Client Consent Form

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CLIENT CONSENT FORM
for Hart & Associates, P.C.
Federal law requires this consent form be provided to you. Unless authorized by law, we cannot use,
without your consent, your tax return information for purposes other than the preparation and filing of your
tax return. Our firm also provides year-round financial consultation and tax planning services which
cannot be provided without your consent. Furthermore, we cannot provide your tax information to other
individuals or businesses without your written consent.
You are not required to complete this form. If your signature is obtained on this form by conditioning our
services on your consent, your consent will not be valid. However, we can elect to not provide service.
Your consent is valid for the amount of time that you specify. If you do not specify a duration, your
consent is valid for one year.
Consent to Use
I consent to the use of my tax information for purposes other than preparation of my tax return, and/or
release of my information to the individuals/businesses specified below.
I also consent for you to
communicate with me via newsletter, website, email, phone, or other means with information and
recommendations that may be of use to me, including but not limited to:
1. Tax Advice. Advisory services relating to events in my life that have tax consequences such as
college, investment transactions, marriage, divorce, retirement, etc.
2.
Tax Planning. Services related to planning and forecasting potential tax obligations and their
.
estimated tax payment requirements
3. Retirement Tax Planning. Services related to retirement planning, social security planning,
minimum required distributions from retirement accounts and other planning services.
4. Investment and Asset Advice. Services relating to the tax considerations of buying, selling, and
exchanging property including stocks, bonds, and real estate.
5. Other Tax and Financial Advice. Services related to responding to your tax and financial
questions.
By signing this form, I expressly consent to the use/release of my tax information for the purposes of
providing auxiliary services to me. I understand the firm is using tax information furnished by me to
provide these services. I understand that I may terminate this consent at any time by providing a written
request for termination. A copy of this form has been provided for your convenience.
Duration of the consent _______________________
(one year from date of signature if left blank)
I authorize the release of my tax information to ______________________________________________
Signature: ____________________________
Spouse Signature ______________________________
Name (print): __________________________
Name (print) __________________________________
Date: ________________________________
Date ________________________________________

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