T A X    O R G A N I Z E R
1 9 8 9    I N F O R M A T I O N
-----------------------------------------------------------------------------
OVER 65   BLIND
NAME _________________      ( )       ( )                             CHECK
FILING STATUS       ONE:
SPOUSE________________      ( )       ( )      ----------------------------
MARRIED FILING JOINTLY   ( )
MARRIED FILING SEPERATE  ( )
TOTAL EXEMPTIONS _________                     SINGLE                   ( )
HEAD OF HOUSEHOLD        ( )
W2 INFORMATION
--------------
HUSBAND   WIFE                FEDERAL        STATE
COMPANY                  GROSS     GROSS      FICA    WITHHOLDING   WITHHOLDING
----------------------  ---------  --------- -------  ------------  -----------
TOTALS
=========  ========= =======  ============  ===========
INTEREST AND DIVIDEND INCOME
----------------------------
INTEREST                                DIVIDENDS
-----------------------------------     -----------------------------------
NAME OF PAYER              AMOUNT       NAME OF PAYER              AMOUNT
--------------------   ------------     --------------------   ------------
TOTALS                                  TOTALS
============                            ============
---------------------------------------------------------------PAGE 2----
MEDICAL EXPENSES
----------------
MEDICINE AND DRUGS                 DOCTORS AND DENISTS
-----------------------------      ---------------------------------------
PAID TO             AMOUNT         PAID TO                       AMOUNT
----------------  -----------      -------------------------   -----------
TOTAL
----------------  -----------                                  ===========
----------------  -----------
OTHER MEDICAL
----------------  -----------      ---------------------------------------
DESCRIPTION                   AMOUNT
----------------  -----------      --------------------------  -----------
HEALTH INSURANCE
MEDICAL TRAVEL
EYE GLASSES
TOTAL                                        TOTAL
===========                                  ===========
---------------------------------------------------------------PAGE 3----
TAXES YOU PAID                          GIFTS TO CHARITY (UNDER $3000 EA)
--------------                          ---------------------------------
PAID TO          AMOUNT
REAL ESTATE TAXES      _____________    -------------------  ------------
PERSONAL PROPERTY TAX  _____________    -------------------  ------------
OTHER TAXES            _____________    -------------------  ------------
_____________    -------------------  ------------
SUBTOTAL          _____________    -------------------  ------------
-------------------  ------------
STATE AND LOCAL INCOME TAXES
----------------------------            -------------------  ------------
WITHHELD FROM INCOME   _____________    -------------------  ------------
PD WITH LAST YR RETURN _____________    -------------------  ------------
TOTAL GIFTS LESS
TOTAL TAXES                        THAN $3000 PER DONEE
=============                         ------------
INTEREST YOU PAID                        GIFTS GREATER THAN
------------------------------------       $3000 PER DONEE
HOME MORTGAGE INTEREST             -------------------------------
PAID TO          AMOUNT                 PAID TO          AMOUNT
------------------  -----------          ------------------  -----------
TOTAL MORTGAGE INT                      TOTAL GIFTS GREATER
-----------          THAN $3000 PER DONEE
-----------
TOTAL CHARITY GIFTS
===========
PERSONAL INTERST
(Credit cards, car loans, etc)
-----------------------------------
TOTAL PERSONAL INT
---------------------------------------------------------------PAGE 4----
MISCELLANEOUS DEDUCTIONS  (JOB EXPENSES AND MOST OTHER MISC DEDUCTIONS)
-----------------------------------------------------------------------
DESCRIPTION        AMOUNT             DESCRIPTION         AMOUNT
--------------------  -----------        ------------------  -----------
JOB TRAVEL (MEALS)                       SAFE DEPOSIT BOX
JOB TRAVEL (LODGING)
JOB TRAVEL (AUTO)
JOB TRAVEL (OTHER)
JOB SUPPLIES
UNION DUES
PUBLICATIONS
UNIFORM COST
UNIFORM CLEANING
TAX PREPERATION FEE
TOTAL JOB RELATED
MISC DEDUCTIONS
MISCELANEOUS DEDUCTIONS NOT SUBJECT TO 2% FLOOR
(Primarily for Handicapped persons with Job related expenses)
-------------------------------------------------------------
TOTAL MISC DEDUCTIONS
NOT SUBJECT TO 2% FLR
---------------------------------------------------------------PAGE 5----
PROFIT OR LOSS FROM BUSINESS OR PROFESSION
------------------------------------------
1 GROSS RECEIPTS OR SALES  . . . . . . . . . . . . . . ._________________
2 LESS COST OF GOODS SOLD (see schedule next page) . . ._________________
3 GROSS PROFIT (line 1 less line 2). . . . . . . . . . ._________________
4 OTHER INCOME . . . . . . . . . . . . . . . . . . . . ._________________
5 GROSS INCOME (add line 3 and 4). . . . . . . . . . . ._________________
6 LESS DEDUCTIONS (Total from below) . . . . . . . . . ._________________
7 NET PROFIT OR (LOSS) . . . . . . . . . . . . . . . . ._________________
DEDUCTIONS
ADVERTISING. . . . . ._______________  REPAIRS. . . . . . . _________________
BAD DEBTS  . . . . . ._______________  SUPPLIES . . . . . . _________________
BANK SERVICE CHARGES  _______________  TAXES. . . . . . . . _________________
CAR AND TRUCK EXPENSE _______________  REMT . . . . . . . . _________________
COMMISSIONS  . . . . ._______________  TRAVEL . . . . . . . _________________
DEPLETION. . . . . . ._______________  MEALS & ENTERTAINMENT_________________
DEPRECIATION . . . . ._______________  UTILITIES. . . . . . _________________
DUES AND PUBLICATIONS._______________  TELEPHONE. . . . . . _________________
EMPLOYEE BENEFIT PRG  _______________  WAGES. . . . . . . . _________________
FREIGHT. . . . . . . ._______________  INSURANCE. . . . . . _________________
INTEREST . . . . . . ._______________  LAUNDRY & CLEANING . _________________
LEGAL & PROFESSIONAL ._______________  OFFICE EXPENSE . . . _________________
OTHER DEDUCTIONS
DESCRIPTION             AMOUNT           DESCRIPTION             AMOUNT
-------------------   ---------------   -------------------   ---------------
TOTAL OTHER DEDUCTIONS_______________
GRAND TOTAL DEDUCTIONS_______________
---------------------------------------------------------------PAGE 6----
COST OF GOODS SOLD
-------------------------------
1 INVENTORY AT BEGINNING OF YEAR . . . . . ._______________
2 PURCHASES  . . . . . . . . . . . . . . . ._______________
3 COST OF LABOR  . . . . . . . . . . . . . ._______________
4 MATERIALS AND SUPPLIES . . . . . . . . . ._______________
OTHER COSTS:
DESCRIPTTION        AMOUNT
---------------- ---------
5      TOTAL OTHER COSTS  . . . . . . . . ._______________
6 ADD LINES 1 THROUGH 5 . . . . . . . . . ._______________
7 LESS INVENTORY END OF YEAR. . . . . . . (_______________)
8 COST OF GOODS SOLD. . . . . . . . . . . ._______________
---------------------------------------------------------------PAGE 7-------
RENTAL INCOME OR LOSS
---------------------
*   PROPERTY A  *   PROPERTY B  *   PROPERTY C  *
* ------------- * ------------- * ------------- *
DESCRIPTION-ADDRESS        *               *               *               *
* ============= * ============= * ============= *
RENTS RECEIVED
LESS EXPENSES (total below)
-------------   -------------   -------------
RENT INCOME OR (LOSS)
=============   =============   =============
NET RENT OR (LOSS) OF ALL PROPERTIES __________________
------------------------------------------------------------------------------
RENT EXPENSES
ADVERTISING                *               *               *               *
AUTO AND TRAVEL            *               *               *               *
CLEANING & MAINTENANCE     *               *               *               *
COMMISSIONS                *               *               *               *
INSURANCE                  *               *               *               *
LEGAL AND PROFESSIONAL     *               *               *               *
INTEREST                   *               *               *               *
REPAIRS                    *               *               *               *
SUPPLIES                   *               *               *               *
TAXES                      *               *               *               *
UTILITIES                  *               *               *               *
WAGES AND SALARIES         *               *               *               *
OTHER EXPENSES
DESCRIPTION                                 --------------
*               *               *               *
-----------------------    * ------------- * ------------- * ------------- *
TOTAL EXPENSES               _____________   _____________   ______________