2021 Personal Tax Organizer - Davies Allen : Davies Allen

Getting Started

When using this Personal Tax Organizer you are submitting sensitive information.(Required)

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You must acknowledge and check the two checkboxes above to fill out the form.

Taxpayer Information

Name(Required)

First Middle Last

Is this the preferred contact?(Required)

Yes

No

Occupation

SSN

Birthdate(Required)

Mobile Phone

Email(Required)

Home Address(Required)

Street Address Address Line 2 City State ZIP Code

Did you pay tuition, fees, cost of books and supplies, for education at a university, college or other post secondary educational institution?(Required)

Yes

No

Spouse Information

Do you have a spouse to add information for?

Yes

No

Name(Required)

First Middle Last

Is this the preferred contact?(Required)

Yes

No

Occupation

SSN

Birth Date(Required)

Email Address

Did you pay tuition, fees, cost of books and supplies, for education at a university, college or other post secondary educational institution?(Required)

Yes

No

Dependent Information

You can use this screen to have us add or remove any dependents.

Add New Dependents

Dependents

Name	SSN	Birthday	Disabled	Actions

There are no Dependents.

Remove Dependents

List the names of any dependents you would like to remove.

Estimated Tax Payments

Do not enter amounts from W-2s or 1099s. Only enter additional estimated payments.

Did you make estimated federal tax payments this year?

Yes

No

Date

Payment Amount(Required)

Date

Payment Amount(Required)

Date

Payment Amount(Required)

Date

Payment Amount(Required)

Did you make estimated UT state tax payments this year?

Yes

No

Date

Payment Amount(Required)

Date

Payment Amount(Required)

Date

Payment Amount(Required)

Date

Payment Amount(Required)

IRA Contributions

Have you or will you make any traditional or ROTH IRA contributions for 2021?

Yes

No

Enter the amounts contributed in the fields below. If nothing was contributed enter a 0.

Traditional IRA (Taxpayer)(Required)

Traditional IRA (Spouse)(Required)

Roth IRA (Taxpayer)(Required)

Roth IRA (Spouse)(Required)

Did the taxpayer participate in a "back door" ROTH contribution?(Required)

Yes

No

Did the spouse participate in a "back door" ROTH contribution?(Required)

Yes

No

Alimony and Child Care (for divorces finalized before Dec 31, 2018)

Have you made alimony payments?(Required)

Yes

No

To(Required)

First Middle Last

SSN(Required)

Amount(Required)

Have you received alimony payments?(Required)

Yes

No

From(Required)

First Middle Last

SSN(Required)

Amount(Required)

Have you made payments for childcare?(Required)

Yes

No

Provider Name(Required)

Address(Required)

Street Address Address Line 2 City State ZIP Code

EIN / SSN(Required)

Amount Paid(Required)

Medical Deductions (Total needs to exceed 7.5% of your Gross Income to qualify)

Did you receive IRS Form 1095-A(Required)

(Health Insurance Marketplace Statement)

Yes

No

Does your employer offer a cafeteria or flexible spending plan?(Required)

Yes

No

Do you participate in the cafeteria plan or flexible spending plan?(Required)

Yes

No

Do you have an HSA Account?(Required)

Yes

No

HSA Tax Forms(Required)

I will upload forms 5498-SA showing contributions and 1099-SA reporting distributions from an HSA.

How much did the taxpayer contribute to the HSA (not counting what your employer contributed)?

How much did the spouse contribute to the HSA (not counting what the employer contributed)?

Out of pocket medical expenses

Accident

Cancer

CHIP

Dental

Health

Long Term Care

Medicare

Medicare Supplemental

Contact Lenses

Amount Paid Pretax (Cafeteria/Flex Spending Plan)

Prescription Medication and Drugs

Doctors, Dentists, and Nurses

Hospitals and Nursing Homes

Glasses and Contact Lenses

Hearing Aids

Travel for Medical Purposes

State Tax Deductions (maximum $10,000)

Real Estate Tax

Principal Residence

Second Residence

Investment Property

Other

Personal Property Tax & Sales Tax

Boats, Trailers, Etc

Automobiles

Sales Tax on Large Purchases

Sales Tax on New Vehicle

Mortgage Interest Deductions

Did you pay mortgage interest in 2021?

Yes

No

Do you have mortgages on your primary residence that total more than $1M if originated prior to 2018 or $750,000 if originated in 2018 or later?(Required)

Yes

No

What was the outstanding mortgage principal at year end?

Do you have more than $100,000 in home equity loans?(Required)

Yes

No

Names of Banks where you have Mortgages for Primary and Secondary Residences(Required)

Residence Mortgage (Other if no form 1098 received)

Name

EIN

Points, Origination Fees

Teaching Supplies Deduction

Out of Pocket Supplies Paid by Teachers

Charitable Contributions Deductions

Charitable Contributions

Organization	Amount	Actions

There are no Organizations.

Travel for Charitable Organizations

Tax Preferences

Would you like to apply refunds to next year's estimated tax payments?

Yes

No

Would you like any refunds directly deposited?

Yes

No

Bank Routing Number(Required)

Bank Account Number(Required)

Do you agree that Davies + Allen may speak with taxing authorities concerning this return?(Required)

Yes

No

Additional Notes

Is there anything else that is pertinent to your taxes, but wasn't addressed anywhere else in the Personal Tax Organizer?

Agree & Submit

A friendly reminder that you need written documentation supporting the claims to all tax deductions. If you are one of the lucky ones selected by the IRS for audit they could ask you to produce these written documents supporting your tax positions. Some of these deductions include business vehicle use, business entertainment, home computer use, charitable contributions, and others.

When you submit this form you agree to engage Davies + Allen to prepare your 2021 federal and state income tax returns.

We will prepare your tax returns using the information you provide. We will not audit or otherwise verify the data you submit unless it appears obvious that there may be some miscommunication, at which time it may be necessary to ask you to clarify some of the information. You take responsibility to supply all the information required for us to prepare complete and accurate returns. You are also responsible to retain all supporting documentation you used to compile your tax information. Because the tax returns we will be preparing are your tax returns, you take responsibility for the accuracy and completeness of the returns. We highly encourage you to review them carefully. If you have any questions regarding their content please don’t hesitate to ask us. We want to make sure your tax returns are correct. The tax return should be used as a document to comply with tax requirements only. Tax returns are not prepared in accordance with GAAP and should not be relied upon as an opinion or statement regarding your financial position. If you require GAAP financial statements we can provide those services as a separate engagement for a separate fee. The fees we charge for the preparation of your income tax returns are due and payable upon completion of the returns and may be subject to late fees of 1.5% per month for each month the fee is unpaid.

Thank you for allowing Davies + Allen the opportunity to serve you.

Name

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2021 Tax Prep Toolkit

Getting Started

Let's Get Started

Taxpayer Information

Spouse Information

Dependent Information

Estimated Tax Payments

IRA Contributions

Income and Other Items

Alimony and Child Care (for divorces finalized before Dec 31, 2018)

Medical Deductions (Total needs to exceed 7.5% of your Gross Income to qualify)

Out of pocket medical expenses

State Tax Deductions (maximum $10,000)

Real Estate Tax

Personal Property Tax & Sales Tax

Mortgage Interest Deductions

Teaching Supplies Deduction

Charitable Contributions Deductions

Tax Preferences

Agree & Submit