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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     Salv Army Guide Goodwill 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)


Notes/Comments:


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