Consent to Disclosure of Tax Return Information

Which type of consent (ONLY PICK ONE OPTION)*

If Single, Consent to Release to a third partyIf Married Filing Jointly, Consent to Release to a third PartyIf Single, Consent to Release to self over the internet or faxIf Married Filing Jointly, Consent to Release to self/spouse over internet or fax

Federal law requires that this consent form be provided to you. Unless authorized by law, we cannot disclose your tax return information to a third party for purposes other than the preparation and filing of your tax return without your consent. Federal law also restricts us from disclosing your tax information, including to you, via email or fax 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, as a condition for our tax return preparation services, 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 MUST TYPE A HYPHEN (-) WHEN ENTERING A SOCIAL SECURITY NUMBER OR PHONE/FAX NUMBER.

I, First Name* Last Name*, and (if married) Spouse First Name* Spouse Last Name* authorize Hampden Hills Tax Service, Inc., and all employees to disclose my tax return(s) for(specify the tax year(s) year or "all years" to myself and my spouse for the purpose of personal use for time or "unlimited".

Email/Fax Number/Mailing Address where information is to be disclosed (must choose at least one): Street Address Address Line 2 City State Zip or Husband Email and Her Email or Area Code Fax Number

I, First Name* Last Name*, authorize Hampden Hills Tax Service, Inc., and all employees to disclose my tax return(s) for the year or years of which year(s)* to person or business to disclose to* for the purpose of reason for release* for duration of time.

Email/Fax Number/Mailing Address where information is to be disclosed (must choose at least one): Street Address Address Line 2 City State Zip or Email or Area Code Fax Number

I, First Name* Last Name*, and Spouse First Name* Spouse Last Name* authorize Hampden Hills Tax Service, Inc., and all employees to disclose my tax return(s) for the year or years of which year(s)* to person or business to disclose to* for the purpose ofreason for release* forduration of time.

Email/Fax Number/Mailing Address where information is to be disclosed (must choose at least one): Street Address Address Line 2 City State Zip or Email or Area Code Fax Number

I, First Name* Last Name*, authorize Hampden Hills Tax Service, Inc., and all employees to disclose my tax return(s) for(specify the tax year(s)year or "all years" to myself for the purpose of personal use for time or "unlimited".

Email/Fax Number/Mailing Address where information is to be disclosed (must choose at least one): Street Address Address Line 2 City State Zip or Email or Area Code Fax Number

This consent authorizes Hampden Hills Tax Service, Inc. to disclose a copy of your entire tax return or all the information contained within your return. You may direct a more limited disclosure of your tax return information.

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 e-mail at complaints@tigta.treas.gov.

Taxpayer Name*

First NameLast Name

Taxpayer Social Security Number*

Must use hyphen (-)

Date*

Date

Signature*

Spouse Name

First NameLast Name

Spouse Social Security Number

Must use hyphen (-)

Date

Spouse Signature

Taxpayer: I consent for my spouse to pick up my supporting tax documents belonging to me (such as W-2's or 1099's). If I consent to this arrangement, then please sign below.

Spouse: I consent for my spouse to pick up my supporting tax documents belonging to me (such as W-2's or 1099's). If I consent to this arrangement, then please sign below.

Taxpayer Signature

Spouse Signature

Consent to Disclosure of Tax Return Information - Individuals