EFTA01222125.pdf

Consent to Use of Tax Return Information Federal law requires this consent form be provided to you. Unless authorized by law, we cannot us your tax return information for purposes other than the preparation and filing of your tax return without your consent. You are not required to complete this form to engage our tax return preparation services. If we obtain your signature on this form by conditioning our tax return preparation services on your consent, your consent will not be valid. Your consent is valid for the amount of time that you specify. If you do not specify the duration of your consent, your consent is valid for one year from the date of signature. If you believe your tax return information has been disclosed or used improperly in a manner unauthorized by law or without your permission, you may contact the Treasury Inspector General for Tax Administration (TIGTA) by telephone at 1-800-366-4484, or by email at [email protected]. The following statements apply: Sign this agreement by entering your name and the date below. First Name Last Name Dale SBIA1001.SCR 04+3015 EFTA01222125