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Personal Organizer

1. Personal Data: First, Middle, Last Name

Taxpayer

Spouse

Dependents Name 1

Relationship

Date of Birth

Dependents Name 2

Relationship

Date of Birth

Dependents Name 3

Relationship

Date of Birth

Contact Information Address

Phone Number

E-mail

2. Did you or your spouse had any of the following income in the United States in 2020?

Wage Income: If yes, please send us all W-2 forms

Yes
No

Retirement Benefits Received (Please send us all 1099R Forms)

Yes
No

Interest Income Please send us all 1099-INT Forms

Yes
No

Municipal Bond Interest Earned

Yes
No

Dividend Income Please send us all 1099-DIV Forms

Yes
No

Stock sales in 2019? If yes, please send us all 1099B forms

Yes
No

Any Other Business Income Received Please send us all 1099s, K-1s and other Forms

Yes
No

Any Other Benefits/Income Received Unemployment, Alimony, State Refund

Yes
No

Capital Assets Sold if yes please send us all forms 1099B and 1099S

Yes
No

Real Estate Sold in 2020

Yes
No

Cars, Asset sold in 2020

Yes
No

Collectibles sold in 2020

Yes
No

Did you have any Rental Income in 2020 Please send us all 1099 Forms?

Yes
No

Did you have any other income in 2020 not mentioned above?

Yes
No

Did you have any Health insurance in 2020?

Yes
No

Did you have any Cryptocurrency transactions in 2020?

Yes
No

3. Did you of your spouse have any of the following foreign income in 2020?

Foreign Wages Income

Yes
No

Foreign Self Employment Income

Yes
No

Foreign Business Income

Yes
No

Foreign Interest Income

Yes
No

Foreign Royalties Income

Yes
No

Foreign Capital Gain Income

Yes
No

Foreign Rental Income

Yes
No

Foreign Asset Sale

Yes
No

Foreign Dividend Income

Yes
No

Any Other Foreign Income

Yes
No

3, Did you or your spouse have interest in 2020 in a:

Foreign partnership

Yes
No

Foreign corporation

Yes
No

Foreign entity or sole proprietorship

Yes
No

Foreign trust

Yes
No

Foreign business

Yes
No

Did you, your spouse or your children have in 2020 any Financial Interest, Signature Authority, Direct or Indirect Ownership or Disposition Authority over any foreign account such as:

Foreign Bank Account

Yes
No

Foreign Business Bank Account

Yes
No

Foreign Investment Account

Yes
No

Foreign Brokerage Account

Yes
No

Foreign Mutual Fund

Yes
No

Foreign Trust Account

Yes
No

Foreign Insurance

Yes
No

Foreign Private Pension

Yes
No

Foreign Government Pension

Yes
No

Foreign Government Pension

Yes
No

Other Foreign Account such as Transferwise or Cryptocurrency

Yes
No

For more information about reporting foreign accounts, definitions, requirements & penalties please visit: https://www.fincen.gov/sites/default/files/shared/FBAR%20Line%20Item%20Filing%20Instructions.pdf

To the best of my knowledge the responses I have entered are correct and include all income deductions and other information necessary for the preparation of this year's income tax returns for which I have adequate contemporaneous records.

Name

Signature

Date

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