               Taxes Paid                                                ______            
State Income Taxes............ General Sales Taxes...........
Real Estate Taxes............... Personal Taxes...................

                 (car registrations, etc)

            Other Taxes Paid
Prior Year Tax Prep Fee....
Gambling Losses................

   (up to W-2G Income Total only)

 

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