Clone of CONSENT TO DISCLOSURE OF TAX RETURN INFORMATION

Choose your preparer

Printed Name of the Tax Preparer

First NameLast Name

Email*

example@example.com

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 disclose your tax return information to third parties for purposes other than the preparation and filing of your tax return 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 in our tax preparation services. If we obtain your signature on this form by conditioning our services on your consent, 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 have indicated that you are interested in receiving an Electronic Disbursement Service and/or Loan (or collectively, "Products or Services") from Pathward, National Association. In order to provide you with the opportunity to apply for one of these Products or Services, we must disclose all of your 2024 tax return information necessary for evaluating the request to Pathward. If you request a more limited disclosure of tax return information, you will not be eligible to submit an application request for these Products or Services. If you would like us to disclose your 2024 tax return information for this purpose, please sign and date your consent to the disclosure of your tax return information.

By signing below, you authorize us to disclose to Pathward all of your 2024 tax return information necessary for the evaluation and processing of your request for a Product or Service. You understand that if you are unwilling to authorize the disclosure and sharing of your tax return information with Pathward, you will not be able to obtain a Product or Service, but you may still choose to have your tax return prepared and filed by us for a fee.

I authorize Hometown Tax Service to use my tax return information
for the purpose of providing additional services, such as:
Audit Protection
Credit Repair
Financial Planning
Other __________________

If you sign this consent, your tax return information may be disclosed to the parties listed above. You do not have to sign this form. If you do, your consent is valid for one year from the date signed unless you revoke it earlier.

I acknowledge and agree to the above use/disclosure of my tax return information.*

Printed Name of Taxpayer:*

Taxpayer Signature:*

Date:*

Date

Printed Name of Joint Taxpayer (if applicable):

Joint Taxpayer Signature (if applicable):

Date:

Date

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.