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| TAX PROJECTION WORKSHEET |
| TAX YEAR | |
| WAGES - TAXPAYER | |
| WAGES - SPOUSE | |
| INTEREST | |
| DIVIDENDS | |
| STATE TAX REFUNDS | |
| NET SHORT-CAPITAL GAINS (LOSSES) | |
| NET LONG-TERM CAPITAL GAINS (LOSSES) | |
| NET SELF-EMPLOYMENT BUSINESS INCOME (LOSS) | |
| NET RENTAL INCOME (LOSS) | |
| PARTNERSHIP, S CORP & LLC PROFIT (LOSS) | |
| IRA, PENSION & PROFIT SHARING INCOME | |
| SOCIAL SECURITY | |
| OTHER INCOME | |
| SELF-EMPLOYED HEALTH INS PREMIUMS | |
| IRA CONTRIBUTIONS | |
| SEP-IRA or KEOGH CONTRIBUTIONS | |
| OTHER ADJUSTMENTS | |
| MEDICAL EXPENSES PAID | |
| PRIOR YEAR STATE TAXES PAID | |
| CURRENT YEAR STATE TAXES PAID | |
| OTHER TAXES (i.e. PROPERTY, DMV) | |
| HOME MORTGAGE INTEREST | |
| INVESTMENT INTEREST | |
| CASH CONTRIBUTIONS | |
| NONCASH CONTRIBUTIONS | |
| INVESTMENT EXPENSES | |
| EMPLOYEE BUSINESS EXPENSES | |
| OTHER MISCELLANEOUS DEDUCTIONS | |
| PROJECTED ANNUAL TAX WITHHOLDINGS: | |
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| ESTIMATED TAX PAYMENTS: | FEDERAL | STATE |
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| ADDITIONAL INFORMATION: |
| Please attach other documents as considered necessary. |
| COLDWELL, SCLAFANI & COMPANY LLP- CERTIFIED PUBLIC ACCOUNTANTS |