Receipt for Stop Smoking Program

Billed To:

Name:_______________________________

Address:_____________________________

Program provided by:_________________________________

Address:_____________________________

____________________________________
Appointment Date:___________

Program Total: $_____________

Paid by (circle one): Check/CC/Cash



Program Type Duration Program Price
Hypnosis $
Program Total: $


Please retain for your tax records.

Stop-Smoking Programs

You can include in medical expenses amounts you pay for a program to stop smoking.
However, you cannot include in medical expenses amounts you pay for drugs that do not require a prescription, such as nicotine gum or patches, that are designed to help stop smoking. Ask your tax preparer to explain medical deductions.

http://www.irs.gov/publications/p502/ar02.html#d0e2013

More Info

IRS website
www.irs.gov

Print this Page and fill out after your Stop Smoking appointment.



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