VERCRUYSSE CONSULTING SASMAILING ADDRESS/OFFICE LOCATION:

38 BIS RUE DE RIVOLI75004 PARIS, FRANCE

TEL: 33 (0)1 45 63 40 00 FAX: 33 (0) 1 44 61 41 53E-MAIL: tax@vercruysse.fr

Website: www.vercruysse.fr

GENERAL TAX ORGANIZER FOR 2016 TAX RETURNS

YOUR NAME

ADDRESSCITY (STATE) ZIP CODEPHONE NUMBER(S)

FAX NUMBER(S)

E-MAIL(S)

(MANDATORY FOR E-FILINGS)

Dear Client,

This is your 2016 TAX ORGANIZER. You need to complete the portions that are relevant to you. Return it to us by post or email scan as soon as you have received all the necessary supporting documents. If we need additional information, we will contact you.

For U.S. citizens and Green Card Holders, 2016 U.S. INDIVIDUAL INCOME TAX RETURNS are due June 15, 2017 (April 18, 2017 if you reside in the U.S.). Note, the extended deadline to June 15th does not stop interest from accruing from April 18th on any tax due, so be sure that all 2016 estimated tax payments have been made and, if required, make any additional payments on or before April 18, 2017. If you are unsure of your requirements please contact us.

If you reside in France, 2016 FRENCH INDIVIDUAL INCOME TAX RETURNS are due sometime in May 2017 (actual date unknown as of this printing). If you are a non-resident of France, last year your filing deadline was the same date, but again, nothing has been officially released by the French authorities. For those of you who are self-employed in France and file Form 2035, or who own an SCI which collects rental income and file Form 2072, the filing deadline for both these forms is May 3, 2017. The French postmark is still considered date of filing for France. Revenue Ruling 2002-23, 2002-18 IRB 811 provides that federal tax returns mailed by taxpayers in foreign countries will be accepted as timely filed if they bear an official postmark dated on or before midnight of the last date prescribed for filing, including any extension of time for such filing.

Important note: As a reminder, US citizens are required to file US tax returns if gross worldwide income levels are met whether or not they have US source income as it is every US citizen's obligation to report worldwide income. The same holds true for green card holders. In addition, all French residents (whether or not they are French citizens) must also report their worldwide

income. In order to avoid double taxation, there is a treaty in place between France and the US. We would like to emphasise that even though you may receive tax exempt income in France (interest from livret A or assurance vie), this income is not exempt for US purposes and must be reported on the US return. Similarly, US tax-exempt interest is reportable on the French tax return.

Last year, the majority of our clients benefited from U.S. e-filing. This option, when available, greatly streamlines the filing process, eliminates the need to send in a paper return by registered mail and speeds up the refund process. If taxes are owed you may also request a direct withdrawal from a U.S. bank account. As your paid preparer, it is our obligation to file your tax return electronically whenever possible. Therefore, for those of you who prefer to file by the traditional paper route, our office will require that an 'opt-out' form is filed.

France has also installed e-filing regulations since last tax season. French tax returns need to be filed online except under certain very limited circumstances. If not exempt, from now until 2019, the e-filing requirement applies for taxpayers based on their ‘revenu fiscal de référence’. Thereafter, it will be obligatory for all taxpayers. The majority of our clients fell under this e-filing requirement last year and will continue to do so this year. Penalties may apply if you do not adhere to the electronic filing requirements, when applicable.

In the past, on-line filing allowed you an additional delay to file (usually 2-3 weeks more depending on where you live). You will also need to complete a "Mandat" furnished with this organizer.

As the French and U.S. filing dates are close in time, we will use your Organizer for the two returns.

Please report all amounts (income, expense, foreign tax payment, etc.) in original currency and CLEARLY note the currency you are using. We will do the necessary exchange rate conversions.

The foreign earned income exclusion for 2016 has been increased to $101,300. It should in-crease to $102,100 for tax year 2017.

WEALTH TAX NEWS: The 2017 threshold for filing this return continues to be 1,300,000 € at the progressive rate of taxation ranging from 0.5% to 1.5%. For the 2017 filing, if your net worth falls between 1,300,000 and 2,570,000 €, your wealth tax declaration should be an integral part of your French income tax return, due sometime in May, 2017. Thus you should ensure that our office receives your calculations for wealth tax at the same time as the information for your income tax return. Two distinct tax assessments (avis d’imposition) will be sent in the fall of 2017 for income tax and wealth tax. Payments of both your income and wealth tax should be due September 15th but the tax office can send out notices later on. If you don't receive your 'avis' in early September, you should contact our offices. If, however, your net wealth is over 2,570,000 €, your individual wealth tax return accompanied by payment of the tax due must be filed by June 15th for French residents. Concerning non-resident filings of ISF, the official filing deadline has not yet been released but should continue to be due in July. An ISF questionnaire will be sent to those clients who request it, as well as those clients for whom we have prepared a return in the past. A wealth tax consultation may be in order for those who are not sure whether they have ISF filing obligations.

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PLEASE INDICATE WHICH RETURNS YOU WOULD LIKE US TO PREPARE,AND ACCURATELY COMPLETE THE ATTACHED QUESTIONNAIRE We request that you sign and return the engagement letter to our offices (by regular mail, fax, email scan) before we work on your returns. This engagement letter is sent under separate email attachment.

U.S. and French U.S. only Form FinCEN 114 (FBAR), reporting requirements see page 8 Form 1099 (ONLY applied to self-employed persons or those who have rental income) Form 8938 (FATCA), sent under separate cover Form 5471/ 8865 (10% shareholder or certain partners of non U.S. entities) French only (we will send you a different organizer next year) Interested in Electronic filings - French and/or U.S. Please indicate ______________

For French electronic filings - please provide your 'impots-gouv' password _______________if we did not set up your account or if you changed your password during the year

I, the undersigned, state that the contents of this Tax Organizer with attachments are complete and accurate and that I have read and fully understand my filing obligations as outlined above.

Your signature(s)__________________________________Date______________*

__________________________________

With kind regards,

Lynda

Lynda Vercruysse

* Client’s signature required, including both spouses if joint returns are to be prepared.

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FRENCH AND U.S. TAXATION - IMPORTANT REMINDERS

FRANCE/US INTERGOVERNMENTAL AGREEMENT - IGA

HTTP://WWW.TREASURY.GOV/RESOURCE-CENTER/TAX-POLICY/TREATIES/DOCUMENTS/ BILATERALAGREEMENTUSFRANCEIMPLEMENTFATCA.PDF

As a result of the intergovermental agreement (IGA) signed between France and the US, certain of our taxpayers have received form W-9 from their French bank(s) as well as FATCA forms from their French bank(s). If you are unfamiliar with this agreement and the implications involved, please contact our office immediately. Although both countries have had reporting requirements for decades, this has become the latest 'hot spot' in tax compliance. It is highly recommended that both the French and US Foreign Bank Account Reports (FBARs) are accurately filed on a yearly basis. Please take a moment to review your past filings and ensure that you are in compliance on both sides of the Atlantic.

FRANCE

CAPITAL GAINS. Capital gains from stock sales made in 2016 continue to be taxed at the progressive tax rate and are also subject to social charges of 15.5% (CSG, CRDS, etc). Of important note, US capital gains which were historically not taken into consideration to determine the effective tax rate for the French return, must now be declared; potentially raising your effective tax rate on French source income. As in the past, a full tax credit will be received for US citizens declaring US capital gains on the French return, they are also exempt from CSG, etc.

DIVIDENDS. Gross dividends will still receive a 40% deduction. In addition to taxation of the net dividends at progressive rates, surtaxes (CSG) of 15.5% will also be applied to gross dividends, however dividends received in France are now subject to a mandatory withholding tax of 21%. If the distributing institution is situated in France, the institution will declare and pay this 21% tax and you will receive the net amount. It is extremely important that we receive the Imprimé Fiscal Unique from your French bank so that we can accurately declare the proper credit for withheld tax. If the distributing institution is situated outside of France, it will be your obligation to declare the dividend and pay 21% tax within the first 15 days of the month following the month you receive the dividend.

You may request exemption from this mandatory 21% withholding payment if your “revenu fiscal de reference” for the two years prior was under 50.000 € for those filing single and 75.000 € for those filing joint returns. This demand will take effect in the year following the request and must be made by November 30th.

FIXED INCOME INVESTMENTS. A similar regime also applies to fixed income investments. In the past, these investments were taxed at a flat rate of 24%. They will now be subject to progressive tax rates with a minimum rate of 24%. The rules for withholding from institutions and spontaneous tax payments will apply in the same way as stated for dividends with one exception. The exemption request for mandatory withholding takes into account a “revenu fiscal de reference” for the prior two years under 25.000 € for those filing single and 50.000 € for those filing joint returns.

ENERGY EFFICIENT TAX DEDUCTIONS. There still remains the possibility for tax deductions on certain energy efficient home improvements on your principal residence. As there are many different considerations, if this may apply to you, be sure to let us know.

HIGH NET WORTH INCOME TAX. The 'contribution sur les hauts revenus' remains in effect. The tax is triggered for those filing singly with a revenue fiscal de reference of

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250.000 € and by those filing jointly with a revenue fiscal de reference de 500.000 €. This tax is either 3% or 4% of the amount exceeding the above mentioned thresholds. Calculating the 'revenue fiscal de référence' can only be made once all tax items are available. It is important to note that the revenue fiscal de reference takes into account worldwide income whether or not subject to tax in France and before any legitimate French deductions can be taken. As previously stated, US capital gains must now be taken into consideration to determine the revenue 'fiscal de référence'.

SELF-EMPLOYED INDIVIDUALS AND FURNISHED RENTALS. The limit to be eligible as a "micro- enterprise" remains at 32.900 € for personal services as well as for furnished property rentals. Under certain very limited circumstances you can temporarily exceed this limit without losing the special benefit of the "micro-enterprise". However, those of you who collected greater rental income on furnished rentals have new filing requirements and will need to seek the services of a French accountant. OF IMPORTANT NOTE: Rental income collected as of January 2017 will fall under a new category. All furnished rental income, whether or not collected on an occasional basis, will be considered under the French regime ‘Benefices Industriel et Commerciaux’ and stricter regulations will be in effect for the amount of rent that can be collected. If you require further information, we will be happy to speak with you on a personal basis.

The highest income tax rate remains constant at 45% plus additional social taxes (CSG – 15.5%) when applicable.

French tax returns need to be filed online except under certain very limited circumstances. If not exempt, from now until 2019, the e-filing requirement applies for taxpayers based on their ‘revenu fiscal de référence’. The majority of our clients will have this e-filing requirement. If we assisted with your on-line filing of your French tax return last year, please ensure that you supply us with your password if in fact you changed what we originally set up.

SETTLORS, DEEMED SETTLORS AND CERTAIN BENEFICIARIES OF TRUSTS.

Stringent laws on trusts were enacted in July 2011. Penalties for non-compliance could lead to an automatic taxation of the assets held in trust. If you are unaware of these trust laws or have any questions, we will be happy to speak with you on an individual basis and recommend a French attorney who can help you with your filing needs. Please be aware that since inception the declaration(s) must be on a yearly basis and the forms as well as the reporting requirements have been a constant subject of change. It is therefore recommended that you seek professional counsel for these filings needs.

UNITED STATES

The gross income levels at which U.S. citizens and Green Card holders must file income tax returns for 2016 are generally $10,350 for a single individual, $20,700 for married filing jointly and $13.350 for head of household. Of important note: if you are married to a non-resident alien spouse and file as married filing separately, you must file a tax return for 2016 if your gross income is $4,050 or more. This is regardless of whether any tax is owed. For example, you may be well under the $101,300 earned income exclusion and have no taxable income but this will not relieve you from your filing obligation. You must file a U.S. tax return if your GROSS income (brut salaire and all investment and rental income, NOT net fiscal) exceeds the above-mentioned income requirements.

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The top tax bracket remains constant at 39.6%.

The kiddie tax laws are still in effect. Parents who have children under age 19 and/or dependent children who are full time students under age 24 may elect to report their child's investment income which will be taxed at their parents’ rate. This applies only to interest and dividend income and it must be no more than $10,500. The first $1,050 of revenue is usually exempt from taxation. Please note that your children's assets also need to be taken into consideration when calculating Form 8938 requirements as well as French ISF thresholds.

The deduction you can take for IRAs on eligible earned income is $5,500 this year with the possibility of an additional deduction of $1,000 in catch up contributions for those of you who are 50 years of age or over. You cannot take an IRA deduction if you are over 70 1/2 years of age. You cannot contribute to an IRA if you have no earned income (wages or fees) or if you exclude all your earned income under the foreign earned income exclusion.

The Alternative Minimum tax (AMT) exemption amount for tax year 2016 has increased to $53,900 (individuals) and $83,800 (married filing jointly).

The long term capital gains and qualified dividend rates increase from 15% to 20% for those taxpayers who fall under the top 39.6% tax bracket. Additionally, there is a 3.8% net investment income tax which may apply to single taxpayers with an adjusted gross income (AGI) of $200,000 and to joint filers with an AGI of $250,000.

The value of each personal and dependency exemption rises to $4,050.

You might be eligible to itemize deductions on your U.S. income tax return. For more information please refer to deductible itemized expenses starting on page 10 of this organizer. If you determine that your itemized deductions exceed the standard deduction in actual expenses, please furnish all relevant information.

There are phase outs and limitations for personal exemptions and itemized deductions.

The annual exclusion for gifts is $14,000 per recipient for tax year 2016. For gifts made to spouses who are not U.S. citizens, the annual exclusion has increased to $148,000.

Estate tax remains at 40% with the exemption increased to $5,450,000 for estates of descendants who died in 2016.

Important compliance reporting requirements:

o Statement of Specified Foreign Financial Assets (FATCA Form 8938). Please be aware that this form is in addition to your FinCEN Form 114 Foreign Bank Account Disclosure form (FBAR). FBAR regulations are explained on page 8 of this organizer and FATCA regulations will be sent under separate cover.

o 1099-MISC is used to report payments of over $600 to an individual. If you have paid U.S. citizens or residents for services and deduct these payments on your US tax return as an expense either on Schedule C or Schedule E you must send in a 1099-misc form to the IRS. The regulations on this form will be sent under separate

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cover. The IRS specifically asks whether you have a 1099-MISC filing requirement and whether you will be filing this form and these questions must be answered.

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INCOME TAX QUESTIONNAIRE 2016

Instructions for Parts I and II

Returning clients, please provide any changes from last year's information.

New clients, please provide ALL information as well as a copy of last year's tax returns (both French as well as U.S. and State returns)

GENERAL INFORMATION

Name US Soc. Sec. No or ITIN

Spouse (include maiden name) US Soc. Sec. No or ITIN

Your occupation Your birth date

Spouse's occupation Birth date

If your marital status changed in 2016, please provide details and dates on the back of this page.

Dependent children: Child 1 Child 2 Child 3 Child 4 Other

DependentName

Social Sec n°

Months lived with you in 2016Birth Date

Did you provide more than 50% supportFull-Time StudentMarital Status

Are you a U.S. citizen? A resident alien of the U.S.?___________Spouse a U.S. citizen? A resident alien of the U.S.?___________

If your spouse is a non-resident alien of the U.S., does he/she wish to make an election to file a U.S. joint return? Election already in effect ______________

IS YOUR NON-US CITIZEN SPOUSE A GREEN CARD HOLDER? _____________Did you or your spouse have your green card taken away or give up your green card in 2016? ________

Does your non-US citizen spouse have a Taxpayer Identification Number (ITIN)? __________ If “yes” please indicate number __________________

Note: Social Security Numbers for all dependents, and spouses are required on your tax return. The IRS will not allow exemptions without a Social Security Number or ITIN, however you may apply for a social security number or ITIN at the same time you file your tax return. Please contact us.

Does your dependent child (18 or under 24 and a full time student) have more than $1,050 of investment income or more than $6,300 of earned income?___________ If Yes, your child will need to file his/her own tax return, even if he/she is still considered a dependant on your return. Please attach copies of his/her 1099s, W-2s, etc.

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If you are due a refund, would you like it refunded /applied to your 2017 tax liability. Please circle one.

If refunded, please supply your U.S. bank account number and routing information here. Refunds cannot be directly deposited into French bank accounts.

________________________________

If you are a partner or have shares in a non-US corporation or if you have previously filed a Form 5471/8865, please supply us with your annual "Bilan" as well as your "Compte de Resultats Detaillés". If you are a new client, please send us a copy of the last Form 5471/8865 filed.

FOREIGN RESIDENCE DATA

(This section applies only to those who had compensation income, such as salary, commissions, directors' fees, self-employment income etc. For this purpose, pensions do not constitute compensation income.)

Date foreign residence commenced ______________________________________Foreign countries in which you resided since you left the U.S. to establish residence abroad :

Country Date residence began Date residence ended

Did you RENT or OWN your living quarters abroad? (Circle one) Did your family live with you during all of 2016 If "no", please explain on the back of this page.

Did you maintain a home in the U.S. while residing abroad? If "yes", give address, and if rented, please supply the names and relationship of occupants (related or unrelated), as well as the number of days rented:_______________________________________________________________________________________________

NEW THIS YEAR, CHANGE IN FILING DEADLINE

US FBAR reporting – FinCEN 114 ( NON-US BANK ACCOUNTS)

- Did you or your spouse at any time during the taxable year have a personal bank account (including checking, savings, securities) or other financial accounts in a foreign country (outside the U.S.) where the aggregate value of the sum total of all the account(s) exceeded $10,000 at any time during the year? If the answer is “yes” please fill in Form FinCEN form 114 for each foreign account, sent as a separate attachment to this organizer. The IRS specifically asks whether you have a FinCEN form 114 filing requirement and whether you will be filing this form. These questions must be answered.Please note that this form is not part of your tax return. Additionally, paper forms will no longer be accepted. We have registered as a third party provider so that these forms may be filed on your behalf. To do so, we will require a special power of attorney (Form 114a), which we will prepare and send to you when your return is ready to be filed.

The new deadline for filing this form is April 15th of each year. Please refer to page 13 of this organizer for more specific information.

If you wish to continue to file the form personally, you must first enroll, filing an online application. For more information, visit http://bsaefiling.fincen.treas.gov/main.html and follow the instructions under Become a BSA Filer (file an individual FBAR) or take the quick tour.

You may also need to complete a Form 8938. Please refer to our specific instructions on FATCA filing requirements sent under separate cover.

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French FBAR reporting – Form 3916 (NON-FRENCH BANK ACCOUNTS). This is part of your French tax return.

If you or one of the members of your family opened, used or closed a financial account held outside France, you must file French form 3916, see the second to last page of this organizer. The penalties for non compliance have risen significantly in France in the recent past. Non conformity in the past may require entering into a 'regularization' program with the French tax office.Life insurance contracts held outside of France also need to be listed as the penalties for non compliance are the same.

EMPLOYMENT

- If you were self-employed in 2016, please provide your completed French Form 2035 or if you are self-employed outside of France, prepare a summary of income and expenses by category and amount. Please provide separate details of French social charges and amounts specifically paid for health insurance, including non-obligatory 'mutuelle' (complementary health insurance).

- Salaried individuals, please supply us with your December 2016 Fiche de Paie and/or W-2. Note that your 'Brut Salaire' (Gross income) is declared on your US tax return while the French continue to tax you on the 'Net Imposable' (net income).

- Please provide the names and addresses of employer(s) for both husband and wife on the back of this page, if not readily available on your W-2(s) and fiche(s) de paie.

Days in U.S. during 2016 (indicate whether business (“b”) or other (“o”).

Date of arrival in US Date of departure from US Purpose of trip Number of business days (if any)

DIVIDEND INCOME, INTEREST INCOME and CAPITAL GAINS / LOSSES

Please attach a copy of your U.S. annual brokerage summary statement including the schedule of realized gains and losses, US Forms 1099 and French Bank Forms entitled 'Justificatif à Produire aux Impôts' (Imprimé Fiscal Unique Form 2561 ter). As previously stated, it is important that we receive the French form so that you are properly credited for tax withheld at source.

RENTAL INCOME, ROYALTIES

Prepare a schedule, on a property-by-property basis including address and type (residential or commercial) of property, showing the following items: Do not duplicate mortgage interest and real estate taxes in the itemized deductions section of this organizer.

Item Property A Property B Property C

ADDRESS OF PROPERTY:Gross rents (or royalties)Mortgage interestReal Estate taxesAgency commissions/Management feesInsuranceRepairs and maintenanceOther expenses (itemize)Date Property purchased

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For NEW properties, please supply us with the date of rental, cost of the property, date of purchase of property and the type of property (i.e. apartment, individual house, land) ______________________________________________

If the fair market value of the property on the first date of rental is less than the actual purchase price please let us know.

Basis for depreciation (generally - original cost plus improvements)

Furnishings acquired and improvements made in 2016. Detail date purchased and cost on separate sheet

Note: If you or your family also used this property in 2016 please state:The number of “personal use” days _______ and the number of days rented in 2016_____________ PARTNERSHIPS, ESTATES, TRUSTS

If you received a distribution from a partnership, estate or trust during 2016, you should have received a Schedule K-1 from the distributing entity, showing the amount of the various income elements to be reported (whether or not actually received by you) and other relevant data. Please attach that form or provide equivalent information.

MISCELLANEOUS INCOME/DEDUCTIONS

The following is a checklist of common income items (in addition to those detailed above). Please provide us with the details of any miscellaneous income received on the back of this page, with the currency clearly indicated.

Income Amount (Clearly indicate currency)Director feesExecutor or Trustee feesPension or annuity incomeLump sum distributions (please provide 1099-Rs)Alimony paid or received (circle one)Farm incomeState/local tax refundUS Social Security received (provide a copy of the SSA Form received)Debt ForgivenOther

DEDUCTIBLE ITEMIZED EXPENSES FOR US TAX RETURNS.

If your itemized deductions (as stated below) exceed the standard allowances ($12,600 for married couples filing jointly, $6,300 for married couples filing separately and single individuals, and $9,300 for 'heads of household'), please supply us with the following information. When in doubt, it is always advisable to send us the numbers and we will decide whether the itemized or standard deduction is appropriate in your case.

Medical expenses Amount (Clearly indicate currency)Medical or health insurance premiums Premium paid for qualified long term care insuranceQualified Long Term CareMedicare premiums Medicines and drugsDoctors and dentists (do not itemize)Hospitals/clinics (do not itemize)Taxis and public transportation used for medical reasonsMiles/km drivenOther medical expenses (see below)

(N.B. Deductible medical expenses include items such as eyeglasses, hearing aids, X-rays, corrective shoes, doctor-prescribed "cures," etc.)

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Please indicate total amount of any reimbursements for the above items _________________

TaxesReal estate taxes on property located in U.S. Note: Do not duplicate expenses already shown on rental property

Real estate taxes, on property located outside the U.S., including “ taxe foncière ”Personal property taxes Taxe d’habitationState and local income taxes French Wealth Tax (if we don't prepare your return)Other

Interest Payments (include payments in U.S and abroad)Home mortgage (Provide Name and address of Bank)Second home (Note: do not include any amountson homes that were rented - entry for this on page 9)Prepayment penalty on loansInterest on loans to carry investment incomeOther (please explain)

Charitable Contributions

Total cash contributions to U.S. charities Did you make cash contributions of $250 or non-cash contributions whose value was in excess of $500? If yes, enclose receipts as substantiation is now a requirement by the IRS. In certain cases, the person/organisation who received your contribution may have to acknowledge receipt. In some cases, an appraisal from a qualified organization may be required.

Casualty Losses

Give full description including nature of property loss (fire, theft, etc.), description of property, original cost, and value at time of casualty, proof of loss, insurance recovery, if any on the back of this form.

Miscellaneous Deductions. (Business and Investment) (Do not include items here that are to be included on Self-Employment Schedule C.)

Un-reimbursed business expenses (Please supply breakdown of expenses, such as, travel, entertainment, tips, telephone, etc. on back of this page) For salaried employees onlyUnion dues (paid or withheld)Subscriptions to business publicationsEducational expense (to maintain or improve skills required in job)Investment periodicals, including subscriptionsInvestment advisers Safety deposit boxIncome tax preparation feesProfessional fees related to income tax auditsProfessional fees related to tax planning and adviceOther (please list)

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HOUSING COSTS IN COUNTRY OF FOREIGN RESIDENCE

Note: The total of these expenses must be more than $16,208 and foreign earned income must be over $101,300 to have any tax benefit. Clearly indicate in local currency

RentCharges/Co-op feesTaxe d’habitationUtilitiesApartment or home insuranceHeatingMinor repairs & maintenanceResidential parking

PRE-PAID U.S. INCOME TAXES

Estimated tax paid by you for tax year 2016 -- indicate amount and dates paid

Due Date 4/15/16 Amount ___________ Date paid ______________Due Date 6/17/16 Amount ___________ Date paid ______________Due Date 9/16/16 Amount ___________ Date paid ______________Due Date 1/15/17 Amount ___________ Date paid ______________

Please note that you may have made two tax payments in April and/or June of 2016. Only the estimated tax payment for the year 2016 should be indicated in this section. Likewise, the payment you may have made in January of 2016 counts towards the 2015 tax year and should not be indicated in this section. If you are unsure of what estimated payments you have made, please indicate here ______________________.

FOREIGN INCOME TAXES

In order to calculate your foreign tax credit, i.e., the amount of credit you may claim for income taxes paid to a foreign government, we need very precise information. If we have not prepared your French taxes for you, please attach a copy of your French "avis d'imposition" for the year 2016 as soon as you receive it or your French “pré-rempli” tax return as it will be filed. Foreign taxes may have been withheld from dividends, interest, royalties, commissions and fees; these should be listed as well.

MISCELLANEOUS ITEMS

If you contributed to a traditional I.R.A. account, indicate: Amount Date________ (This contribution must be made before April 18, 2017 to be eligible as a deduction for tax year 2016.) Please indicate whether your employer operates a qualifying U.S. 401(k) plan for you ______________

If you are self employed and contributed to a SEP-IRA or other qualified self-employment plan, indicate:Amount: ___________________Date of contribution: _____________

If you contributed to a Roth IRA, indicateAmount: Date of contribution: _________________

If you converted or rolled over a retirement account to a Roth IRA in 2016 please check here. _________

Moving expense and storage costs. If you moved during 2016, either from the U.S. to a foreign country, from one foreign country to another, or from a foreign country back to the U.S., please indicate with an “X”________ and we will contact you for further information. If you only have storage costs, please indicate that amount

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here.________________

Sale of residence. Did you sell your principal or any other residence in 2016? If so, please indicate with an “X”________ and we will contact you for further information.

New Due Date for FBARs

Form 114 (FBAR) Foreign Bank Accounts. For U.S. purposes, you are required to report all foreign bank accounts if the total of your non US accounts exceeded $10,000 on any one day in 2016. Please note that you must report all of your bank accounts, even if the balance was minimal, and you must report the account’s maximum value during the year, even if you have transferred money between accounts. Here is the link to the most recent form http://bsaefiling.fincen.treas.gov/NoRegFBARFiler.html

The new annual due date for filing Reports of Foreign Bank and Financial Accounts (FBAR) for foreign financial accounts is April 15. This date change was mandated by the Surface Transportation and Veterans Health Care Choice Improvement Act of 2015, Public Law 114-41 (the Act). Specifically, section 2006(b)(11) of the Act changes the FBAR due date to April 15 to coincide with the Federal income tax filing season. The Act also mandates a maximum six-month extension of the filing deadline. To implement the statute with minimal burden to the public and FinCEN, FinCEN will grant filers failing to meet the FBAR annual due date of April 15 an automatic extension to October 15 each year. Accordingly, specific requests for this extension are not required. (Please note: The due date for FBAR filings for foreign financial accounts maintained during calendar year 2016 is April 18, 2017, consistent with the Federal income tax due date.)We can submit the form on your behalf as a paid preparer but will require a signed power of attorney to do so. We will send you the power of attorney once we have completed your FBAR. You may also personally file this form online. To be eligible, you must fill out an application and once accepted you may file your form online.

For more information, visit http://bsaefiling.fincen.treas.gov/main.html and follow the instructions under 'Become a BSA Filer' (file an individual FBAR).

Gifts:

Did you make a gift of more than $14,000 to any one donee this year? If so, please indicate with an “X”________ and we will contact you for further information/instructions.

Did you receive a gift from a non-U.S. person during the year? If so, please indicate with an “X”________ and we will contact you for further information/instructions.

Interest on Student Loans: Indicate amount of interest paid and year of the loan. Higher deductions apply this year. It is important that you provide us with IRS Form 1098-T

Qualified child-care expenses. Indicate the amount spent per child, the name and address of the care-giver or institution, his/her social security number if applicable, and the address where the services were provided. (i.e. URSSAF or PAJE statement if the services were provided in France)______________________________________________________________________________

Did your employer make pension contributions on your behalf? __________________________

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INFORMATION EXCLUSIVELY FOR FRENCH RETURN

Date of arrival in France or Country of tax residence___________________________________________________

Your Birthplace, Nationality and Birthdate

Your Spouse's (or PACS partner’s) Birthplace, Nationality and Birthdate

If any of the below occurred in the year 2016:Date of Marriage : Day Month Year

If Divorced, (or rupture de PACS) date of Divorce : Day Month Year

If Widow/ Widower, Date of Spouse's death : Day Month Year _____________

If you were once married, your spouse is deceased, and you had a child with that spouse, please check here. __________It does not matter whether your child is no longer your dependent.

If you are PACSed please provide date of PACS Day Month Year

Provide the following information for each child who was a part of your household during 2016 (including children in school or otherwise temporarily away from home):

Child 1 Child 2 Child 3 Child 4NameBirth DateBirthplaceMarital Status Indicate School Level (Collège ,Lycée, Université)

Note: Your dependents’ income must be included on your French return.

Child’s name Net Salary (net imposable) Attach fiche de paie

Pension Alimentaire Interest, Dividends, Capital Gain Distributions

Expenses related to your principal residence (renters and owners) Generally speaking, this covers major home improvements related to energy saving devices, such as hot water heaters, double glazed windows, etc. Did you incur expenses related to the above?__________ If “yes” attach the contractors' receipts to be attached to the French return. (Work done by you is not deductible, not even the cost of materials).

Alimony and other support

If you paid alimony to a former spouse, please give the following details:Was this a prestation compensatoire or a pension alimentaire? (circle one)_______Name of former Spouse_______________________________________Address___________________________________________________Amount paid in 2016_________________________________________If you paid a support allowance to any other person (e.g., child not claimed as a dependent, parent), give the following details:To whom paid (name and relationship to you)_______________________________Date of judgment or decree, if any Amount paid in 2016________Address of recipient___________________________________

Note: Regarding support paid to parents and children over age 25 (or over 18 and who are

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not students), you must be able to substantiate that these family members are destitute for deductions on the French return.

Charitable Contributions (receipts from qualified French organizations no longer need be attached to the tax return however please provide receipts when applicable so that we can determine the type and eligibility of the deduction.

Child care expenses and household employees . Please provide us with the official URSSAF, PAJE, etc receipt so that the correct deduction may be applied.

Miscellaneous

Contributions made in 2016 to U.S.-based IRA or other IRS-qualified retirement plan. (These may be deductible for French tax purposes): ________________________

Payments of French union dues? _________________________

Other information/deductions you consider relevant to your French return:_________________________________________________________________

VERY IMPORTANT:

1. Do you rent or own your primary residence in France?___________

2. Do you own a television in France? __________________________

3. If you would like us to file your French return electronically do not forget to complete the "Mandat" attached to this organizer. If applicable, please provide us with the password you used to allow access to the impots gouv website.

4. Please forward your pre-printed French tax forms as soon as you receive them (scheduled to be sent on or about May 1st). While these forms are sent to you with certain salary items and investment income pre-printed, we ask that you send us the corresponding bank statements and fiche de paie so that we may confirm the numbers on the form. Mistakes have been made in the past.

FOR FRENCH RESIDENTS

Foreign (non-French) bank account form 3916 :

You must complete a form declaring all non-French bank, security and life insurance accounts. Large penalties may be imposed by the French government for each omission. We attach a substitute sample form on the next page. For your convenience, we have also provided a link to this form on our website www.vercruysse.fr. You can fill out the form online, print and send it back to our offices along with your organizer for filing.

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DECLARATION PAR UN RESIDENT D’UN COMPTE OUVERT A L’ETRANGER(DECLARATION NUMERO 3916)

2016

NOM: PRENOM: DATE ET LIEU DE NAISSANCE: ADRESSE:

DESIGNATION ET ADRESSE DE L’ETABLISSEMENT DE L’ORGANISME, DE L’ADMINISTRATION OU DE LA PERSONNE GESTIONNAIRE DU COMPTE

NOM DU TITULAIRE DU COMPTE

NUMERO DE COMPTE

NATURE DU COMPTE (de dépôt, d’épargne, de chèque, opérations sur marché, certificats de dépôt, valeurs mobilières, etc.)

TYPE ET USAGEprofessionnel, privé, conjoint

AVEZ VOUS UNE PROCURATION SUR LE COMPTE OU EN ETES-VOUS LE TITULAIRE?

ADRESSE A LAQUELLE EST ENVOYEE LE RELEVE DE COMPTE (si différente de l’adresse en France)

DATE D’OUVERTURE OU DE FERMETURE DU COMPTE (seulement si en 2016/ only for 2016)

Signature(s) Date

MANDAT

Je soussigné(e)

Domicilié(e)

Donne procuration à Madame Lynda Vercruysse, domiciliée 20 Domaine de Grosbois, 94470 Boissy Saint Leger, ou son délégué(e), aux fins de signer les déclarations fiscales et les déposer auprès de l'administration fiscale française.

Fait à , le 2017

Signature(s) du mandant(s) Signature du mandataire

Précédée de la mention Précédée de la mention"Bon pour pouvoir" "bon pour acceptation"

________________________ Lynda Vercruysse

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