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Tax Data Form

Please allow up to 24 hours for a response via email or phone call. Please be advised if you are submitting documents for a quote, you MUST still have all of your documents and dependents' information in order, to ensure that you get a more accurate quote (our quotes are free)!

PERSONAL INFORMATION

Filing Status

If you selected "Married Filing Separately" Please list Spouses Full Name, DOB and Full Social (this is required by IRS"

First Name

Last Name

Spouses Full Name, DOB, Social, & Email

Today's Date

Date of Birth

Social Security Number

Full Address

Phone Number

Email

NAME OF PERSON WHO REFERRED YOU

Check all that apply:

Check all that apply:

INCOME INFORMATION

Occupation

If you or your dependent attended college, how did you pay? *

If you or your dependent attended college, how did you pay? *

Do you own and operate a small business/home based business?

Do you own and operate a small business/home based business?

What is the name of your business?

Business Entity Type (LLC, Non-Profit, etc.)

What is your EIN? (If you are not a business owner, add your social instead)

Do you operate out of your home or do you have an outside rented space? Also, what is the address?

Did you receive a 1099?

Did you receive a 1099?

Please list total business income

Please list all business expenses and amounts for each expense

REFUND OPTIONS

Would you like to apply for the Tax Advance? Up to $9500

Would you like to apply for the Tax Advance? Up to $9500

How would you like your Advance refund to be deposited when ready?

How would you like your Advance refund to be deposited when ready?

How would you like your refund to be deposited when ready? (*If you did not opt in to the advance loan)

How would you like your refund to be deposited when ready? (*If you did not opt in to the advance loan)

Direct Deposit Information (Account, Routing & Name of the Bank)

Are there any other issues or concern regarding this year or any previous year tax returns? If yes, please explain.

DEPENDENT INFORMATION

Number of dependents

Please provide full name, date of birth, social security number, and your relation to each dependent.

Did you pay any childcare in 2024?

Did you pay any childcare in 2024?

Please provide name of provider, address, phone number, tax id number and amount of fees paid.

Please provide your 6 digit Identity Pin Number if one was mailed and issued by the IRS. HERE IS THE LINK TO REQUEST IT ONLINE. THIS PREVENTS YOUR RETURN FROM BEING DELAYED DUE TO VERIFICATION. https://www.irs.gov/identity-theft-fraud-scams/get-an-identity-protection-pin

DOCUMENT UPLOAD

W2 or Income Verification Documents/1099

Dependents Birth certificate & Social Security Cards

Upload your ID and Social Security Card

College/Tuition or Daycare Receipts *If filing for college credits a 1098T must be included

Upload all supporting documents for your business (IF APPLICABLE). (DBA, receipts, log sheet, flyers, business cards or price list)

Upload form 1098 if you are claiming mortgage interest. (Homeowners Only)

Upload form 1099-G if you received Unemployment Benefits

Upload Previous 1040 if this is an Amendment

DUE DILIGENCE QUESTIONNAIRE

The United States Congress have, as a reaction to the substantial tax fraud resulting from their original error of choosing to distribute federal social welfare program benefits via the tax return, placed new excessive inappropriate “due diligence” requirements on paid tax return preparers whose clients are claiming certain tax credits. This added to the excessive and inappropriate requirements previously implemented by the Internal Revenue Service, the IRS has forced tax preparers to, in many cases, become Social Workers and verify that their clients qualify to receive certain credits i.e. EIC, CTC, ACTC and now HOH.
We preparers are not compensated by the IRS or the government for doing their job for them but must pass the costs of this required additional work on to our taxpayer clients.
You will be claiming an Earned Income Credit, Child Tax Credit, Additional Child Tax Credit, HOH, and/or an American Opportunity Credit on your 2024 tax return. Because of this you must complete, sign, and return this questionnaire to me. I will keep the original signed copy of this questionnaire with my file copy of your 2024 tax return and will include a photocopy of the completed questionnaire in the package I send you with the finished returns.

1. I/we certify that the child(ren) for whom the tax credit(s) will be requested can be claimed as my/our dependent(s), as per the information provided at the end of this questionnaire.

1. I/we certify that the child(ren) for whom the tax credit(s) will be requested can be claimed as my/our dependent(s), as per the information provided at the end of this questionnaire.

2. The child(ren) for whom the tax credit(s) will be requested lived with me/us for the year, except for temporary absences.

2. The child(ren) for whom the tax credit(s) will be requested lived with me/us for the year, except for temporary absences.

3. I am the custodial parent of the child(ren) for whom the tax credit(s) will be requested, and I released the dependency deduction to my former spouse for 2024 by signing Form 8332 (Release/Revocation of Claim to Exemption for Child by Custodial Parent).

3. I am the custodial parent of the child(ren) for whom the tax credit(s) will be requested, and I released the dependency deduction to my former spouse for 2024 by signing Form 8332 (Release/Revocation of Claim to Exemption for Child by Custodial Parent).

4. I am not the custodial parent of the child(ren) but I have been given a signed Form 8332 by my former spouse, the custodial parent, allowing me to claim the child(ren) as the dependent(s) on my 2024 tax returns (you must give me the Form 8332)

4. I am not the custodial parent of the child(ren) but I have been given a signed Form 8332 by my former spouse, the custodial parent, allowing me to claim the child(ren) as the dependent(s) on my 2024 tax returns (you must give me the Form 8332)

5. I/we, or my child(ren), have documentation to substantiate the credit(s) being claimed, such as Form 1098-T, bills, statements, and receipts for college tuition, fees, and book and material costs (you are responsible for keeping this documentation and providing it to the IRS if you are audited or questioned)

5. I/we, or my child(ren), have documentation to substantiate the credit(s) being claimed, such as Form 1098-T, bills, statements, and receipts for college tuition, fees, and book and material costs (you are responsible for keeping this documentation and providing it to the IRS if you are audited or questioned)

6. Was a Child Tax Credit, Additional Child Tax Credit, or American Opportunity Credit claimed by you disallowed or reduced by the IRS on a past tax return?

6. Was a Child Tax Credit, Additional Child Tax Credit, or American Opportunity Credit claimed by you disallowed or reduced by the IRS on a past tax return?

7. I claim I am unmarried or separated, support a qualifying person as your dependent, and pay more than half the cost of maintaining your household.

7. I claim I am unmarried or separated, support a qualifying person as your dependent, and pay more than half the cost of maintaining your household.

8. Do you want to File or receive a free Quote?

8. Do you want to File or receive a free Quote?

ATTESTATION AND DISCLAIMER

CBC & Co is not responsible if the taxpayer provides us with incorrect information (i.e., social security numbers for self, spouse, or dependents, last names, birth dates). This may delay your refund. CBC & Co is not responsible for any IRS audits. All information obtained from the taxpayer and/or spouse must be presentable if the IRS audits your tax return. CBC & Co is not responsible for any incorrect tax figures provided by the taxpayer and/or spouse. If your tax figures change, you will need to file an Amendment. Prices vary.

If you have any federal or government debts (i.e., school loans, child support, DPP, DFCS, etc.), there is a chance that your refund will be applied toward your debt. You can call the offset department at 1-800-304-3107 or 1-800-829-7650 to see if your refund will be partially or fully taken. If your refund is fully taken, you are responsible for paying the preparation fees.

CBC & Co provides the taxpayer with ONE complimentary copy of their tax return. Should you need any additional copies, there is a $15 fee per copy (federal and state included). CBC & Co is not responsible for any discussions or changes the IRS or bank may make regarding disbursement dates, filing status, or any other required information from the IRS. CBC & Co is not responsible for any IRS glitch problems or IRS issues that may cause a delay in your tax refund. We DO NOT reimburse any bank fees in the event of such occurrences.

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CONSENT TO USE:

Federal law requires this consent form be provided to you (“you” refers to each taxpayer, if more than one). Unless authorized by law, we cannot use your tax return information for purposes other than the preparation and filing of your tax return without your consent. You are not required to complete this form to engage our tax return preparation services. If we obtain your signature on this form by conditioning our tax return preparation services 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 from the date of signature. For your convenience, we have entered into an arrangement with certain companies to offer an Electronic Refund Disbursement Service and/or Loan product. To determine whether these offerings may be of interest to you, we will need to use your tax return information. If you would like us to use your tax return information to determine whether these offerings are relevant to you while we are preparing your return, please sign and date this consent to the use of your tax return information. By signing below, you authorize us to use the information you provide to us during the preparation of your 2024 tax return to determine whether to offer you an opportunity to apply for the Electronic Refund Disbursement Service and/or Loan product.

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CONSENT TO DISCLOSURE OF TAX RETURN INFORMATION: Federal law requires this consent form be provided to you (“you” refers to each taxpayer, if more than one). Unless authorized by law, we cannot disclose your tax return information to third parties for purposes other than the preparation and filing of your tax return without your consent. If you consent to the disclosure of your tax return information, Federal law may not protect your tax return information from further use or distribution. You are not required to complete this form to engage our tax return preparation services. If we obtain your signature on this form by conditioning our tax return preparation services on your consent, your consent will not be valid. If you agree to the disclosure of your tax return information, 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 from the date of signature. You have indicated that you are interested in utilizing the Electronic Refund Disbursement Service and/or Loan product from Refund Advantage or Santa Barbara Trust. To provide you with the opportunity to apply for and/ or receive the Electronic Refund Disbursement Service and/or Loan product, we must disclose all of your 2024 tax return information to Refund Advantage. You may request a more limited disclosure of tax return information, but you will not be eligible to submit an application for the Electronic Refund Disbursement Service and/or Loan product. If you would like us to disclose your 2024 tax return information to Refund Advantage for this purpose, please sign and date your consent to the disclosure of your tax return information. By signing below, you authorize us to disclose to the designated bank all of your 2024 tax return information so that it can evaluate and process your application for the Electronic Refund Disbursement Service and/or Loan product. You understand that if you are not willing to authorize us to share your tax information with our designated banks, you will not be able to obtain the Electronic Refund Disbursement Service and/or Loan product, but you can still choose to have your tax return prepared and filed by us for a fee. If you believe your tax return information has been disclosed or used improperly in a manner unauthorized by law or without your permission, you may contact the Treasury Inspector General for Tax Administration (TIGTA) by telephone at 1-800-366-4484, or by email at [email protected].

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The information contained in this office or on this website is of a general nature. It should not be construed as legal advice nor should it be acted upon in your specific situation without further details and/or professional assistance. Any use of information contained in this office or on our website is done so at the risk of the user, and CBC & Co is not responsible for the result or outcome of its use. CBC & Co does not guarantee and is not liable for the truthfulness, accuracy, effectiveness, or any resulting effects of the use of any information contained in this office or on the website. It is advised and it is the responsibility of the visitor of this office or website to seek proper instruction and/or seek professional assistance in all matters regarding taxes and the IRS. CBC & Co is thus held harmless, released of, and users of information contained in this office or on this website assume full responsibility for any violation of tax laws and/or IRS procedure, and any other legal liability resulting from use of any information contained in this office or on this website.

I attest that all information contained in this income tax return was obtained from the taxpayer or spouse and is true and correct to the best of his/her knowledge.

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Engagement Letter:

Dear Taxpayer,

Thank you for the opportunity to work with you in preparing your income tax returns. To foster a complete understanding of our relationship, take a moment to review the following information.

We will prepare your income tax returns based solely on the information you furnish to us. Upon completion of your tax returns, we will return any original tax documents to you. From time to time, our office may retain scanned copies of your documents for our records; however, you should retain all documents, canceled checks, and other data that form the basis of income, deductions, and other tax return forms, schedules, elections, and disclosures. Such documents include, but are not limited to, proper records to support deductions claimed for meals, entertainment, travel, business gifts, charitable contributions, and vehicle use (if applicable), as well as bank and credit card statements. These records will be necessary to prove the accuracy and completeness of the returns to taxing authorities, should your returns be selected for examination.

We recommend keeping all documents and copies of your returns for a minimum of five years after you file your tax returns or after their due date, whichever is later.

Our work in connection with the preparation of your income tax returns cannot be relied upon to disclose errors, irregularities, or illegal acts, including, without limitation, fraud that may exist within the documents or figures you provide. We will use our professional judgment in resolving questions where the tax law is unclear or where there may be conflicts between the tax authority’s interpretations of the tax law and other supportable positions. Unless instructed by you, we will take a tax position in your favor whenever reasonable. We cannot provide any assurance that tax positions taken will not be challenged or ensure the ultimate outcome of such a challenge. Moreover, we cannot be responsible for issues arising from any income, expenses, or other information not provided to us at the time of tax preparation or prior to the filing of your returns.

Please note that this engagement, and this firm’s services, include but are not limited to general and annual income tax-related services. Unless specifically requested by you and agreed upon in writing, we do not provide any services related to payroll tax, sales tax, excise tax, or personal or real property tax. Nor can we be relied upon to determine or report your compliance, or lack thereof, with any federal, state, or local business-related laws, health care or human resources regulations, retirement plan compliance, or any business, property, or professional permitting/licensing.

The charges for our services are on a “per form” basis with references to time spent by our professional staff to perform the work, and costs incurred for related supplies and expenses, including copy charges, long-distance phone charges, and computer processing charges. Our fee for the preparation of your tax returns will be due and payable upon presentation of your completed income tax filing. It is company policy not to release tax returns or any tax-related reports, schedules, information, advice, or notes without payment in full.

Should a situation arise where services have been rendered but payment is not received and our firm is forced to or elects to seek legal assistance to collect fees due to us, please note that you may be asked to reimburse our firm for the legal costs to collect any outstanding balance due. Because we understand that cost is an important issue for many clients, we will do our best to provide you with an estimate of our fees prior to completing your returns, but please understand that circumstances arise which may raise or lower the estimated fee. We will contact you if such a situation arises after you receive an estimate.

Upon completion of your returns and after you have paid your tax preparation fees, we will provide you with a copy of your returns as well as the e-file signature authorizations and any applicable payment vouchers to complete your tax filing. You should review the completed returns carefully. If you see anything that requires changing, please bring it to our attention immediately and we will either explain the matter to you or correct it without delay and provide you with new, corrected copies. If you are satisfied with the returns and see no issues, please sign and date the e-file signature authorizations and return them to this office immediately. Please note that all taxing authorities prohibit us from transmitting your tax returns without signed authorization from you. If your returns cannot be e-filed, we will provide you with paper copies to sign and mail to the taxing authorities.

By signing this engagement, you are agreeing to compensate CBC & Co for services you have requested. In the event you terminate the engagement prior to the completion of your tax accounting work, CBC & Co reserves the right to invoice you for any out-of-pocket expenses, time at our hourly rate, or other expenses incurred during this engagement.

If you sought in-person consultation services, received advisory services by phone or email, sought representation work, or received any tax accounting services, by signing this engagement letter, you are agreeing to compensate CBC & Co for these services, even if you terminated the engagement prior to our firm completing the work requested or required.

If you agree with the terms of our engagement as described in this letter, please sign below. By signing this letter and providing your income tax information, you expressly agree to these terms.

We want to thank you for putting your trust in CBC & Co and look forward to a long and mutually satisfying relationship.

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