Whitehouse Station, New Jersey 08889

Fringe Benefits

There are many other types of taxable fringe benefits. Please call our office to discuss which ones may apply to you.

(CLICK HERE FOR EXCEL VERSION)

Company leased/owned vehicle:

Company Name: ____________________ Phone #: ____________________ Contact Name: ____________________

Vehicle 1 Vehicle 2 Vehicle 3 Date acquired/leased __________ __________ __________ Year/Model __________ __________ __________ Cost (if leased, what would cost if purchased) __________ __________ __________ Commute-round trip __________ Total for year __________ __________ __________ Other personal mileage __________ __________ __________ Business mileage __________ __________ __________ Total mileage __________ __________ __________

Life Insurance - Only if company is not beneficiary:

Is it a group policy?   __________   If so, is face amount greater than $50,000?   __________   If so, please provide the following for each member of the group:       Employee Name Face Amount Age   _________________________ _______________ __________   _________________________ _______________ __________   _________________________ _______________ __________

If you have individual life policies, we need the employee's name and the amount of premium paid from January 1 through December 31:

Employee Name Amount Paid   _________________________ _______________   _________________________ _______________   _________________________ _______________

Accident and Health Insurance - For stockholder of S Corporations only:

Amount of premium paid from January 1 through December 31:   Name Amount Paid   _________________________ _______________   _________________________ _______________