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Documents Required

PERSONAL DOCUMENTS INCOME DOCUMENTS Previous year's tax return W-2s 1099-Misc 1099-SSA (Social Security statement) 1099-DIV and 1099-INT (Dividend and interest statements) Alimony received 1099-R (Retirement distribution) 1099-B (Brokerage statement) (Download Stock details in an xls/csv format) Income and expenses for your rental properties K-1 statements reporting earnings from small business, partnerships and trusts. DEDUCTION DOCUMENTS Real estate/property taxes 1098 (Mortgage Interest Paid) Child/Depdendent Care expenses (SSN/Tax ID required) Charitable donations greater than $ 250 IRA contributions/Distrubutions (Traditional/Roth) 1098-E (interest on your student loan) Residents of MA - 1099HC Purchase of new automobile Purchase of new home Residential Improvements 1098-T (Tuition fees) ITIN PREPARATION Passport, Visa page

Required
BUSINESS DOCUMENTS Previous year Tax return (Fed, State & City) REQUIRED
Attached

IRS Notices (if any) 1099 received, and details of other income Asset Sale - Dates, Value & purchase info Rental Property statements Share purchase & Sold details Dividend Statements Quickbooks file Last Bank Statement & Reconciliation Loans owed Statement Salary register Quarterly & Annual Payroll filings Fixed Asset Register

REQUIRED, IF APPLICABLE

OPTIONAL

R. Ashok KumarSr. Tax Associate Cynergytax.comUS Number:+1 201.510.0123 EXT-9025Indian Number: +91 406.464.8160/61T

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T-9025Indian Number: +91 406.464.8160/61Timings: 8.30 AM to 07.30 PM CST E-mail: ashok@cynergytax.comWeb: www.cynergytax.com

gytax.comWeb: www.cynergytax.com

Software Services IT Consulting Retail Finance Construction Food Service Health Care Insurance Real Estate Rental & Leasing Transportation Hotel Non Profit Organisation Religious Organisation Chamber of Commerce Services

PERSONAL & FAMILY INFO

Personal Information First Name(As on SSN Card) Middle Name Last Name Gender Date of Birth Occupation TYPE OF U.S VISA CLIENT ID MARRITAL STATUS Contact Information Address (Number, Street and Apt, or Suite No.) City State County Zip / Postal Code Country E-mail Address Phone Number (LandLine) Phone Number (Mobile) Fax number Family Information (insert additional columns if required) First Name(As on SSN Card) Middle Name Last Name Gender Relationship Date of Birth TYPE OF U.S VISA Occupation Social Security Number(SSN) or ITIN Number of months stayed with you in the United States Child/Dependent Care expenses. Blind/Age 65 or greater INFORMATION ONLY IF WE APPLYING FOR ITIN ITIN HELP Passport Number Passport Expiration date City and State of Birth Date Entered into US Visa Number Visa Expiry date

<select>

Home

Spouse

No

NO

Foreign Tax ID (PAN for Indians), if any Previously received a US Temporary TIN/EIN

No

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MANDATORY: FIRST DAY IN US TYPE OF VISA AT THE TIME OF FIRST ENTRY

Office

Child/DEPNDENT

Child/DEPNDENT

Child/DEPNDENT

No

No

No

No

No

No

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son Daughter Father Mother Grandparent Brother Sister Aunt Uncle Newphew Neice Other

<SELECT> CYN10A CYN10B CYN10C CYN10D CYN11A CYN11B CYN11C CYN11D CYN12A CYN12B CYN12C CYN12D CYN13A CYN13B CYN13C CYN13D

<select> us citizen B1 B2 F1 F2 J1 J2 H1 H1-B H4 L1

Child/DEPNDENT

Child/DEPNDENT

No

No

2 3 4 5 6 7 8 9 10

No

No

YES NO

11 12

Male Female

Year

Trip 1 2 3 1 2 3 1 2 3

From Date

TAX PAYER To Date Days 0 0 0 0 0 0 0 0 0 RESIDENCY STATUS FYCT MEETS ON

Total Days

2013

2012

2011 First port of entry

0 N/R 7/3/2014

State Residence of Tax Payer State you reside for tax year 2013 State Name City/county start date <SELECT> If you reside in multiple states State Name City/county Start date end date

End date

<SELECT> <SELECT>

MOVING EXPENSES IF ANY Did you change your residence during this year? If YES change is due to employment, transfer, or self-employment? Number of miles from your former residence to your new business location: Number of miles from your former residence to your former business location: Did your employer reimburse or pay directly any of your moving expenses? Reimbursement amount received Transportation expenses in moving household goods and family Cost of storing and insuring household goods

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CA TO NJ NJ TO IN

<select> YES NO

<SELECT> Alabama Alaska American Samoa Arizona Arkansas California Colorado

Connecticut Delaware

Dist. of Columbia

Florida Georgia Guam Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland

Marshall Islands

Massachusetts Michigan

Micronesi a

Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota

Northern Marianas

Ohio Oklahoma Oregon

Palau

Pennsylvania Puerto Rico

Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia

Virgin Islands

Washington West Virginia Wisconsin Wyoming

Year 183 2013 0 183 2012

Trip 1 2 3 1 2 3 1 2 3

From Date

SPOUSE To Date

Days 0 0 0 0 0 0 0 0 0 RESIDENCY STATUS FYCT MEETS ON

2011 First port of entry

State Residence of SPOUSE IF WORKING State you reside for tax year 2013 State Name City/county start date <SELECT> If you reside in multiple states State Name City/county Start date <SELECT> <SELECT> <SELECT> <SELECT> <SELECT> <SELECT> end date

End date

MOVING EXPENSES IF ANY <select> Did you change your residence during this year? If YES change is due to employment, transfer, or self-employment? Number of miles from your former residence to your new business location: Number of miles from your former residence to your former business location: Did your employer reimburse or pay directly any of your moving expenses? Reimbursement amount received Transportation expenses in moving household goods and family Cost of storing and insuring household goods

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YES NO

Alabama Alaska American Samoa Arizona Arkansas California Colorado

Connecticut Delaware D i s t . o f C o l u m b i a Florida Georgia Guam Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland M a r s h a ll I s l a n d s Massachusetts Michigan

M i c r o n e s i a Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota N o r t h e r n M a r i a n a s Ohio Oklahoma Oregon P a l a u Pennsylvania Puerto Rico

Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia V i r g i n I s l a n d s Washington West Virginia Wisconsin Wyoming

Total Days 1/1/2014 7/1/2014 181.5 183 1.5 0.166666667 N/R 7/1/2014

0.333333333

<select>

T NON RESIDENT Have you ever applied for green card? Permanent Residency Address Country : State : City : Zipcode : Of what country were you a Citizen or In what country did you claim residence for Have you ever changed your visa type ? Did you file US Income tax return for any prior year: Type of tax return you field Number of days you stay in US for each year FOR F,J,M and Q VISA HOLDERS Date you enter in to US Citizen of which country during the year What Country issued passport Passport Number Name and address of the academic institution you attend during the year Name & Telephone number of university director

No

TYPE OF VISA <SELECT>

2013

2012

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NON RESIDENT

<SELECT> Yes No

<SELECT> 2011

1040 NR 1040 EZ F1 F2 J1 J2 H1 H1-B H4 L1 L2 TN

T.P 2106(EBE) PROJECT/ASSIGNMENT INFO Work location Employer Name Project Name / Client name* Work Location of the Project - City/County, State * Project Start Date Project End Date Number of Months City and State you Reside * EXPENSES "PAID" PER MONTH Apartment Rent * Cell Phone Internet Laundry expenses Parking fees Others, if any (describe) Any Amounts reimbursed by Employer: TYPE OF CAR Daily Commuting MILES ( To and From, Round trip) Car model car purchase date Total Miles travel in Year by car EXPENSES PAID FOR THE ENTIRE ASSIGNMENT Books purchased Education expenses that improves or maintains your skills Job Hunting / employment agency expenses/Resume preparation Job related Training Lease breakage due to Project cancelation Subscriptions to journals required for work / Technical periodicals Transportation cost to attend job interviews Uniform/work clothes required for work expenses Others, if any (describe) Project/Assignment 1 Project/Assignment 1 Project/Assignment 1 EMPLOYER

MODE OF COMMUTING <SELECT>

PERSONAL ASSETS USED FOR WORK Laptop Desktop computer Printers Scanners Other asset

Date Purchased

PRE

YES NO <SELECT> CLIENT EMPLOYER

T.P 2106(EBE) Project/Assignment 2 <SELECT> Project/Assignment 3 <SELECT> NOTE:-

Project/Assignment 2 Project/Assignment 3

F COMMUTING <SELECT>

<SELECT>

<SELECT> OWN CAR RENTAL CAR SHARING BUS TRAIN WALK

Project/Assignment 2

Project/Assignment 3

Cost of the Asset

Business use in %

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S.P 2106(EBE) PROJECT/ASSIGNMENT INFO Work location Employer Name Project Name / Client name * Work Location of the Project - City/County, State * Project Start Date Project End Date Number of Months City and State you Reside * EXPENSES "PAID" PER MONTH Apartment Rent * Cell Phone Internet Laundry expenses Parking fees Meals and Incidentals Others, if any (describe) Less: Amounts reimbursed by Employer: TYPE OF CAR Daily Commuting MILES ( To and From, Round trip) Car model car purchase date Total Miles travel in Year by car EXPENSES PAID FOR THE ENTIRE ASSIGNMENT Books purchased Education expenses that improves or maintains your skills Job Hunting / employment agency expenses/Resume preparation Job related Training Lease breakage due to Project cancelation Subscriptions to journals required for work / Technical periodicals Transportation cost to attend job interviews Uniform/work clothes required for work expenses Others, if any (describe) PERSONAL ASSETS USED FOR WORK Laptop Desktop computer Printers Date Purchased Project/Assignment 1 <SELECT>

Project/Assignment 1

MODE OF COMMUTING <SELECT>

Project/Assignment 1

Scanners Other asset

PRE

YES NO <SELECT> CLIENT EMPLOYER

S.P 2106(EBE) Project/Assignment 2 <SELECT> Project/Assignment 3 <SELECT> NOTE:-

Project/Assignment 2 Project/Assignment 3

OMMUTING <SELECT>

<SELECT>

Project/Assignment 2

Project/Assignment 3

Cost of the Asset

Business use in %

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<SELECT> OWN CAR RENTAL CAR SHARING BUS TRAIN WALK

Deduction Medical Expenses for Self, Spouse or for dependents Health insurance premium for self / Spouse or for dependents MONTH) Total number of medical miles you have travelled Did you contribute to any Charity during the year Total number of Charity miles you have travelled Tax Return Prep Fee paid last year Have you incurred any education related expenses for yourself, spouse or dependents? Taxpayer <SELECT> Spouse <SELECT> Dependent <SELECT> HAVE YOU PAID ANY EDUCATION LOAN INTEREST Do you make contributions to a traditional IRA? Have you paid home mortgage interest Safe deposit box rental paid Have you purchased any Energy Saving equipment (PER

AMOUNT

<SELECT>

<SELECT>

<SELECT>

<SELECT>

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AL AK AZ AR CA CO CT DE DC FL GA HI ID IL IN IA KS KY LA ME MD MH MA MI MN MS MO MT NE NV NH NJ NM NY NC ND OH OK OR PW PA PR RI SC SD TN TX UT VT VA VI WA WV

YES NO

WI WY

AMOUNT NOTES <SELECT>

<SELECT>

<SELECT> Yes No

<SELECT>

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<SELECT> PER MONTH PER YEAR

INCOME
Do you recive any Interest/Dividend income in 2013 Do you own any rental property Do you recive any self-employment Income (1099-mis) Did you receive income from sale of stocks or securities? Did you receive brokerage statement for sale of stocks Did you receive refund from any State authorities Have you itemized your deductions last year STATE FROM WHICH YOU GOT REFUND (OR) DUE STATE FROM WHICH YOU GOT REFUND (OR) DUE Did you receive any other Income from any other source <SELECT> <SELECT> <SELECT> <SELECT> <SELECT> <SELECT> <SELECT> <SELECT> <SELECT> <SELECT>

PRE

<SELECT>
AL AK AZ AR CA CO

CT DE DC FL GA HI ID IL IN IA KS KY LA ME MD MH MA MI MN MS MO MT NE NV NH NJ NM NY NC ND OH OK OR PW PA PR RI SC SD TN TX UT VT VA VI WA WV

WI WY

AMOUNT

<SELECT> Yes No

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COMPLETE THIS ONLY PAGE ONLY YOU HAVE R


Rental Business Information Date started (as Rental property) Address of the property for each property City, State, Zip Material Participation (activity participated in rental business) Time spent in business (hours per day) Rental Business Income & Expenses Total Rent Received during the Tax year ExpensesAdvertising Cleaning and maintenance. Commissions Insurance. Interest Legal Fees Local transportation expenses. Points Rental Payments Repairs Tax return preparation fees(only to perpare Sche E) Taxes (real estate tax, property Tax) Travel expenses Utilities Other Expenses

Rental Prop 1 Rental Prop 2

No

No

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Y YOU HAVE RENTAL INCOME


Rental Prop 3 Rental Prop 4

No

No

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Business Information
Name of Business Doing business as (DBA) Tax ID Nature of Business SIC Code NAICS Code State File number State Webfile number Business Address (state "home" in case of Home office) City, State ZIPCODE Basis of Accounting

Business Income received during the tax year


Income from Business

Business expenses paid during the tax year Accounting fees Advertising Bank charges Commissions and sales expenses Consultation expenses Continuing professional education Contract labor Credit and collection fees Delivery charges Dues and subscriptions Employee benefit programs Equipment rentals Factory expenses Insurance Interest paid Internet subscriptions, domain names, and hosting Laundry Legal fees Licenses Maintenance and repairs Home office Expense Office expenses and supplies Pension and profit-sharing plans Postage Print and copy Professional development and training

Professional fees Promotion Rent Salaries, wages, and other compensation Gifts (Upto $ 25 per person per year) Automobile and transportation expenses Meals and entertainment Security Small tools and equipment Software Supplies Taxes Telephone Trade discounts Travel - Airfare - Within USA Travel - Airfare - Foreign Travel Travel - Lodging- Within USA Travel - Lodging- Foreign Country Utilities Assets used for Business Laptop Cell phone - Instrument purchased Desktop computer Computer accessories Routers, Servers, Backup disks purchased for business Computer furniture Printers Scanners Software Other asset
Notes:
Any expense above $ 75 per transaction needs receipts. These will have to be produced in case of an IRS/State audit*

mation

Cash

ng the tax year


the tax year

Cost of Asset

Business use %age Date Purchased

n case of an IRS/State audit*

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HOME OFFICE EXPENSE COMPUTATION


Office Rent Computation Mortage Interest (If Owned) Rent Expenses (If Rented) Real Estate Taxes Home Owners / Renters insurance Electricty (Average) Water, Sewerage & Trash expenses(Avg) Heating expenses Cable TV Internet Charges Housekeeping expenses Pest Control Repairs & Maintenance Direct Expenses Per month Number of months Total(Full Cost)

12 12 12 12 12 12 12 12 12 12 12 12 0

Total Square Feet of the House *Space used for Office measurements: (in sqft) Dedicated Space: Garage used for business car Office Space with/without attached Rest Room Shared Space: Foyer, Lobby and Stair Case leading to Office/2nd Floor (do not include one used by personal and office Guests) Total Sqft for Business Common Expenses Incurred Home - Used for Business* Business Use %age Allocated Expenses for Business
Depreciation Expenses Furniture Furniture Furniture Home Cost (exclude land value)

SQUARE FEET Enter in Square Feet - Net Usable square feet

Date Purchased Cost of Asset Business use %

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ter in Square Feet - Net Usable square feet

Depreciation

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Taxes Paid
Have you paid any estimated taxes during the year Can you provide us your Prior Year AGI Have you paid any real estate taxes in US Taxes Paid in Other Countries Country to which the tax has been paid Source of Income:(compensation or other) <SELECT> <SELECT> <SELECT> <SELECT> <SELECT> <SELECT>

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<SELECT> YES NO

AMOUNT

COMPLETE THIS ONLY PAGE ONLY YOU HAVE FOREIGN BANK

The Department of the Treasury requires that every US citizen or resident with an interest in accounts that exceed $10,000 USD in aggregate value at any time during the calendar year mu June 30 of the following year. Foreign Bank Account Information (FBAR)
Details FBAR Account Belongs to (Name) Type of Account Account Number Maximum A/c Value during the tax year Jointly owned by anybody else Name of Financial Institution Mailing Address of Financial Institution City, State, Zipcode Country Financial Account 1 <SELECT> Select

<SELECT>

<SELECT> YES NO

U HAVE FOREIGN BANK ACCOUNTS

en or resident with an interest in or an authority over foreign bank accounts, other financial me during the calendar year must report the foreign bank accounts Information no later than June 30 of the following year.
Add more columns if reqd

Financial Account 2 <SELECT> Select

Financial Account 3 <SELECT> Select

Financial Account 4 Financial Account 5 <SELECT> <SELECT> Select Select

<SELECT>

<SELECT>

<SELECT>

<SELECT>

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re columns if reqd

DETAILS FOR DIRECT DEPOSITS (OR) CREDIT BANK NAME ACCOUNT NUMBER ROTTING NUMBER TYPE OF ACCOUNT

BANK INFORMATION
DETAILS FOR DIRECT DEPOSITS (OR) CREDIT

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NOTE:

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