7216 Business

At Herbein + Company, Inc., we place a high value on your privacy and the security of your personal information. We have always had policies in place to safeguard the information you provide to us, whether it is in paper or electronic format.

There are current federal regulations in place to ensure that all tax preparers handle their clients’ information with care. The regulations require that we obtain your written consent before we use or disclose your information for any purpose other than preparing your tax return, such as recommending services or sending you our firm newsletter.

Below are two forms for your review. The forms describe the reasons why we have used or disclosed your information in the past and request your consent to keep doing so in the future. We assure you that our business practices will not change and we will continue to respect your privacy and maintain confidentiality. The only difference is that we are now required by law to obtain your written permission before contacting you regarding our services.

Please note that you are not required to sign and return either form in order to keep doing business with Herbein + Company, Inc. You may give your consent for all, some, or none of the situations. However, without your signed consent, we cannot contact you regarding matters that do not relate directly to your tax return.

This means we would not be able to contact you to recommend services that might be of benefit to you. Also, you might not receive our newsletters, enewsletters, event invitations, or other Herbein + Company, Inc. news.

To give us your consent, please complete the survey below prior to the completion of your tax return.

For questions or additional information, contact your Herbein advisor directly or via 1.855.HC.TODAY.

CONSENT TO DISCLOSURE OF TAX RETURN INFORMATION

Federal law requires this consent form be provided to you. 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.

Name of financial advisor/name of bank:*

This consent authorizes the disclosure of a copy of your entire tax return and all information contained within your tax return

Purpose for disclosing information (Check one or both):*

Providing a copy of your entire entity tax return to your financial advisor to assist in advising you on retirement plans such as an IRA, SEP, or Roth IRA, purchase or sale of investments, managed funds accounts, and otherwise advise you on your financial investmentsProviding a copy of your entire entity tax return to your bank, mortgage company, or other third party to satisfy loan covenants or to apply for new or additional credit.None of the above

Name of recipient:*

First NameLast Name

The duration of this consent will continue as indicated below, unless Herbein & Company, Inc. is notified in writing to no longer disclose your tax return information to this recipient:*

Remain effective to the extent Herbein & Company, Inc. is engagedOther

If you approve the disclosure of your tax return information to the recipient named above and for the duration indicated, please sign below.

Entity Name:*

Officer/Partnership Representative Name:*

First NameLast Name

Signature: Typing a name here represents a signature*

Form Completed*

Date

CONSENT TO USE OF TAX RETURN INFORMATION

Federal law requires this consent form be provided to you. 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 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 hereby consent to the use by Herbein & Company, Inc. of all tax return information contained in your federal income tax returns and supporting schedules for the purpose of mailing, including electronic transmission, of information pertaining to

Please check all boxes for which the consent applies:*

Newsletters, eNewsletters, event invitations, firm news and other information of Herbein & Company, Inc.Providing information to you regarding additional services that might be appropriate, including tax planning, estate planning, accounting or other personal or business consulting, from one of our affiliated companies.None of the above

The tax information may not be disclosed or used by Herbein & Company, Inc. for any purpose other than that permitted by this consent document.

The duration of this consent will continue as indicated below, unless Herbein & Company, Inc. is notified in writing to no longer use your tax return information for purposes identified above:*

Remain effective to the extent Herbein & Company, Inc. is engagedOther

If you approve the use of your tax return information by Herbein & Company, Inc. for the duration indicated above, please sign below.

Entity Name:*

Officer/Partnership Representative Name:*

First NameLast Name

Signature: Typing a name here represents a signature*

Form Completed*

Date

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 complaints@tigta.treas.gov.

For Business Taxpayers