Clone of 2025 Central Florida Tax Pros / Secure Client Information Form

HOW DID YOU HEAR ABOUT US:
Referred by:
Cash Advance (Are you interested in a Refund Advance?)*
Did you file with us last year?
What best describes your current tax situation?
Tax Year Filing *
Filing Status:*

SingleMarried Filing JointMarried Filing SeparateHead of HouseholdWidow/ WidowerNot sure/ Need help determining my filing status
Full Legal Name (as it appears on your Social Security card) *

First NameMiddle NameLast NameSuffix
Phone Number*
Email Address*
example@example.com
Date of Birth *

MonthDayYear
Date
Social Security Number *
XXX-XX-XXXX
Spouse Information
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Do you have any dependents you would like to claim on your tax return?

YesNo
If any of your dependent didn't live with you in 2025, please let your preparer know...
1.Dependent Information
Is this dependent considered disabled or receiving benefits? *
If your dependent is over the age of 18 and disabled, what is the nature of the disability?
2.Dependent Information
Is this dependent considered disabled or receiving benefits? *
If your dependent is over the age of 18 and disabled, what is the nature of the disability?
3.Dependent Information
Is this dependent considered disabled or receiving benefits? *
If your dependent is over the age of 18 and disabled, what is the nature of the disability?
4.Dependent Information
Is this dependents considered disability or receiving benefits? *
If your dependent is over the age of 18 and disabled, what is the nature of the disability?
Were you the taxpayer affected by any natural disaster doing 2025?*

YesNo
If yes, what is the City & State of disaster? Did you have insurance to cover damages? Damage amount?
In case your contact information change or in case of an emergency who do I contact:
Name, Phone Number
Did you receive unemployment compensation income?*

YESNO
Can someone else claim you or your dependent on their tax return?*

YESNO
If you have an Identity Protection list below.
Do you owe any delinquent?*

Child SupportAlimonyStudent LoansBack TaxesState TaxesNone of the above
Did you or your dependents have Marketplace in 2025?*

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

YESNO
Complete Only if Your Filing an Dependent

Earned Income (EIC) Eligibility
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.
Do you currently receive government assistance?*

YESNO
Child Care Provider

Babysitter- Child and Dependent Care Provider
Childcare Name
Name /
Childcare Address
Childcare EIN / SSN
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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

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Marketplace/ 1095-A

Cancelof
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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CLIENT CERTIFICATION, AUTHORIZATION & ACKNOWLEDGMENT
Central Florida Tax Pros – 2025 Tax Year

Client Certification of Accuracy
By signing below, I certify under penalty of perjury that all information provided in this intake form and throughout the tax preparation process is true, correct, and complete to the best of my knowledge.

I acknowledge that:

I have read and understand all questions and instructions contained in this application.
I am solely responsible for the accuracy and completeness of the information I provide.
Central Florida Tax Pros relies entirely on the information supplied by me in preparing my federal and/or state tax return(s).

Responsibility for False or Incomplete Information
I understand and agree that any penalties, interest, additional taxes, audits, adjustments, or legal consequences resulting from false, misleading, incomplete, or omitted information provided by me are my sole responsibility.

I further agree to indemnify and hold harmless Central Florida Tax Pros, its owners, employees, and agents from any liability, penalties, costs, or damages arising from information I provided inaccurately or failed to disclose.

Authorization to Prepare Tax Returns
I hereby authorize Central Florida Tax Pros to prepare my federal and applicable state tax return(s) based solely on the information I have provided.

I understand that:

I will receive a completed copy of my tax return prior to submission.
It is my responsibility to review the return for accuracy before authorizing electronic filing.
Approval of submission constitutes my acceptance of the return as filed.

Fees, Payments & Refund Intercepts
I acknowledge and agree that:

If a balance is due, tax preparation fees must be paid in full prior to filing.
If my refund is reduced, delayed, intercepted, or offset by any federal, state, or other governmental entity, I remain fully responsible for all tax preparation fees for services rendered.
All fees, including bank and service fees disclosed in the tax return, are non-refundable and non-negotiable, with no exceptions.

Amended Returns
If an amended return is required due to client-provided errors, omissions, changes, or additional information not caused by the tax preparer, an amendment fee of $150.00 is due prior to filing.

Copies of Tax Returns
I acknowledge that:

A copy of my completed tax return will be provided to me electronically prior to submission.
Any additional copies requested after the initial copy will incur a $10.00 per copy fee.

Refund Tracking & IRS Communication
I understand that:

Federal refunds must be tracked at www.irs.gov
State refunds must be tracked through the appropriate State Department of Revenue
Federal and state refunds are processed separately and must not be combined when tracking
I should allow up to eight (8) weeks from the date of submission before contacting the IRS regarding refund status
I further understand that Central Florida Tax Pros does not control refund processing times and is not responsible for delays caused by the IRS, state agencies, identity verification, prior filings, offsets, or government backlogs.

Client Communication
For direct assistance, I may contact:
📧 info@centralfloridataxpros.com

IRS Contact:
📞 800-829-1040

To check my federal refund status, I understand I will need:

My filing status
My Social Security Number
My refund amount (before fees)

Electronic Signature Acknowledgment
By signing electronically below, I acknowledge that this signature carries the same legal effect as a handwritten signature and confirms my agreement to all terms stated above.
Type a question
Name*

First NameLast Name
Date*

MonthDayYear
Date
Signature*

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CONSENT TO USE OF TAX RETURN INFORMATION
Central Florida Tax Pros – 2025 Tax Year

Definitions
For purposes of this consent, the terms “we,” “us,” and “our” refer to Central Florida Tax Pros, its owners, employees, contractors, and authorized agents.

Federal Law Disclosure
Federal law requires this consent form to be provided to you.

Unless authorized by law, we may not use or disclose your tax return information for purposes other than the preparation and filing of your tax return without your consent, as required under Internal Revenue Code §7216 and applicable Treasury Regulations.

You are not required to complete this consent in order to engage our tax return preparation services.

Voluntary Consent
Your consent is voluntary.
Your tax return will still be prepared and electronically filed whether or not you provide this consent, subject to applicable preparation fees.

If we were to condition our tax preparation services on your consent, such consent would not be valid under federal law.

Purpose of Consent
For your convenience, Central Florida Tax Pros has entered into arrangements with third-party financial institutions and service providers that may offer:

Electronic refund disbursement services
Refund advance or loan products
To determine whether you may qualify for these products, we must use certain tax return information (such as refund amount calculations) during the preparation of your tax return.

Authorization
By signing below, you authorize Central Florida Tax Pros to use the tax return information you provide solely for the limited purpose of:

Determining your eligibility for electronic refund disbursement services and/or loan products, and
Presenting you with information regarding such products while preparing your 2025 tax return
This authorization does not require you to apply for or accept any product.

Duration of Consent
This consent is valid for:

The period you specify below, or
If no period is specified, one (1) year from the date of signature, as permitted by federal law
You may revoke this consent at any time by providing written notice, except to the extent action has already been taken in reliance on your consent.

Limitations & Safeguards
Your tax return information will not be used or disclosed for any purpose not expressly authorized herein.
Disclosure is limited to what is necessary to determine eligibility for the described services.
All disclosures are made in accordance with federal confidentiality and data security requirements.

Improper Use or Disclosure
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) at:

📞 1-800-366-4484
📧 complaints@tigta.treas.gov

Acknowledgment & Electronic Signature
By signing electronically below, you acknowledge that:

You have read and understand this consent
You voluntarily authorize the limited use of your tax return information as described above
Your electronic signature has the same legal effect as a handwritten signature
Date*

MonthDayYear
Date
Signature*

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OFFICE USE ONLY:
FORM OF COMMUNICATION:

PHONEVIRTUALOTHER
Should be Empty:

Child Care Provider

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