{"text_format":"dbase-jsonl-2026-09-30","columns":[{"name":"LINEITEM","type":"character","width":80}],"n_rows":245,"rows_kept":245,"cut":false,"deleted_skipped":0,"read_ended":"whole","bounds":"16MiB/16384/4096/first_that_fit","version":"dbase_level_three","encoding_class":"enc_absent","reader":"statdb_count/9"}
["T A X   D A T A   W O R K S H E E T"]
[null]
["1 9 9 1    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        ( )"]
[null]
["W2 Information"]
["______________"]
[null]
["Husband   Wife                Federal        State"]
["Company                  Gross     Gross      FICA    Withholding   Withholding"]
["______________________  _________  _________ _______  ____________  ___________"]
[null]
["______________________  _________  _________ _______  ____________  ___________"]
[null]
["______________________  _________  _________ _______  ____________  ___________"]
[null]
["______________________  _________  _________ _______  ____________  ___________"]
[null]
["______________________  _________  _________ _______  ____________  ___________"]
[null]
["______________________  _________  _________ _______  ____________  ___________"]
[null]
["______________________  _________  _________ _______  ____________  ___________"]
[null]
["Totals"]
["=========  ========= =======  ============  ==========="]
[null]
[null]
["Interest and Dividend Income"]
["____________________________"]
["Interest                                Dividends"]
["___________________________________     ___________________________________"]
["Name of Payer              Amount       Name of Payer              Amount"]
["____________________   ____________     ____________________   ____________"]
[null]
["____________________   ____________     ____________________   ____________"]
[null]
["____________________   ____________     ____________________   ____________"]
[null]
["____________________   ____________     ____________________   ____________"]
[null]
["____________________   ____________     ____________________   ____________"]
[null]
["____________________   ____________     ____________________   ____________"]
[null]
["____________________   ____________     ____________________   ____________"]
[null]
["____________________   ____________     ____________________   ____________"]
[null]
["Totals                                  Totals"]
["============                            ============"]
["EJECT"]
["T A X   D A T A   W O R K S H E E T"]
[null]
["1 9 9 1    I N F O R M A T I O N"]
["-------------------------------------------------------------- Page 2 ----"]
[null]
["Medical Expenses"]
["________________"]
[null]
["Medicine and Drugs                 Doctors and Dentists"]
["_____________________________      _______________________________________"]
["Paid to                 Amount          Paid to                   Amount"]
["______________________  ___________     _______________________   ___________"]
[null]
["______________________  ___________     _______________________   ___________"]
[null]
["______________________  ___________     _______________________   ___________"]
[null]
["______________________  ___________     _______________________   ___________"]
[null]
["______________________  ___________     _______________________   ___________"]
[null]
["______________________  ___________     _______________________   ___________"]
[null]
["______________________  ___________     _______________________   ___________"]
["Total"]
["______________________  ___________                               ==========="]
[null]
["______________________  ___________"]
[null]
["______________________  ___________"]
["Other Medical"]
["______________________  ___________    _______________________________________"]
["Description                   Amount"]
["______________________  ___________    __________________________  ___________"]
["Health Insurance"]
["______________________  ___________    __________________________  ___________"]
["Medical Travel"]
["______________________  ___________    __________________________  ___________"]
["Eye Glasses"]
["______________________  ___________    __________________________  ___________"]
[null]
["______________________  ___________    __________________________  ___________"]
[null]
["______________________  ___________    __________________________  ___________"]
[null]
["______________________  ___________    __________________________  ___________"]
[null]
["______________________  ___________    __________________________  ___________"]
[null]
["______________________  ___________    __________________________  __________"]
[null]
["______________________  ___________    __________________________  ___________"]
["Total                                      Total"]
["===========                                ==========="]
["EJECT"]
["T A X   D A T A   W O R K S H E E T"]
[null]
["1 9 9 1    I N F O R M A T I O N"]
["-------------------------------------------------------------- Page 3 ---"]
[null]
["Taxes You Paid                          Gifts to Charity (Under $3000 ea)"]
["______________                          _________________________________"]
["Paid to              Amount"]
["Real Estate Taxes       _____________    ___________________  ____________"]
[null]
["Personal Property Tax   _____________    ___________________  ____________"]
[null]
["Other Taxes             _____________    ___________________  ____________"]
[null]
["_____________    ___________________  ____________"]
[null]
["Subtotal           _____________    ___________________  ____________"]
[null]
["___________________  ____________"]
["State and Local Income Taxes"]
["_____________________________________    ___________________  ____________"]
[null]
["Withheld From Income    _____________    ___________________  ____________"]
[null]
["Paid w/last Yr's return _____________    ___________________  ____________"]
[null]
["Est. paid this year     _____________"]
[null]
["Total Gifts Less"]
["Total Taxes                        Than $3000 Per Donee"]
["=============                         ____________"]
[null]
[null]
["Interest You Paid                        Gifts Greater Than"]
["_____________________________________    $3000 Per Donee"]
["Home Mortgage Interest             _______________________________"]
["Paid to             Amount               Paid to             Amount"]
["__________________  ___________          __________________  ___________"]
[null]
["__________________  ___________          __________________  ___________"]
[null]
["__________________  ___________          __________________  ___________"]
[null]
["Total Mortgage Int                      Total Gifts Greater"]
["___________          Than $3000 Per Donee"]
["___________"]
["Total Charity Gifts"]
["==========="]
["EJECT"]
["T A X   D A T A  W O R K S H E E T"]
[null]
["1 9 9 1    I N F O R M A T I O N"]
["-------------------------------------------------------------- Page 4 ---"]
[null]
["Miscellaneous Deductions  (Job Expenses and Most Other Misc Deductions)"]
["________________________________________________________________________"]
[null]
["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 Preparation Fee"]
["____________________  ___________        __________________  ___________"]
[null]
["Total Job Related"]
["Misc Deductions"]
["==========="]
[null]
[null]
[null]
[null]
["Miscellaneous Deductions not Subject to 2% Floor"]
["(Primarily for Handicapped persons with Job related expenses)"]
["_____________________________________________________________"]
[null]
["Description        Amount             Description         Amount"]
["____________________  ___________        __________________  ___________"]
[null]
["____________________  ___________        __________________  ___________"]
[null]
["____________________  ___________        __________________  ___________"]
[null]
["____________________  ___________        __________________  ___________"]
[null]
["Total Misc Deductions"]
["Not Subject to 2% FLR"]
["==========="]
["EJECT"]
["T A X   D A T A   W O R K S H E E T"]
[null]
["A D D I T I O N A L   I N F O R M A T I O N"]
["------------------------------------------------------------------ Page 5 ---"]
[null]
["Employers are required to send W2 forms to all employees showing the amount"]
["of gross wages and taxes withheld for the year.  Also anyone who paid you $600"]
["or more for contract labor, rent, interest or dividends is required to send"]
["you a form 1099 indicating the amount paid to you.  You should receive all W2"]
["and 1099 forms by January 31, 1992."]
[null]
["You may owe self-employment income if you were paid on a contract labor basis."]
["Self-employment income is applied to your net business income, which is the"]
["amount you earned less all of your business expenses."]
[null]
["Interest and dividends are reported to you on a form 1099.  A copy of these"]
["forms is also sent to the IRS."]
[null]
["Mortgage companies are required to send you a form 1098 for interest you paid"]
["to them on loans.  These year-end statements frequently have information about"]
["deductible property taxes paid from your escrow account during the year."]
[null]
["Tax practitioners recommend you keep copies of all receipts and informational"]
["forms for at least 5 years."]
["EJECT"]
[null]