Long Form Questions

MEDICAL:
	     Miles __________________________	     		Acupuncture ___________________
	     Doctor _________________________	      		Prescription ____________________
               Eye ___________________________ 	     		Herbalist _______________________
                Insurance ______________________       		Hotel _________________________
                Chiropractor ______________________       		Mental Health _________________________
                In-Home Nurse ______________________       	Smoking Program _________________________
                LongTerm Care ______________________       	WeightLoss Program _________________________
                Drug/Alcohol Treatment Program _____________       Lactation _________________________
                Eye Surgery ______________________       		Breast Pump _________________________

TAXES:                     
	     DMV (VLF FEE ONLY) ____________	 Sales Tax on Car/Boat ____________ Property Tax _____________

	     Estimated Taxes (JAN)  ____________ (APRIL) ____________ (JULY) ____________ (OCT) ____________

MORTGAGE:
	     Mortgage Interest ________________	     Points __________________

CHARITY:
	     Cash Donation___________________	     Stuff Donation ___________________

MISC. EXPENSES                                        

Work related expenses to allow a Disabled person to work: 
tools ________________ Seating ________________  desk ________________   Electronincs ________________   Other ________________    

Gambling Losses ________________   Gambling Winnings ________________