I, ( First Name Last Name ) ACKNOWLEDGE THAT THE INFORMATION PROVIDED TO TAX THERAPY INC. FOR THE PREPARATION OF MY ( Date ) TAX RETURN IS TRUE AND ACCURATE. I UNDERSTAND THAT TAX THERAPY INC. IS NOT LIABLE AND WILL NOT ACCEPT RESPONSIBILITY FOR ANY FRAUDULENT INFORMATION PROVIDED TO THE IRS. WITH THIS KNOWLEDGE, I WILL ACCEPT FULL RESPONSIBILITY FOR ANY FALSE INFORMATION THAT HAS BEEN PROVIDED. Signature Date
By signing this statement, I affirm that: