Tax Client Information Sheet
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Taxpayer Signature Date Taxpayer’s Printed Name Spouse Signature Date Spouse’s Printed Name Company: By: Individual Name, individually and on behalf of Company Name Title: "" " " " " " " A 7Il3PjlR=lA l5Rh l5 KRflA3l3TTLjlRljRbl=RZl l .cX8B4 9lB 4M`BlCQ cY4Q8 l SXlkScX M lSYl4l 4NCMklN N6 Xl`BXSc Bl`B l 4M`Bl Q cX4Q8 l+4XJ `UM48 l i8B4Q l ``48Bl SYNl l 4M`Bl Q cX4Q8 l+4YJ `UM48 l1`4` N Q` l X4Q` 9l `S8JlSU`CSQ l6klkScXl NUMSk Xl4Q9SXl i X8C 9l NUMSk Xl `S8JlSU`CSQ l -gQ 9l4Qkl 8cXC`C lSXlB M9l4Qkl9 6` l`B4`l6 84N lgSX`BM l9cXCQ l`B lk 4Y l "SQ`XC6c` 9l`SlSXlX 8 Cd 9l9C `XC6c`CSQ l XSNl4Ql X8B Yl+ 9C84Ml14dCQ l 88ScQ`l+1 l .cX8B4 9l4lVc4MC C 9l c Ml8 MMld BC8M l .cY8B4 9l4l ScYgB M 9lUMc CQl M 8`YC8l9YCd lNS`SXld BC8M lSXl4llSXlgB M 9l M 8`YC8ld BC8M l 2X4d M 9lNSX l`B4QllNCM l`SlU SXNl9c`C l4 l4l,4`CSQ4Ml c4X9lN N6 XlSXlX XdC `l .. X SXN 9l XdC8 lCQl`B lU X SXNCQ l4X` l SXl4`lM 4 `l`gSl NUMSk X l Cd 9lSYlgSXJ 9lDQl4l SX C Ql8ScQ`Xk l c 9l4QlMQ9 Q`C`kl.XS` 8`CSQl.(,l6kl`B l 01 l 99l.(, l 1 Yd 9lCQl`B l+CMC`4Ykl 0 8 Cd 9l4QklQS`C8 l YSNl`B l 01lSXl4l `4` l`4iCQ l4c`BSXC`k l ``48Bl4l8SUkl SXl4QklcQX SMd 9lC c l 4d l4l1SMSll)SXlS`B XlVc4MC D 9lU Q CSQlUM4Ql8SQQ 8` 9lgE`Bl M NUMSkN Q`lgF`BlUM4Ql4 ` l Vc4Ml`SlSXl X 4` Xl `B4Ql l4`l4Qkl`CN l9cXCQ l`B l`4ilk 4X l /K 3 lTZReG: l3PjlRA ZlGP=RZO3HRPlZ L3 :lRljRbZl lah lPRlZ TR :l K fA Z lRPlA lWb GRPP3HZ l Health Care Coverage Certification In March 2010 President Obama signed the Affordable Care act..
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