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Midwest Tax Service Intake Form

This form is used to collect information about clients and is for internal purposes only. The information you provide is confidential and will be treated accordingly. If you are uploading additional documents from a previous submission only complete the asterisk fields.

How Many?
1
2
3
4
Birthday
Month
Day
Year
Did the primary taxpayer have health insurance coverage at any time during 2025?
No
Yes
Do you own or rent?

By signing this document, I acknowledge the inherent risks and voluntarily assume full responsibility for any injury, damage, or loss that may result from my participation. I hereby waive and release the business, its owners, and its staff from any and all liability, past, present, and future, relating to the services provided.

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