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Name

Any self-employment Income?

If Yes, # of 1099-MISC forms:

# of K-1 forms:

Please list any States lived and / or worked in besides N.Y. :

Do you itemize deductions?

Do you own your own home?

Did you receive $1,500 or more of interest income and/or dividends?

Did you SELL any stocks and / or bonds?

Did you receive any rental income from real estate?

If yes, how many properties and what states are they in?

Did you have $10,000 or more in foreign bank accounts?

If you are not a U.S. Citizen or Permanent Resident, what is your immigration status and/or type of Visa?

Please list any other income and/or deductions not mentioned above:

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