Itemized Deductions First & Last NameTax YearDate Submitted MedicalDrugs & MedicinesMedical Insurance PremiumsDoctors, Dentists & HospitalsLab Fees, Eyeglasses, Hearing AidsParkingMedical MilesInsurance Reimbursements TaxesReal Estate ResidenceReal Estate/ OtherSales TaxState Income Tax Paid/ What state? Interest PaidHome MortgageMortgage Insurance PremiumsPointsHome Improvement LoanInvestment Margin Interes Credit Card Interest NOT Deductible ContributionsAll Cash ContributionsOther Than Cash what was donatedWhat you paid for items (approx)Where you donated to (all locations)Date DonatedCharitable Miles Casualty LossesAuto AccidentDateTheftDateTornado or Freeze (specify)DateFireDateOtherDate Unreimbursed Employee ExpensesProfessional/ Union DuesSafe Deposit BoxTeachers ExpensesEducation ExpenseTax Prep FeesOther (please specify)Gambling Losses (Not more than gambling income)Additional NotesPrint
