HARN Financial Group

Phone *

(###)

###

####

Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Did you have health care insurance all last year? *

Yes

NO

Have you provided correct identification number (photocopies if possible)? *

yes

no

Do the names on the return match your social security records, children included? *

yes

no

Are you legally married based on your state's legal definition of marriage? *

yes

no

if yes, did your spouse live in your home at any time during July through December?

yes

no

Can someone else claim you/spouse as a dependent? *

yes

no

Did you/spouse receive any kind of Military pay earnings? *

yes

no

Did you/spouse receive any kind of housing allowances or government assistance? *

yes

no

Did you /spouse live with anyone with a higher adjusted gross income? *

yes

no

If yes, but renting do you have a rental agreement?

yes

no

Have you verified your dependent's birthday information as entered in the return? *

yes

no

Did you/spouse provide over 50% of total support for each dependent? *

yes

no

Do your EIC qualifying children meet any one of these requirements. *

yes

no

Under age 19 and lived in the taxpayer's home more than one half of year? *

yes

no

Under age 19 and foster child of taxpayer ad lived in taxpayers home full year? *

yes

no

Full time student age 19 to 23? *

yes

no

Totally disabled and can provide proof? *

yes

no

Did your EIC qualifying children live with you in the same main home in the US?

yes

no

Harn Financial Group will prepare your 2018 tax return from the information you have provided, we will not audit or verify the information you have furnished to us, you the taxpayer , are ultimately responsible for the preparation and filing of your tax return . I, the taxpayer named above, have provided to Harn Financial Group the attached tax information and to the best of my knowledge this information is true, correct, and complete *

I AGREE