2024 Central Florida Tax Pros Information Request Form

HOW DID YOU HEAR ABOUT US:

SOCIAL MEDIAWALK INGOOGLEOTHER: ______________________
Cash Advance (Are you interested in a Refund Advance?)*
Did you file with us last year?

YesNo
Tax Year Filing *
Referred by:
Filing Status:*

SingleMarried Filing JointMarried Filing SeparateHead of HouseholdWidow/ Widower
Name *

First NameMiddle NameLast NameSuffix
SSN*
Date of Birth *

MonthDayYear
Date
Phone Number*
Email*
example@example.com
Spouse Name

First NameLast NameSuffix
SSN
Date of Birth

MonthDayYear
Date
Phone Number
Driver License/ ID Number
Spouse Email
example@example.com
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Dependant Information
If any of your dependent didn't live with you in 2024, please let your preparer know...
Dependents Information:
Are any of your dependents considered disability or reciving benefits? *
If yes, please list name:
If your dependent is over the age of 18 and disabled, what is the nature of the disability?
Were you the taxpayer affected by the storm?*

YesNo
If yes, what is the City & State of disaster? Did you have insurance to cover damages? Damage amount?
Are you listed as the Social Security Representative Payee for this dependent?
In case your contact information change or in case of an emergency who do I contact:
Name, Phone Number
Complete Only if Your Filing an Dependent

Earned Income (EIC) Eligibility
If you have an Identity Protection list below.
You may claim the EIC if you answer Yes to all 4 tests below (See publications 17, Chapter 36)
Relationship Test: 1. Your child/children is/are one of the following: A son, daughter, adopted child, stepchild, grandchild, or eligible foster child, or is your brother, sister, stepbrother, or stepsister), and you care for them as you would your own.
Can someone else claim you or your dependent on their tax return?*

YESNO
Do you currently receive government assistance?*

YESNO
Do you owe any delinquent?*

Child SupportAlimonyStudent LoansBack TaxesState TaxesNone of the above
Did you or your dependents have Marketplace in 2023?*

YESNO
Did you live a the above listed address for more than 6 months?*

YESNO
Did you receive unemployment compensation income?*

YESNO
Did you or your dependent attend college?*

YESNO
Do you have a 1098-T form from your or your dependent college?*

YESNO
How would you like to receive your refund?*

Refund Transfer Direct DepositRefund Transfer Money CardRefund Transfer Paper Check
Child Care Provider
Name / Childcare Name
Childcare Address
Childcare EIN / SSN
Uploads
FRONT: ID/ Driver License *

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BACK: ID/ Driver License *

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Spouse FRONT: ID

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Spouse BACK: ID

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Taxpayer Social Security Card *

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Dependent #1 Social Serurity Card

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Dependent #2 Social Security Card

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Dependent #3 Social Security Card

Cancelof
Income/ W2/ 1099

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Income/ W2/ 1099

Cancelof
Marketplace/ 1095-A

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Other Docs:

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Other Docs:

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By signing below, you, the taxpayer, agree to provide supporting documentation upon request from the government or the Internal Revenue Service (IRS). This documentation may include but is not limited to school records, medical, daycare, place of worship, / birth certificates.*

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Selfie Photo*
Signatures: By signing below you represent that everything you stated in the above area is true and correct. You respresent that you have read and understand the questions asked and conditions herein. You will acknowledge receving a completed copy of this complete application, among other things, consent the collection authorization in the above information.

I, hereby, state that all the information above is true to the best of my knowledge and that I am allowing On Time Taxes to prepare my taxes based on that fact. I understand that I am financially responsible for any outstanding balance due to any false information given.

If there is a balance due, you must pay the tax preparation fee upfront. If for any reason you owe an entity and they take the entire refund, you are STILL responsible to pay the tax preparation fee for services rendered.

*For any reason an amendment has to be filed with no fault of the tax preparer, an upfront fee of $150.00 is required! Please view your tax return, which is emailed to you (it is sent prior to submission). Any copy after the first copy is a fee of $10.00.

ALL FEES (bank and service fees) are found in the return and are non-refundable nor negotiable! NO EXCEPTIONS TO THIS!!

Please utilize www.irs.gov for all federal refund tracking. Please utilze your state Department of Revenue site for any State Refund tracking. Do NOT add the amounts together. Federal taxes are federal, and state taxes are state when tracking your status. Please allow 8 weeks to surpass from the date of submission before calling the IRS, if you have any tracking questions.

For any direct assistance please email info@centralfloridataxpros.com

IRS Contact 800-829-1040

Please check the irs site for your -federal refund status. You will need your filing status, social security number, and the total amount of the refund before fees
Name*

First NameLast Name
Date*

MonthDayYear
Date
Signature*

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CONSENT TO USE OF TAX RETURN
INFORMATION For the purposes of this consent form, “we,” “us,” and “our” mean

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 in our tax return preparation services.

If we obtain your signature on this form by conditioning our tax 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. If you do not consent, you may still have your tax return prepared and electronically filed by us for a fee.

For your convenience, we have entered into an arrangement with third parties to provide qualifying taxpayers with the opportunity to apply for an Electronic Refund Disbursement Service and/or Loan product. To determine whether these products may be available to you, we will need to use your tax return information in order to calculate the amount of your anticipated refund. If you would like us to use your tax return information to determine whether these products may be available 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 present you with the opportunity to apply for these products and services.

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.
Date*

MonthDayYear
Date
Signature*

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OFFICE USE ONLY:
FORM OF COMMUNICATION:

IN PERSONPHONEVIRTUALOTHER
Should be Empty:

Dependant Information

Child Care Provider

Uploads