ITEMIZED DEDUCTIONS (Round all figures to the nearest dollar.)
Medical Expenses
Deductible only if net cost exceeds 7.5% of AGI
Note:  Do not include amounts paid for or reimbursed by insurance, or health
insurance premiums paid with pre-tax income.
Did you pay medical expenses for a person you cannot claim						yes		no
as a dependent? (if yes, ask your tax preparer.
Hospitalization and Health Insurance Premiums include
after-tax amounts paid or withheld at work
Medicare Insurance Premiums Paid (Form SSA-1099)
Long-Term Care Insurance Premiums
Vision/Dental Insurance
Prescribed Drugs and Insulin
Doctors and Clinics
Dentists and Orthodontists
Glasses, Contact Lenses, Eye Exams, Laser Eye Surgery
Hospitals, Nurses, Alcoholism Treatment, Ambulance
Lab tests, Therapy, X-Ray, Anesthesiology
Prescribed medical Equipment
Hearing Aids, Batteries and Related Equipment Costs
Vasectomy/Tubal Ligation/Abortion Costs
Stop Smoking Programs, including prescribed drugs
nondeductible:  Nonprescription nicotine patches and gum
Weight-Loss Program (if prescribed)
Nursing or Long-Term Care Facility
Schooling for Handicapped
Cosmetic Surgery  (generally not deductible unless
it corrects a congenital abnormality, disfiguring disease or injury
Medical Transportation (Taxi, bus, ambulance, etc.)
In-Home Nursing and Long-Term Care Services
Medical Miles ______@ .14cents = _______ plus Parking_________
Lodging While Obtaining Medical Treatment (limited to $50 per night, per person
TAXES
State or City Income Taxes Withheld (W-2)
Other Real Estate Taxes (second home, cabin, etc.)
Sales Tax on Vehicle, RV, Boat, etc.
CASUALTY LOSS
Auto Accident, Fire, Theft, Storm, Etc.  Deductible on if your combined net loss after insurance
claim exceeds 10% of AGI.  Contact your preparer if you are unsure.
INTEREST PAID
First Mortgage Interest *provide Forms 1098
*Secondary Mortgage
*Home Equity/Home Improvement Loan
Loan Points
CONTRIBUTIONS  (use separate sheet if needed)
Churches or Synagogues
United Way
Cancer or Heart
Scouts Boy/Girl
M.S./M.D./March of Dimes
Out-of-Pocket Expenses for Charitable Work
Vets/Goodwill/Salvation Army (noncash)
*Fair Market Value of Items Given to Charities If over $500,
provide documentation
Charitable Mileage on Auto _________Miles @14cents =
Other
Other
MISCELLANEOUS
Job-Seeking Expenses in Same Field
Travel/Air Fare/Lodging………………..$____________
Food……………………………………...$____________
Employment Agency Fees…………….$____________
Resume…………………………………$____________
Other……………………………………..$____________
Total
Tax Prep.   Financial Planning/Consultation Fees
Investment Expenses
Phone/Postage/Supplies for Investments…………..$____________
Safe Deposit Box…………………………………….....$____________
Investment Publications and Journals………………$____________
IRA and Keogh Fees You Paid Directly…………….  $____________
Total
Gambling Losses   (Limited to Total Gambling Winnings)
Union Dues
Tools
Special Uniforms
Safety Equipment
Professional Dues & Subscriptions
Job Education
Meals
Auto (use auto chart)
HOTEL
Travel (air/parking)
Other
Other
Other
Other
Other
Other
BUSINESS USE OF HOME
Sq. Ft. of House
Sq. Ft. of Office
Electric
Gas/Fuel Oil
Water
Trash
Insurance
Improvements