Forms

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DID YOU HAVE HEALTH INSURANCE? NoYes

Tax Payer Information- INFORMACIÓN SOBRE IMPUESTOS PAGAN

First Name
Nombre de pilla

Last/Apellid

M.I.

Street Address Dirección

Apartment/
Unit#

CityCiudad

State
Estado

ZIP
/Postal

Cell Phone/Telefono:
Cell Phone Provider:

E-mail Address/
correo eleclectrónico

Date Of Birth Fecha de
Nacimiento

Social Security No.
Número de Seguro Social

Occupation/
Ocupaci

Spouse Information- INFORMACIÓN DEL CÓNYUGE

First Name
Nombre de pilla

Last/Apellid

M.I.

Street Address Dirección

Apartment/
Unit#

CityCiudad

State
Estado

ZIP
/Postal

Cell Phone/Telefono:
Cell Phone Provider:

E-mail Address/
correo eleclectrónico

Date Of Birth Fecha de
Nacimiento

Social Security No.
Número de Seguro Social

Occupation/
Ocupaci

Dependent Information- INFORMACIÓN DE LOS DEPENDIENTES

First Name
Nombre de pilla

Last/Apellid

Date Of Birth Fecha de
Nacimiento

Relationship/relación
(i.e.: son, daughter, niece, nephew, etc…)

SSN/
Número de Seguro Social

Dependent Information- INFORMACIÓN DE LOS DEPENDIENTES

First Name
Nombre de pilla

Last/Apellid

Date Of Birth Fecha de
Nacimiento

Relationship/relación
(i.e.: son, daughter, niece, nephew, etc…)

SSN/
Número de Seguro Social

Dependent Information- INFORMACIÓN DE LOS DEPENDIENTES

First Name
Nombre de pilla

Last/Apellid

Date Of Birth Fecha de
Nacimiento

Relationship/relación
(i.e.: son, daughter, niece, nephew, etc…)

SSN/
Número de Seguro Social

I CERTIFY THAT THE ABOVE INFORMATION PROVIDED WAS COMPLETED TO THE BEST OF MY KNOWLEDGE AND THAT TAX USA HOLDS NO RESPONSIBILITY FOR INACCURATE OR FALSE CLAIMS.

TAX PAYER SIGNATURE: Date: SPOUSE SIGNATURE: Date:

Consent to Disclose Tax Return Information

Federal law requires this consent form be provided to you. Unless authorized by law, our firm cannot use, without our consent, your tax-return information for purposes other than the preparation of filing of your tax return.

You are not required to complete this form. If we obtain your signature on this form by conditioning our service on your consent, your consent will not be valid. Your consent is valid for the amount of time that you specify. If you do not specify the duration of your consent, your consent is valid for one year.

I, hereby consent to the use, by TAX USA Certified Preparer, of the following information provided to the firm with the respect to my tax-return preparation: (1) name, (2) company name (if applicable), (3) address, (4) phone number and (5) e-mail address (if applicable). The purpose of the use is the mailing, including electronic transmissions, to me of newsletters, brochures, and other information pertaining to the non-tax services the firm offers and non-tax news and information that might apply to my individual situation (for example, information on accounting, financial/retirement planning, or business planning).

The tax information may not be disclosed or used by TAX USA Certified Preparer for any purpose other than that permitted by this consent document.

This consent will be valid for a period of one calendar year

Printed Name of Taxpayer:

Taxpayer’s Signature:

Date:

Printed name of Joint Taxpayer:

Joint Taxpayer’s Signature:

Date:

If you believe your tax return information has been disclosed or used improperly in a manner unauthorized by law or without our permission, you may contact the Treasury Inspector General for Tax Administration (TIGTA) by telephone at 1-800-366-4484 or by e-mail at complaints@tigta.treas.gov.

CERTIFICATION AND WAIVER

I certify that I have provided all documentation related to the preparation of my Form 1040 Individual income Tax Return to my tax return preparer, and I certify that I have reported all income sources to my Tax Return Preparer.
In the event I have not provided any information or document related to every income source I had for this Tax year, I take full responsibility for this omission.
I certify that my Tax Return Preparer has requested that I provide information regarding every income source and documentation supporting my income for this tax year. I hereby take full responsibility for the reporting of my income.
I verify that the information included on my Form 1040 Individual Income Tax Returns is true and correct to the best of my knowledge. I hereby waive any recourse against my Tax Return Preparer and take full responsibility for the proper reporting of my income to the United State Treasury, Internal Revenue Service.

Print Name

Signature

Date

AUDIT ASSISTANCE FEE DISCLOSURE

At TAX USA we value our clients’ rights and responsibilities during the IRS Audit Process. Self-employed, household-employed and Non-biological dependent tax filings have a higher chance of audit than those clients who can verify their income and deductions in the form of a W2 and standard deductions. Because of this, TAX USA has developed the Audit Assist Program to better service our clients in case of an audit situation.

The IRS will audit approximately 2.3 million tax returns submitted this year. Get the peace of mind of knowing that if you do receive any letters from the IRS, you will have someone by your side to help guide you through the process

TAX USA Specialists will:

Help you through the process of understanding the IRS letter or audit notice you receive
Help you know what kind of records you need to gather to answer the IRS letter or prepare for an audit
Help you write a response to the IRS notice
Help you prepare for an audit
Help you after the audit is done, to understand the results and what steps you can take next
If you owe the IRS money, help you understand the options you have in settling your debt with the IRS

TAX USA Audit Assist Coverage is available to all clients who have successfully submitted a tax return filing with a TAX USA Specialist. State returns are not covered by TAX USA Audit Assist and cannot be added as an option.

A TAX USA Specialist will help prepare you in the event of an audit; however the TAX USA Specialist will not accompany you to the audit itself or correspond directly with the IRS. If however, all documentation has been submitted and 90 days or more have passed without a response from the IRS, TAX USA will gain further authorization from you to contact the IRS by phone to inquire further about your case.

With Audit Assist, clients can rest assure that if they should ever receive any form of paperwork from the IRS for the related tax year, they can bring it to the same location where they filed their taxes or they can contact our corporate office located at 2201 Seacrest Blvd, Suite A, Delray Beach 33444. A TAX USA representative will file all the necessary paperwork and forms throughout the audit*. The audit process can take anywhere from a few weeks to several months and the outcome varies from case to case; the outcome also depends on the amount of paperwork requested by the IRS and provided by the tax payer.

By reading the above definition and disclosure, you hereby agree to have TAX USA charge you an Audit Assistance Fee based on your tax filing and that said fee is non-negotiable, and non-refundable. By being charged this fee, you are also in understanding that no additional fees will be charged to you by a TAX USA Representative in regards to an Audit Assist.

PRINT NAME
DATE

SIGNATURE

Economic Impact Payment Acknowledgment

RE: Recovery Rebate Credit
Tax payer detailed below has signed to affirm the Economic Income Payments are true and accurate during the tax year 2020.
In the event of inaccuracies within the EIP Acknowledgment please be advised that if the creation of an amendment is needed there will be a 1040X Filing Fee.

EIP Payment 1:

EIP Payment 2:

Tax Payer Name:

Taxpayer’s Signature:

Date:

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Tax Payer Information- INFORMACIÓN SOBRE IMPUESTOS PAGAN

Spouse Information- INFORMACIÓN DEL CÓNYUGE

Dependent Information- INFORMACIÓN DE LOS DEPENDIENTES

Dependent Information- INFORMACIÓN DE LOS DEPENDIENTES

Dependent Information- INFORMACIÓN DE LOS DEPENDIENTES

Consent to Disclose Tax Return Information

CERTIFICATION AND WAIVER

AUDIT ASSISTANCE FEE DISCLOSURE

Economic Impact Payment Acknowledgment

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