Income Tax Preparation Disclosure Form

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INCOME TAX PREPARATION DISCLOSURE FORM
ESTIMATED CHARGES FOR THE FOLLOWING RETURNS ARE:
TAX SITUATION
FEDERAL
STATE
$
$
1040EZ Simple Return
$
$
1040A Standard Deduction
$
$
1040
Itemized Deduction
$
$
1040
Complex
$
$
$
$
$
$
$
$
$
$
$
$
$
$
ADDITIONAL CHARGES APPLY FOR:
_______________________________________________. . . . . . . . . . . . . . . $ ________________________
Earned Income Credit
_______________________________________________. . . . . . . . . . . . . . . $ ________________________
Refund Anticipation Check (RAC)
_______________________________________________. . . . . . . . . . . . . . . $ ________________________
Health Care Related Forms
_______________________________________________ . . . . . . . . . . . . . . . $ ________________________
_______________________________________________ . . . . . . . . . . . . . . . $ ________________________
_______________________________________________ . . . . . . . . . . . . . . . $ ________________________
_______________________________________________ . . . . . . . . . . . . . . . $ ________________________
_______________________________________________ . . . . . . . . . . . . . . . $ ________________________
_______________________________________________ . . . . . . . . . . . . . . . $ ________________________
Charges may vary in accordance with the standard schedule of charges depending upon such factors
as any necessary additional forms (including forms needed for itemizing deductions, sale of property or
business ownership). You will receive an estimate of the cost for the tax preparation services you
have selected prior to entering into a contract.
• If you file a paper tax return by U.S. Mail and elect to receive your tax refund through the U.S. Mail,
you can expect your refund _______________________________________________________________.
• If you file your tax return electronically and elect to receive your tax refund through the U.S. Mail, you
can expect your refund __________________________________________________________________.
• If you file your tax return electronically and elect to receive your tax refund to your personal bank
account, you can expect your refund _______________________________________________________.
___________________________________________________________________________________________
Client Signature
Date
I certify that I have presented and verbally reviewed all required disclosures with the consumer:
___________________________________________________________________________________________
Tax Preparer Signature
Date

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