If any of the following items pertain to you or your spouse for 2016, please check the appropriate box and include allpertinent details. Provide additional schedules or back up information as requested.

PERSONAL INFORMATION- Everyone must answer all questions in this section Yes No

Did your marital status change in 2016? If yes, how?

Did your address change during the year? If so, the new address is:

Did you and your dependents have health care coverage for every month in 2016?

Do you want to allocate $3 to the Presidential Election Campaign Fund?

Does your spouse want to allocate $3 to the Presidential Election Campaign Fund?

May the IRS and the state taxing agency discuss this return with Beth Kissinger, CPA?

Do you want to make a voluntary contribution to reduce the National Debt OR pay more income tax thanlegally required? If so, how much $________

In 2016 did either the IRS or the state change your prior year's tax return in any way or notify you of anyadjustments made to a return that was previously filed? If so, provide the notices.

Did you buy any items for use in your resident state that you did not pay the proper amount of sales tax onat the time of purchase? If so, how much sales tax do you owe? $________

Did the IRS issue you, your spouse or any dependent a special PIN code for electronic filing purposes? Ifso, you must provide the notification of PIN assignment.

Did you or your spouse have any debts canceled or forgiven or file for bankruptcy protection in 2016?

Do you know who said "Bureaucracy is the death of all sound work.”?

In 2016 did you purchase any residential solar, wind energy, geothermal, or fuel cell property or otherenergy saving improvements (other than appliances)?

At December 31, 2016 did you have uncashed savings bonds that were issued in 1986?

Do you or your spouse have any foreign financial bank accounts or investments that are not held with abroker? If so, provide details of amounts and location.

Did you or your spouse receive any inheritances of retirement accounts or savings bonds in 2016?

Did you or your spouse make any gifts to an individual that total more than $14,000, any gifts to a trust, oradd anyone to the deed of any property you own? If so, a gift tax return may need to be filed.

Did you receive any income in 2016 that is not reported on a tax form (W-2, 1099, K-1, etc) and notwritten on the organizer you are providing to me? If so, how much $________. Please note the source ofthis income.

Do you participate in any bartering arrangements in 2016?

Are any of your assets held in a trust? If this is a new trust established in 2016, or this is the first year I willbe processing a trust return for you, please provide a copy of the trust document.

NYS TAX RETURN SPECIFIC QUESTIONS: All people filing a NYS tax return MUST answer all these questions:

Were either you or your spouse a volunteer firefighter or volunteer ambulance driver for the entire 2016 taxyear? If so, for what department?

Did you receive a NYS Property Tax Freeze Credit Refund in 2016? If yes, what was the amount$_____________

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2016 1040 US Miscellaneous Questions

Miscellaneous Questions

Yes No

Do you or your spouse maintain living quarters in New York City?

Do you or your spouse have long term care insurance? If so, provide the amounts paid for each person forthe NYS tax credit calculation.

Did you fund a NYS Section 529 (College Savings) plan in 2016? If so, provide proof.

Did you withdraw or transfer any money from a NYS 529 college savings plan? If so, please provide alldocumentation.

DEPENDENTS

Are you claiming all the same people (taxpayer, spouse and dependents) in 2016 as were on your 2015 taxreturn? If not, why?

Are any of the dependent children you are claiming age 24 or older as of December 31, 2016?

Did any child you are claiming as a dependent file a 2016 federal or state income tax return? IF SO,PLEASE PROVIDE A COPY or indicate if you want me to prepare the returns. Additional fees willapply.

Are you paying for child care for any child age 12 or under in order for you to work, attend school or lookfor a job? If yes, you must complete the section of the tax organizer pertaining to this.

HOME, INVESTMENTS, PURCHASES, SALES AND DEBT

Did you receive any payments on an installment sale during 2016? If so, provide details.

Did you sell any personal assets (collectibles, automobiles, artwork, gems, stamps, coins, etc.) during 2016at a gain? Please note: Sale of items on the internet or in person that result in a gain are reportable onyour tax returns. Provide the complete details regarding the cost/basis of the item sold, the date youacquired it and the information regarding the sale.

Did you sell any stocks or bonds during 2016 through an investment account? If so, please provide thecomplete tax information package from the broker. (All pages)

Did you purchase or sell a home during 2016? If so, please provide the closing papers for all sales and/orpurchases.

Did you refinance your principal home or second home, or did you make a home equity loan? If so, pleaseprovide the closing documents for all refinances. The proceeds received in 2016 from the loan proceeds thatwere not used for home improvements was $____________________

Do you know who said "An investment in knowledge pays the best interest"?

PENSION AND RETIREMENT PLANS

Did you or your spouse participate in a non-employer retirement plan in 2016?

Did you or your spouse contribute to a nonemployer (personal) IRA (Traditional, Roth, SEP, or selfemployed 401(k) during 2016? If so, please provide proof of the amount and account to which it wascontributed.

Did you roll over or convert any retirement money in 2016 to a new account?

Do you plan to contribute any money to a retirement plan prior to April 15, 2017 to be counted as a 2016contribution? If so, please tell me how much and what type of IRA you are going to contribute to.

Did you or your spouse receive a Form 5498 (Shows the value of Account at 12/31/2016) from a retirementaccount? If you or your spouse are 69 years of age, or older, please provide a copy.

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Miscellaneous Questions (Continued)

Yes No

If age 70-1/2 or older at December 31, 2016 have you (or your spouse - if age 70-1/2 or older) taken all2016 required minimum distributions (RMD) from IRAs and qualified retirement plans?

ITEMIZED DEDUCTIONS

At any time during 2016 did you owe $100,000 or more on home equity borrowing?

Do you have proof that will satisfy the IRS regulations for every charitable contribution you made during2016? All substantiation for this deduction must be provided if itemizing deductions.

Did you have uninsured losses, greater than 10% of your total income during 2016? If so, I will need allthe documentation supporting these losses.

Do you agree with Warren Buffet that “Price is what you pay. Value is what you get"?

EDUCATION

Did you, your spouse, or a dependent incur any tuition expenses and book costs in 2016 that were requiredto attend a college or vocational school? If so, you must provide the college bills covering the periodDecember 2015 through January 31, 2017 for each student.

Did you pay interest on a student loan during 2016? If so, provide the Form 1098-E or its equivalent.

Do you know why a dog's nose is wet?

TAX REFUNDS, TAX PAYMENTS, ESTIMATED TAXES AND 2017 TAX PLANNING

Did you make estimated income tax payments in 2016? If so, please provide proof of every payment thatwas made during 2016 and to date in 2017.

An overpayment of 2016 taxes should be applied to your 2017 estimated tax (instead of being refunded)?

Do you want me to calculate your 2017 estimated tax obligations based on something other than your 2016tax? If so, indicate what it should be based on. _________________________________

Do you expect your income in 2017, to be significantly different than your 2016 income? If so, what willbe the reason for the difference?

Do you expect your withholding in 2017 to be at least the amount that was withheld in 2016? If not, will itbe higher or lower?

Do you plan to start a new business in 2017?

Beth Kissinger, CPA should apply any overpayment to my 2017 estimated tax that in her opinion is wise,to prevent or reduce any potential underpayment penalties on the 2017 tax returns and/or eliminate orreduce the need for further estimated payments in 2017. NOTE - A "yes" answer may conflict with youranswers above and will override those answers.

Do you want 2017 estimated tax payment forms for mailing payments to the taxing authority? If no - do youpay them online?________(y/n)

BUSINESS CLIENTS - To be answered if you (or your spouse) own any business interests in 2016 or plan to in 2017

Do you or your spouse have a single member LLC? If so, did you file the NYS-IT-204LL form?

Did you start a business or farm, purchase rental or royalty property, or acquire an interest in a partnership,S corporation, trust, or REMIC in 2016?

If you own a business and/or rental property as a sole proprietor or single member LLC, did you file allrequired 1099 forms by 1/31/2017 to your payees? If so, please provide copies.

A sundial has the fewest moving parts of any timepiece. Do you know which timepiece has the most?

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2016 1040 US Miscellaneous Questions

Miscellaneous Questions (Continued)

MISCELLANEOUS

Yes No

Is there anything else you would like to bring to my attention? If so, please note it at the bottom of hispage.

Now that we are end of this list of questions, and you are ready to put your information together, remember the quote by William James:"Nothing is so fatiguing as the eternal hanging on of an uncompleted task." So get that tax paperwork together and get your info to me.

Deadlines approach quickly so get started putting everything together!! Good luck!!

Completed by:____________________________ ______________________ (Please Print your name) Date Completed

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2016 1040 US Miscellaneous Questions

Miscellaneous Questions (Continued)