You MUST KEEP RECEIPTS — WRITTEN PROOF ** ITEMIZED DEDUCTION WORKSHEET Medical Prescriptions Drugs/Insulin $ Doctor, Dentist, Hospitals ete Medical Devices (eyeglasses etc) Health Insurance - paid (Pre-TAX Insurance plans are NOT deductible) Long Term Care Insurance Less: Insurance Reimbursement ‘Transportation/Medical- Ambulance Mileage to/from Drs/Hospitals ete. mi. Taxes Sales Tax on purchase of: Manufactured Home Boat, Motorcycle, or Car Real Estate Taxes - on Home -on Investment Property Vehicle Registration(s), (Bring Form 1098) _ Mortgage Interest Interest Balance Due Ist Mortgage $ $ 2nd Mortgage 8, Mortgage Insur Premium Points Paid (Purchase) Points Paid (Refinance) ISyr 30yr Investment Interest (on Land, etc) Student Loan Interest Cash Contributions Cash: Church/Temple $ Name Miscellaneous Deductions Union & Professional Dues . Employee Expenses: Uniforms & Laundry Protective & Safety Equip Job Supplies & Tools Occupational License Continuing Education Job Hunting Costs/Resumes Investment Management Costs ‘Tax Preparation Fees Safe Deposit Box Employee Travel Meals & Entertainment Air Fare, Rental Car, Taxi, Hotel Personal Vehicle Use for Employer’s benefit: ‘Total Miles Driven Business miles Commuting miles Do you have written records? Yes No (Circle one) Other Electric Vehicle Purchase Teaching Supplies K-12 teachers Alimony/Separate maintenance paid Contributions to: IRA self $ spouse $ ROTH IRA self $. spouse $. Adoption Expenses 8 Adoption completed on. COLLEGE TUITIONS - (Bring Tuition Stmts) Self. Spouse Child 8. Arizona Only - Deductions College Savings Plan Contributions $. AZ Private School Scholarship Contrib. $. Org. Name Address Volunteer Expenses AZ Public School Contributions 3 Donated Mileage Miles School Name oe ee Non-Cash: Original Cost__Estimated Value AZ Working Poor Charity Contribution S___ Goodwill ‘Name of AZ Charity Salvation Army. Address