Amendment Intake Form

Tax Year *

Phone *

Name *

Last Name *

Email Address *

Address

Street Address

Address Line

Address Line 2

City

State/Region/Province

Postal / Zip Code

Country

"Errors" which needs to be corrected and amended

Please upload a copy of the Entire Tax Return or Transcript

Did anyone on the Tax Return have Marketplace Insurance? *

Are there any additional notes that the Tax Professional should be aware of?

Document Upload 1

Document Upload 2

Document Upload 3

Document Upload 4

I am giving Fresh Start Business Service and/or associated affiliates permission to prepare all forms related to my tax return and I have signed all necessary forms to file my income tax return electronically. I take full responsibility for the accuracy of this client intake form and understand that Fresh Start and/or associated affiliates hold no responsibility for any misrepresentation or false claims.

UNDER PENALTIES OF PERJURY, I DECLARE THAT I HAVE EXAMINED THIS TAX RETURN, ACCOMPANYING SCHEDULES AND STATEMENTS, AND TO THE BEST OF MY KNOWLEDGE THEY ARE TRUE AND CORRECT.

Signature

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Date

I agree to terms & conditions provided by the company. By providing my phone number, I agree to receive text messages from the business.