201.621.5579|cpa@chenellen.com

Personal Tax Return

Personal Tax Return2016-01-16T12:15:10-05:00

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Thanks for considering Chenellen CPA to address your tax needs.

[[[["field11","equal_to","Married"],["field11","equal_to","Married but separated"]],[["show_fields","field14,field2,field12,field13"]],"or"],[[["field20","equal_to","One"]],[["show_fields","field29,field28,field21,field22,field23,field24,field25"]],"or"],[[["field25","equal_to","Yes"]],[["show_fields","field30,field31,field32,field33"]],"and"],[[["field20","equal_to","Two"]],[["show_fields","field29,field28,field21,field22,field23,field24,field25,field39,field34,field35,field36,field37,field38,field40"]],"and"],[[["field40","equal_to","Yes"]],[["show_fields","field41,field42,field43,field44"]],"and"],[[["field20","equal_to","Three"]],[["show_fields","field43,field29,field28,field21,field22,field23,field24,field25,field39,field34,field35,field36,field37,field38,field40,field46,field47,field48,field49,field50,field51,field52"]],"and"],[[["field52","equal_to","Yes"]],[["show_fields","field64,field54,field55,field56"]],"and"],[[["field20","equal_to","Four"]],[["show_fields","field43,field29,field28,field21,field22,field23,field24,field25,field39,field34,field35,field36,field37,field38,field40,field46,field47,field48,field49,field50,field51,field52,field58,field57,field59,field60,field61,field62,field63"]],"and"],[[["field63","equal_to","Yes"]],[["show_fields","field75,field65,field66,field67"]],"and"],[[["field20","equal_to","Five"]],[["show_fields","field43,field29,field28,field21,field22,field23,field24,field25,field39,field34,field35,field36,field37,field38,field40,field46,field47,field48,field49,field50,field51,field52,field58,field57,field59,field60,field61,field62,field63,field69,field68,field70,field71,field72,field73,field74"]],"and"],[[["field74","equal_to","Yes"]],[["show_fields","field53,field76,field77,field78"]],"and"],[[["field20","equal_to","More than Six"]],[["show_fields","field43,field29,field28,field21,field22,field23,field24,field25,field39,field34,field35,field36,field37,field38,field40,field46,field47,field48,field49,field50,field51,field52,field58,field57,field59,field60,field61,field62,field63,field69,field68,field70,field71,field72,field73,field74,field79,field80"]],"and"],[[["field20","equal_to","None"]],[["hide_fields","field30,field31,field32,field33,field41,field42,field43,field44,field64,field54,field55,field56,field75,field65,field66,field67,field53,field76,field77,field78"]],"and"],[[["field108","equal_to","Yes"]],[["show_fields","field112,field114,field113,field115"]],"and"],[[["field81","equal_to","Yes"]],[["show_fields","field83,field82"]],"and"],[[["field84","equal_to","Yes"]],[["show_fields","field85,field86,field87"]],"and"],[[["field87","equal_to","Yes"]],[["show_fields","field88,field92,field96"]],"and"],[[["field96","equal_to","Yes"]],[["show_fields","field89,field93,field97"]],"and"],[[["field97","equal_to","Yes"]],[["show_fields","field90,field94,field98"]],"and"],[[["field98","equal_to","Yes"]],[["show_fields","field91,field95"]],"and"],[[["field100","equal_to","Yes"]],[["show_fields","field101,field102,field105,field104"]],"and"],[[["field106","equal_to","Yes"]],[["show_fields","field107"]],"and"],[[["field117","equal_to","Yes"]],[["show_fields","field118,field120,field119"]],"and"],[[["field117","equal_to","Yes"]],[["show_fields","field118,field119,field120,field145"]],"and"],[[["field121","equal_to","Home Owner"]],[["show_fields","field122,field123,field126"]],"and"],[[["field121","equal_to","Home Owner"],["field125","equal_to","Yes"]],[["show_fields","field127"]],"and"],[[["field121","equal_to","Renter"],["field125","equal_to","Yes"]],[["show_fields","field124,field128"]],"and"],[[["field129","equal_to","Yes"]],[["show_fields","field130,field131,field132"]],"and"],[[["field132","equal_to","Yes"],["field129","equal_to","Yes"]],[["show_fields","field133,field134,field135"]],"and"],[[["field135","equal_to","Yes"],["field129","equal_to","Yes"]],[["show_fields","field136,field137"]],"and"],[[["field138","equal_to","Yes"]],[["show_fields","field139"]],"and"],[[["field139","equal_to","Yes"]],[["show_fields","field140,field142,field143,field144"]],"and"],[[["field146","equal_to","Yes"]],[["show_fields","field147,field153,field149,field150,field151"]],"and"],[[["field151","equal_to","Yes"],["field146","equal_to","Yes"]],[["show_fields","field152,field148,field154,field155"]],"and"],[[["field156","equal_to","Yes"]],[["show_fields","field157,field158,field160,field159"]],"and"]]
1 Taxpayer Info
2 Dependent
3 Income
4 Deductions
5 Other
Your Nameyour full name
Social Security Numberyour social security #
Date of Birthyour date of birth
Addressyour address, city, state & zip
PhoneContact Number
Occupationyour occupation
Marital Status
Spouse Namespose's full name
Spouse Social Security Numberspouse's social security #
Spouse Date of Birthspouse's date of birth
How many dependents?

Dependent #1

Name - Dependent 1Dependent 1
SSN - Dep 1Dep1's social security #
DOB - Dep1dep1's date of birth
Relationship1
Child care?
Provider Name - Dep 1
Address- Dep 1
TIN / SSN - Dep 1
Amount - Dep 1

Dependent #2

Name - Dependent 2Dependent 2
SSN - Dep 2Dep2's social security #
DOB - Dep2dep2's date of birth
Relationship2
Child care?
Provider Name - Dep 2
Address- Dep 2
TIN / SSN - Dep 2
Amount - Dep 2

Dependent #3

Name - Dependent 3Dependent 3
SSN - Dep 3Dep3's social security #
DOB - Dep3dep3's date of birth
Relationship3
Child care?
Provider Name - Dep 3
Address- Dep 3
TIN / SSN - Dep 3
Amount - Dep 3

Dependent #4

Name - Dependent 4Dependent 4
SSN - Dep 4Dep4's social security #
DOB - Dep4dep4's date of birth
Relationship4
Child care?
Provider Name - Dep 4
Address- Dep 4
TIN / SSN - Dep 4
Amount - Dep 4

Dependent #5

Name - Dependent 5Dependent 5
SSN - Dep 5Dep5's social security #
DOB - Dep5dep5's date of birth
Relationship5
Child care?
Provider Name - Dep 5
Address- Dep 5
TIN / SSN - Dep 5
Amount - Dep 5
Dependent 6 and moremore details
0 /
Do you have earned income (W-2, 1099-MISC) ?

Please upload your W-2 or 1099-MISC forms

W-2 or 1099-MISCupload
Upload
Do you have interest or dividend income (1099-INT, 1099-DIV) ?
Amount
Payer
More?
Amount
Payer
More?
Amount
Payer
More?
Amount
Payer
More?
Amount
Payer
Do you have rental income ?
Income
Expense

Please upload your worksheet for your rental income and expenses. If you need to construct retal worksheet. Please comment at the end of this form.

rental uploadupload
Upload
Do you have any other income ? (SSA, Pension, Overseas Income or etc)
Other Incomemore details
0 /
Do you have any sale of capital assets?
Date of Purchaseof appointment
Purchased Amount
Date of Saleof appointment
Sold Amount
income uploadPlease upload any income documents
Please upload any income source documents or related worksheets
Do you have MEDICAL EXPENSE?
Insurance Premium
Prescription Drug
Medical Bill / Copay
Special Items
Are you a HOME OWNER or RENTER?
Did you live in New Jersey?
Mortgage Interest
Property Tax
Homestead Rebate Refund (if applicable)
Upload Mortgage Statmentupload
Upload Mortgage Statment
Total Rent Paid in 2015
Rental Period
Did you make Contributions in 2015?
Organization
Amount
More?
Organization
Amount
More?
Organization
Amount
Did you MOVE in 2015?
Was it work-related and more than 50 miles?
Moving Expense Amount
Moved Date
Old Address
New Address
Did you have any foreign financial account (eg. bank acct, stock or cash) in 2015?
Bank / Financial Institution
Account Number
Highest Balance in 2015
Bank Address
More?
Bank / Financial Institution
Account Number
Highest Balance in 2015
Bank Address
Did you (your entire household) have Medical Insurance for entire year in 2015?
Insurance Company Name
Policy Number

Please attach Form 1095-A from Marketplace, or insurance premium payment receipts for12 months

Medical Insuranceupload
Upload
Commentsmore details
0 /
I verify that to the best of my knowledge and belief all information are true and correct.
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Chenellen LLC is a CPA firm located in Tenafly NJ. We serve mainly local small businesses in Northern New Jersey, Bergen County, especially Northern Valley area including Tenafly, Creskill, Demarest, Norwood, Closter, Northvale, Old Tappan, Hackensack, Oradell, River Edge, Bergenfield, Dumont, Hillsdale, Westwood, Palisades Park, Fort Lee, Edgewater, Englewood, Paramus, Ridgewood, Teaneck and New York.

Contact Information

Chenellen CPA Firm - Hugh Kim, CPA
32 Washington St. Ste 2B2
Tenafly, NJ 07670
 T 201.621.5579
F 201.983.4261
cpa@chenellen.com