1040 Tax Return Organizer (US Citizen or US Resident)
Husband and Wife must each complete a separate organizer.

Tax Year Ending:

1. Your Name: US Address:
US Telephone:
US Cellular: City:
Fax: State:
E-mail: Zip:
2. Non-US Telephone: Non-US Address:
Non-US Cellular:
Non-US Fax: City:
Province:
Postal Code:
(use 00000 if N/A)
3. US Tax ID# (if any): Birth Date:
4. Marital Status: Occupation:
5. Details of Dependant Children: Child 1 Name: Child 1 Day Care Expenses:
Child 2 Name: Child 2 Day Care Expenses:
Child 3 Name: Child 3 Day Care Expenses:
6. Did each dependant child live with you the entire year?:
Child 1 Date of Birth: Child 1 Social Security or I.T.I.N. #:
Child 2 Date of Birth: Child 2 Social Security or I.T.I.N. #:
Child 3 Date of Birth: Child 3 Social Security or I.T.I.N. #:
7. Are you legally blind?: Year spouse died (if applicable):
8. Country of Citizenship:
Were either of your parents U.S. citizens?:
9. Country issuing your passport: Country of residence:
Number of days in U.S. this year?:
10. Do you have a Green Card?: If, Yes, what date was it issued?:
If No, have you applied for a Green Card?: If, Yes, what date did you apply?:
Have you abandoned a Green Card or relinquished U.S. citizenship since February 2, 1995?:
Do you have any other U.S. Visa?: If, Yes, what type?: Visa #:
11. Are you faxing a copy of a "foreign country" tax return for this questionnaire?:
If Yes, does it include all your foreign income for the year?:
If No, please mail or fax a summary of your worldwide income for the year to (011) 561.241.6331
12. Please state the amount of the following expenses paid during the year:
Un-reimbursed Medical Expenses:
 Medical Insurance Premiums:
 Interest on a Residence:
Mortgage Interest on Other Residence:
 Home Equity Loan Interest:
 Other Interest:
Taxes on a Residence:
 Other Taxes:
 Charitable Contributions:
Casualty Losses/Theft:
 Tax Preparation:
 Investment Expenses:
Safe Deposit Box:
 Alimony:
13. Excluding the info on IRS Form W-2, please list the date(s) and amount(s) of U.S. taxes withheld during the year:

Federal Tax Paid:
State Tax Paid:
Date Paid: Date Paid:
Amount Paid: Amount Paid:
Tax Year: Tax Year:
Date Paid: Date Paid:
Amount Paid: Amount Paid:
Tax Year: Tax Year:
Date Paid: Date Paid:
Amount Paid: Amount Paid:
Tax Year: Tax Year:
Date Paid: Date Paid:
Amount Paid: Amount Paid:
Tax Year: Tax Year:
14. Did you sell or own any Canadian, European, or other Non-US Mutual Funds during the year?:
15. With respect to any IRA or 401(k) accounts, did you have any contributions, rollovers or withdrawals?:
16. For what tax year did you last file a U.S. tax return ?:
17. Did you receive any correspondence from the IRS regarding your prior year tax return?:
18. Did you sell any assets (stocks, bonds, real estate, etc.) during the year?:
19. Did you have a Guaranteed Investment Certificate (GIC) mature during the year?:

Annuity Payments You Received
20. Did you receive any annuity payments during the year?:
If yes, Name of Insurance Company: Plan Number:
Date Purchased: Cost of Annuity: Date Payments Commenced:
Initial Amount of Payment: Payable for your life only?:
Payable for you and your spouse?: Payable for fixed number of years?:
Canadian Pension/Profit Sharing Plan
21. Were you the owner/beneficiary of any of the following Canadian pension plans?
A registered pension plan or deferred profit sharing plan or an RRSP or RRIF (or equivalent)?:
Have you completed the Canadian Pension Plan Organizer?:
If no, Please print, complete and fax or mail the the Canadian Pension Plan Organizer.
Foreign (NON-U.S.) Private Pension Plans
22. Do you belong to a non-U.S. employer or private pension (e.g., Canadian, European or other non-U.S. Plan?:
If yes, Name of Plan Trustee: Plan Number:
Approx. Date you entered plan: Total contributions you have made to the plan:
Total contributions your employer has made to the plan:
Date your pension payment commenced:
 Original amount of your annual pension payment:
Non-U.S. Bank Accounts, Brokerage Accounts, Etc.
In addition to the tax returns, U.S. citizens and residents must file U.S. reports on their non-U.S. accounts. Therefore, for any non-U.S. bank, stockbrokerage, trust company, RRSP, RRIF or similar account you held during the year (including corporate accounts), please provide the following: (if you have more than 4 of these types of accounts, please send us the balance of the information that did not fit on this form.)
23. Name of Institution 1: Account Number: Type of Account :
Address of Institution:
Name on Account: Maximum Balance During the Year:
Name of Institution 2: Account Number: Type of Account :
Address of Institution:
Name on Account: Maximum Balance During the Year:
Name of Institution 3: Account Number: Type of Account :
Address of Institution:
Name on Account: Maximum Balance During the Year:
Name of Institution 4: Account Number: Type of Account :
Address of Institution:
Name on Account: Maximum Balance During the Year:
24. During the year, did you have signature authority over any non-U.S. account without having any ownership interest in the account?:
If Yes, Please state the name, adress, and U.S. taxpayer number, if any, of the owner of the account:
25. During the year, did you have any ownership interest in any U.S Company, Partnership, or Trust that had any type of account mentioned above?:
Other Important Reporting Requirements
26. At any time during the year, did you and/or your family own or control directly or indirectly 10% or more of any Canadian, European, or other non-U.S. Company, Trust, or Partnership?:
27. Were you or your spouse an officer or director of any non-U.S. corporation during the year?:
If Yes, did any U.S. person own 10% or more of the corporation?:
28. During the year, did you TRANSFER any money or property to a non-U.S. Corporation, Partnership, Trust or Estate, OR to any U.S. partnership that has a non-U.S. partner?:
29. During the year, did you RECEIVE any money or property from a non-U.S. Corporation, Partnership, Trust or Estate (excluding any dividends received from publicly traded corporations in which you held an insignificant percentage interest)?:
30. Were you the executor of any deceased individual that had a connection or transaction with a non-U.S. trust?:
31. Did you receive any inheritances during the year?:
32. Do you have any connection whatsoever with any non-U.S. trust?:
Other Important Information (Please complete the applicable sections)
33. If your country of residence is the U.S., please indicate what date you became a resident:
If you are a Florida resident, please print, complete and fax or mail the Florida Intangible Tax Organizer.
34. Did you receive salary income from a non-U.S. source?:
If Yes, total salary earned expressed in foreign currency: U.S. Dollars:
Employer Name & Address:
Occupation: Date you became a resident of a foreign country:
Do you own or rent your foreign home?:
How many days were you in the U.S. ON BUSINESS during the year?:
35. Do you have a foreign VISA?:
If Yes, Type: Terms:
36. Is there anything else you feel we need to know or would like to tell us?