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STANDARD TAX RETURN

TAX FILE NUMBER

Title

Name(*)

Surname

Date of of Birth

Address

Suburb and Postcode

State

Address changes since last return
 yes no

Phone number

Email(*)

Spouse
 yes no

If Yes Spouse Full Name

Spouse Date of Birth

Spouse Tax File Number

Spouse Taxable Income

YOUR INCOME DETAILS

payment summary 1 Employer Name and ABN

payment summary 1 Gross Income and Tax withheld

payment summary 2 Employer Name and ABN

payment summary 2 Gross Income and Tax withheld

payment summary 3 Employer Name and ABN

payment summary 3 Gross Income and Tax withheld

Allowances, tips, director'sfees ...

Govt Allowances: Amounts and tax withheld

Govt pensions : Amount and tax withheld

Gross Interest

Income from dividends

Franking Credits

Any CGT event to report?
 yes no

Describe any other Income if any:

Personal info Part 2 :Deductions

If you are unsure, leave it blank and we will contact you

Work related deductions, Donations, Accounting feees etc.

Motor Vehicle

Did you use your car for any work purposes?
 yes no

if yes : Reasons & number kms travelled per month or year

WORK RELATED TRAVEL EXPENSES

If applicable: Purpose and travel costs:

Uniform

Do you have a logo on your purchased uniform?
 yes no

Do you have wear any protective uniforms?
 yes no

Donations

Did you make any donations this year?
 yes no

Total donations made:

Other notes about my deductions:

PRIVATE HEALTH INSURANCE

Were you and your dependants covered by private health insurance?
 yes no

If Yes: Name of Fund, Member number and type of cover

Medical expenses

Did you have any out of pocket expenses over $2120 for you or familly members?
 yes no

HELP/HECS repayments

Did you have any HELP/ HECS debt ?
 yes no

If Yes amount owed (estimate)

DECLARATION

I authorise Gerard Marino to represent me and lodge my tax return
 yes no

The information provided for the preparation of this tax return is true and correct
 yes no

How will you be paying your tax return fee?
 Direct deposit Paypal

BANK DETAILS
BSB

Account number and name