Ex-Claimed My Dependent

Name

First NameLast Name

Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Phone Number

Please enter a valid phone number.

Email

example@example.com

Number of dependents that were claimed incorrectly*

How many months out of the year does the dependent(s) live with you?*

What year(s) are yours to carry your dependent(s)?*

Do you have a court order designating alternating years for tax filing purposes?*

YesNo

Can you provide a copy of your court order if requested?*

YesNo

Do you have proof that your dependent(s) cannot be filed on your tax return?*

YesNo

Did you still file your tax return?*

YesNo

Who is the primary parent?*

I amMy ex is the primary parent

Who's address is used to for school registration?*

My addressMy ex-spouse's address

Has your dependent ever been claimed on someone's return other than yours or the other parent?*

I amMy ex is the primary parent

Have you already filed a claim to the IRS regarding this matter?*

YesNo

Have you ever signed form 8332?*

YesNo

Have you ever texted or emailed your co-parent a separate arrangement about taxes outside of your court order?*

YesNo

By submitting this request for investigation regarding the alleged unlawful claiming or crediting of the Child Tax Credit by another party, I, the undersigned client, hereby acknowledge, affirm, and agree to the following:

1. Accuracy of Information
I certify that all information, documentation, statements, and representations provided by me are true, correct, and complete to the best of my knowledge and belief. I understand that any false, misleading, or omitted information may result in denial of the request, penalties, interest, or other adverse actions by the Internal Revenue Service and/or the applicable Department of Revenue.

INITIAL*

2. Client Responsibility
I acknowledge that I am solely responsible for the factual basis of this request, including but not limited to custody arrangements, residency requirements, support provided, and eligibility to claim the Child Tax Credit under applicable federal and state law.

INITIAL*

3. Authorization to Act
I authorize The Great Tax Return, it's tax preparer(s)/authorized representative(s) to submit paperwork, correspondence, and supporting documentation to the Internal Revenue Service and the applicable Department of Revenue solely on my behalf and strictly based on the information I have provided.

INITIAL*

4. Indemnification

I agree to indemnify, defend, and hold harmless the tax preparer/authorized representative, its owners, employees, contractors, and agents from and against any and all claims, liabilities, penalties, fines, damages, losses, costs, or expenses (including reasonable administrative or legal costs) arising out of or related to:

Inaccurate, incomplete, or false information provided by me;
My ineligibility to claim the Child Tax Credit;
Disputes between myself and the other parent or any third party;
Any determination made by the IRS or Department of Revenue that is contrary to my assertions.

INITIAL*

5. No Guarantee of Outcome
I understand and acknowledge that submission of this request does not guarantee a favorable outcome, refund, credit adjustment, or enforcement action. Final determinations are made solely by the IRS and/or Department of Revenue.

INITIAL*

6. No Legal Representation
I acknowledge that this service does not constitute legal representation and that I have been advised to seek independent legal counsel if legal advice or court action is required.

INITIAL*

7. Independent Service Fees & Payment Requirements
I acknowledge and agree that fees associated with the preparation and submission of paperwork to the Internal Revenue Service and/or Department of Revenue for the purpose of investigating the Child Tax Credit are separate from and independent of any other services offered by The Great Tax Return.

All fees for these services are due in full and payable upfront prior to the commencement of any work. No services will be performed, initiated, or provided until full payment has been received and cleared.

If payment is made by credit card, I understand and agree that a 4% credit card processing fee will be added to the total amount due. Personal checks are not accepted as a form of payment.

I further acknowledge that payment of fees does not guarantee a specific outcome, determination, or resolution by the IRS or Department of Revenue.

INITIAL*

By signing below, I confirm that I have read, understand, and voluntarily agree to the terms of this indemnification statement and services, fees, and payment statement.

By submitting this form, I again affirm that the information provided is true, accurate, and complete to the best of my knowledge and belief. I understand that submission of this form does not constitute an agreement, contract, or guarantee of services.

I further acknowledge that services are subject to review and prequalification, and that we reserve the right to decline or discontinue services if your circumstances do not align with our service qualifications, scope, or capacity.

Signature

Date

Ex-Claimed Your Dependent

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