| Medical and Dental |
2000 Amount |
| Prescription Drugs |
|
| Doctors, Dentist and Nurses |
|
| Hospitals and Nursing Homes |
|
| Long-Term Care Premiums (excluding
long-term care) |
|
| Insurance Reimbursement (enter a
positive number) |
|
| Lodging and Transportation |
|
| Out-of-Pocket expenses |
|
| Number of Medical Miles |
|
| Other Medical and Dental Expenses (i.e.,
dentures, braces, prosthesis, etc.) |
|
| |
|
| |
|
| Taxes Paid (State
& local withholding and 2000 estimates are automatic) |
|
| State&Local Income taxes -1/99 payment on 1999
st. estimates |
|
| State&Local Income taxes -paid with 1999 state
extentions |
|
| State&Local Income taxes -paid with 1998 state
return |
|
| State&Local Income taxes -paid for prior years
and/or to other states |
|
| Real Estate Taxes - Principal Residence |
|
| Real Estate Taxes -Property Held for Investment |
|
| Personal Property Taxes (including
automobile fees) |
|
| Foreign Income Taxes |
|
| Other Taxes |
|
| |
|
| |
|
| Interest Paid |
|
| Home Mortgage interest and points reported on form
1098 |
|
| |
|
Home Mortgage interest not reported on form 1098
(if paid to the home seller, enter seller's name, SSN of EIN, and
address) |
|
| |
|
| |
|
| Points not reported on form 1098 |
|
| |
|
| Investment Interest |
|
| |
|
| |
|
| Passive Interest |
|
| Certain home mortgage interest included above (6251) |
|
| Cash
Contributions |
|
| 50% Limitation |
|
| Volunteer Expenses (out-of-pocket) |
|
| Number of charitable miles |
|
| Contributions by cash of check |
|
| |
|
| |
|
| 30% Limitation |
|
| Volunteer Expenses (out-of-pocket) |
|
| Number of charitable miles |
|
| Contributions by cash of check |
|
| |
|
| |
|
Non-Cash Contributions
(if over $500 complete Non-Cash
Contribution form) |
|
| 50% Limitation |
|
| |
|
| 30% Limitation |
|
| |
|
| 20% Limitation |
|
| |
|
| 30% Capital Gain Property |
|
| |
|
| 20% Capital Gain Property |
|
| |
|
| Miscellaneous Deductions
(submit to 2% AGI limit) |
|
| Union and Professional Dues |
|
Other unreimbursed employee expenses
(i.e., classes,books, mileage, uniforms) |
|
| |
|
| |
|
| |
|
| Investment expense |
|
| |
|
| |
|
| Tax return preparation feee |
|
| Safe deposit box rental |
|
| Miscellaneous deductions (2% AGI) |
|
| |
|
| |
|
| |
|
| Other Miscellaneous Deductions |
|
| Gambling losses to extent of winnings |
|
| Estate tax, section 691(C) |
|
| Other miscellaneous deductions |
|
| |
|
| |
|
| |
|
