Client Data Sheet

Consent to Use: 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, By signing below, you authorize us to disclose to Pathward all of your 2025 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 choose to have your tax return prepared and filed us for a fee. Printed Name and Date (below)

Signature

Engagement Agreement By providing us with your signature, you are accepting the terms and conditions, * it's your responsibility to provide all the information required for the preparation of complete and accurate return, you retain all the documents data that form the basis of income, expenses, credits and deductions may be necessary to prove the accuracy.* you have final responsibility for the income tax returns and, therefore, you should review them carefully before you sign * I understand that this information is being provided to the IRS and State Revenue. I have been advised by my tax preparer that any false and misleading information that I provide for income tax filing purposes is against the law and are subject to penalties. I understand that Hierarchy Tax Service is only liable for any Error and Omission on their part and will be responsible for any interest and penalties and not tax due. Printed Name and Date (below)

Signature

Consent to Disclosure: 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, By signing below, you authorize us to disclose to Pathward all of your 2025 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 choose to have your tax return prepared and filed us for a fee. Printed Name and Date (below)

Signature

Filing status

Name

First NameLast Name

Taxpayers Date of Birth

Date

Email

Taxpayers phone Number

Please enter a valid phone number.Format: (000) 000-0000.

Did you or your dependents receive Identity Theft PIN from the IRS?, if so please provide

Occupation

Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Can you be claimed as a dependent on someone else taxes?

Please ensure we have the full names and dates of birth for all children and dependents with SIN if applicable.

Are Dependents Disabled?

if yes, what is their disability?

if yes, was it half your income? (if it was half, you do not quality for EITC for this dependent)

Dependent #1

First NameLast Name

Dependent #1 DOB

Date

Relationship

Dependent #2

First NameLast Name

Dependent #2 DOB

Date

Relationship

Dependent #3

First NameLast Name

Dependent #3

Date

Relationship

If your dependent have a different last name than you, please explain why the names are different

Did you care for more than 50% of your household expenses?

Did your dependent(s) stay with you for at least 6 months out of the year? If so, can show proof such as school records, lease, medical records or church records

Did you receive any type of government assistance?

Did anyone else help take care of the dependent (s)

Did you have health insurance last year? If yes, please provided 1095A

Do you owe back taxes, students' loans, child support or any other government agency?

Did you receive unemployment benefits last year?

Have you been disallowed EITC previously? If yes list reason

File Upload

DIRECT DEPOSIT AUTHORIZATION I(we) hereby autorize to electronically credit my (or our, if filing a joint return) account (and , if necessary, to electronially debit my (our) account to correct to erroneous credits as follows..... Select One :

Financial Institution

Routing Number

Account Number

Name(s) on the Account

Signature