C.O.L.F.S.

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C.O.L.F.S.

client information
Full Name

First NameLast Name
Date of Birth

MonthDayYear
Date
Social Security Number
Height
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Address

Street Address

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Phone Number
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Email
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Employer Name

First NameLast Name
Employer Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Please provide copies of the following support documents:1. **Color Copy of Government ID: ** (i.e., Driver's License, ID card, Passport Front of ID - Back of ID)2. **Social Security Card:** (Front of Social Security CardBack of Social Security Card) 3. **Utility Bill: - Copy of a recent utility bill as proof of address.Cedars Of Lebanon Financial Services, LLC (281)627-2933

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A clear selfie of you holding your government-issued ID.5. **Pay Stubs: ** - (Two most recent pay stubs OR one month's worth of pay stubs.)6. **Yearly Income Documents: ** - (Current end-of-year W-2 forms - 099 forms (if applicable)7. **Personal Bank Statements: **-Three most recent personal bank statements showing direct deposits.8. **Void Check or Official Bank Letter: **- [] A voided check OR an official bank letter indicating your bank account details. It must be from the same bank account that receives direct deposits.- [] Have you ever declared bankruptcy? If yes, provide details. - [] Are you currently involved in any legal proceedings? If yes, provide details. - [] Do you have any outstanding debts or loans? If yes, provide details. - [] Do you have any other sources of income or financial assets? If yes, provide details.,certify that the information provided and the support documents submitted are accurate to the best of my knowledge. I understand that this information will be used for the purpose of(taxes,Medicaid,ETC)

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Cedars Of Lebanon Financial Services, LLC
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C.O.L.F.S.