SCHEDULE (A) FORM
MEDICAL EXPENSES TAXES PAID
AGI |
|
7.5% |
|
Health Insurance Payments |
|
Co-Payments |
|
Prescription Medicine |
|
Eye Surgery |
|
Contact Lenses |
|
Glasses |
|
Quit Smoking Programs |
|
Special Disability Schools |
|
Wheel Chairs |
|
Dentist |
|
Miles to Dr. Office |
|
Other Medical Expenses |
|
Other Medical Expenses |
|
Other Medical Expenses |
|
Income Tax Paid Last Year ______________
Sales tax in Purchase Contract $ __________
Real Estate Taxes Paid $ ________________
Personal Property Taxes (Plates)
Make _______________ VLT $ __________
Make _______________ VLT $ __________
Make _______________ VLT $ __________
GIFTS TO CHARITY
Cash: $ ______________
Non Cash: $ __________
To Whom: ___________________________
Items: _______________________________
WORK EXPENSES
(Unreimbursed Work Related)
Miles: __________________________
Equipment & Tools: $ _____________
Uniforms & Shoes: $ ______________
C.P.E: $ ___________
Licenses: $ _________
Safe Deposit Box: $ _______________
Telephones: $ ____________________
Mortgage Interest & points Paid