Note: If you did not receive your Form 1095-A, call (800) 300-1506 to obtain it, or you can log in to your online account at CoveredCA.com to download it.

*Tax service agreement The purpose of this agreement is to confirm and specify the terms of our service and to clarify the nature and extent of those services. By signing this form, you confirm: you (and your spouse) accept this agreement. Please review all schedules especially A, C, and E for accuracy. We will prepare your Federal and/or State income tax return from the information you provided us. We are not auditors for the IRS; we will not audit or verify that data you submit to us. We may need to ask for your clarification of some of the data. Before your return is filed, we will provide a copy of the return for your review. You are responsible for providing to us al the data required to prepare complete and accurate tax returns for you. You represent that the data you supply to us is accurate and complete to the best of your knowledge. You should keep all documents, canceled checks, and other data that form the basis of your tax return. You are responsible for your income tax returns; you should carefully review them before they are filed. We will use our judgment to resolve (1) questions where tax lax is unclear, or (2) questions where there may be conflicts between taxing authority's interpretation of the law and other supportable positions. We plan to do reasonable research to support the positions we take in your income take returns. Unless you instruct us to do otherwise; whenever possible, we will resolve such tax questions in your favor. Tax authorities may pick your tax return for review. If penalties, interest, or additional taxes are assessed; you agree that you are responsible for their payment and will not look to us for reimbursement. If you receive a letter from a tax authority regarding a return, we prepared for you; we can help prepare a response. However, we cannot represent you in (1) an audit of your return or (2) a formal appeal of the tax authorities proposed adjustments to your return unless a separate agreement is drafted. You understand and agree some fees will be incurred in filing electronic (RACs, ELECTRONIC REFUNDS, ETC) we will disclose the total fees and by signing this form you agree to all fees and understand preparer firm will be compensated from such fees. This is separate from preparation fees you already paid.

Nota: Si no recibió su formulario 1095-A, llame al (800) 300-1506 para obtenerlo, o puede ingresar a su cuenta en línea en CoveredCA.com para descargarlo. 

*Forma del acuerdo de impuesto

Yo he leído y certifico bajo penalidad de perjurio de California que la información que estoy otorgando de mis dependes, seguros sociales, babysitter, trabajo, gastos y status de casado/a son verdaderos y que se usaran para preparar mis taxes y que mis hijos o niños que me califican para el EIC crédito de niños solo yo los declaro y mis hijos son verdaderos y residen conmigo todo el año en USA. Que si declaro cabeza de familia es porque no vivo con mi esposo/a en la misma casa los últimos 6 meses del año, tengo documentación original para verificar mi declaración y he leído mi preparación y es correcta y verdadera.

Si aplica también certifico que mi salario anual por trabajar por mi cuenta en cash o con forma 1099-misc en mi profesión (Schedule C) es correcta/verdadera y tengo recibos para respaldar mis deducciones.

He leído y revisado la forma (A)(E) y los gastos del mortgage y taxes, las deducciones de gastos, y la cantidad de rentas anuales son correctos. He declarado a mi preparador toda mi ganancia como desempleo, retiro, lotería, todos los trabajos y en general toda la información de mis taxes. Firmando me hago responsable de toda la información que aparece en mi declaración y no responsabilizo a mi preparador por alguna auditoria del IRS o el estado ya que mis taxes se complementaron con información proporcionada por mí.

Estoy de acuerdo y entiendo que costos por recibir mi cheque rápido serán reducidos de mi cheque y se compensara al preparador aparte de los costos de la preparación.