Make an appointment

Online Form

  • 1
  • 2
  • 3
  • 4
  • 5

Full Name

Address

Did you receive the third stimulus check?

If yes, how much?

Did you receive the monthly child tax credit advance?

If yes, how much?

Do you have health insurance through Obama Care?

If yes, you must submit tax form 1095-A.

Do you own a business?

If yes, please fill out requested information

below. Business

Name:

Job Title:

Responslbilitles:

From:

To:

Does your business have an EIN?


If yes, provide the number below, EIN:

I certify that my answers are true and complete to the best of my knowledge.
I understand that false or misleading Information may delay my return.

Signature:

Date:

Consent to Disclosure of Tax Return Information

Printed name of tax preparer


(''we'', "us" and "our")

Federal law requires this consent form be provided to you (''you'' refers to each taxpayer, if more than one). Unless authorized by law, we cannot disclose your tax return information to third parties for purposes other than the preparation and filing of your tax return without your consent. If you consent to the disclosure of your tax return information, Federal law may not protect your tax return information from further use or distribution.

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. If you agree to the disclosure of your tax return information, 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.

You have indicated that you are interested in applying for a Refund Transfer (''RT'') product from Santa Barbara Tax Products Group, LLC, a division of Green Dot Corporation, a Delaware corporation (''Processor'') using banking services of Civista Bank (''Bank''). In order to have your refund processed by and through Processor, we must disclose all of your 2021 tax return information to Processor and Bank.

If you· would like us to disclose your 2021 tax return information to Processor and Bank for this-purpose, please sign and date your consent to the disclosure of your tax return information.

By signing below, you (including each of you if there is more than one taxpayer) authorize us to disclose to Processor and Bank all of your 2021 tax return information so that Processor can evaluate and process your application and Bank can provide banking services for the RT product. You understand that if you are not willing to authorize us to share your tax information with Processor and Bank, you will not be able to obtain an RT product from Processor, but you can still choose to pay us directly to have your tax return prepared and filed.

Printed Name of Taxpayer

Taxpayer Signature:

Date:

Printed Name of Joint Taxpayer:

Joint Taxpayer Signature:

Date:

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 complalnts@tigta.treas.gov.

Consent to Use of Tax Return Information

Printed name of tax preparer


(''we'', "us" and "our")

Federal law requires this consent form be provided to you (''you'' refers to each taxpayer, if more than one). Unless authorized by law, we cannot use 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.

For your convenience, we have entered into an arrangement with Santa Barbara Tax Products Group, LLC, a division of Green Dot Corporation, a Delaware corporation (''Processor''), using banking services of Civista Bank, to provide qualifying taxpayers with the opportunity to apply for refund processing services offered by and through Processor. To determine whether these services may be available to you, we will need to use your tax return information by analyzing it and calculating the amount of your anticipated refund.

If you would like us to use your tax return information to determine whether these services may be available to you while we are preparing your return, please sign and date this consent to the use of your tax return information.

By signing below, you (including each of you if there is more than one taxpayer) authorize us to use the information you provide to us during the preparation of your 2021 tax return to determine whether to present you with the opportunity to apply for refund processing services through Processor.

Printed Name of Taxpayer:

Taxpayer Signature:

Date:

Printed Name of Joint Taxpayer:

Joint Taxpayer Signature:

Date:

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 complalnts@tigta. treas.gov.

Personal Information

FIRST NAME

LAST NAME

M.I .

  • SOCIAL

  • SECURITY

  • NUMBER

  • DATE

  • OF

  • BIRTH

OCCUPATION

CURRENT STREET ADDRESS

CITY

STATE

ZIP

MAILING ADDRESS

CITY

STATE

ZIP

DRIVERS LICENSE

ISSUE DATE

STATE

EXPIRATION DATE

LIVING NEXT OF KIN

HOME PHONE NUMBER

CELL PHONE NUMBER

E-MAIL ADDRESS

HEALTH INSURANCE COMPANY

AMOUNT

LIFE INSURANCE COMPANY

COVERAGE AMOUNT

AMOUNT

SINGLE

MARRIED FILING JOINTLY

HEAD OF HOUSEHOLD

WIDOW ER) WITH DEPENDENT

MARRIED FILING SEPARATELY

SPOUSE FIRST NAME

LAST NAME

M.I

  • SOCIAL

  • SECURITY

  • NUMBER

  • DATE

  • OF

  • BIRTH

OCCUPATION

CURRENT STREET ADDRESS

CITY

STATE

ZIP

MAILING ADDRESS

CITY

STATE

ZIP

DRIVERS LICENSE

ISSUE DATE

STATE

EXPIRATION DATE

LIVING NEXT OF KIN

HOME PHONE NUMBER

CELL PHONE NUMBER

E-MAIL ADDRESS

HEALTH INSURANCE COMPANY

AMOUNT

LIFE INSURANCE COMPANY

COVERAGE AMOUNT

AMOUNT

Dependent Information

FIRST NAME

M.I.

LAST NAME

DATE OF BIRTH

RELATIONSHIP

SOCIAL SECURITY NUMBER

FIRST NAME

M.I.

LAST NAME

DATE OF BIRTH

RELATIONSHIP

SOCIAL SECURITY NUMBER

FIRST NAME

M.I.

LAST NAME

DATE OF BIRTH

RELATIONSHIP

SOCIAL SECURITY NUMBER

FIRST NAME

M.I.

LAST NAME

DATE OF BIRTH

RELATIONSHIP

SOCIAL SECURITY NUMBER

FIRST NAME

M.I.

LAST NAME

DATE OF BIRTH

RELATIONSHIP

SOCIAL SECURITY NUMBER

AMOUNT OF REFUND LAST YEAR$

CELL PHONE CARRIER

AMOUNT OF REFUND LAST YEAR$

CELL PHONE CARRIER

Refund & Service Options

DEBIT CARD

CARD NUMBER

PICK UP

CHECKING ACCOUNT

ROUTING NUMBER

ACCOUNT NUMBER

SAVINGS ACCOUNT

ROUTING NUMBER

ACCOUNT NUMBER

I hereby authorize TATOR TAX SERVICE to prepare and file my Federal and/or State Income taxes. I understand that by signing and submitting the application, I am submitting to the process of tax preparation by TATOR TAX SERVICE. I also authorize TATOR TAX SERVICE to may make deductions from my RAL and or RT, PERC or account for services rendered and/or all collections. I also acknowledge the Information provided 1$ true and can provide Information supporting this. If chosen, I authorize TATOR TAX SERVICE to process and withhold the credit services amount Indicated above from my Federal Tax Refund.

CLIENT:

Date:

SPOUSE:

Date: