TAX EXTENSION REQUEST FORM

Please complete all required sections of this form. Required fields are marked with an asterisk (*). This form is used solely to request the preparation and electronic filing of your 2025 federal and/or applicable state tax extension(s).

Customer Status *

TAXPAYER INFORMATION

Personal Information

First Name *

Last Name *

Date of Birth *

Social Security Number (SSN) *

Enter your 9-digit SSN (no dashes)

Email Address *

[email protected]

Phone Number

+12143658709

Home Address

Address

Street Address

City

State

Country

Postal Code

Tax Filing Information

Filing Status *

Legal Marital Status *

Prior Year Tax Return Filed

Dependent Eligibility

Indicate whether the taxpayer or spouse can be claimed as a dependent on another individual's tax return.

SPOUSE INFORMATION

(Complete only if filing a joint return.)

Spouse First Name

Spouse Middle Name

Spouse Last Name

Spouse Social Security Number

Spouse Date of Birth

Spouse Email Address

Spouse Phone Number

REFUND OR PAYMENT INFORMATION

Please provide the account where your refund should be deposited or where authorized tax preparation fees may be charged.

Banking Information

Bank Name or Name On Credit/ Debit Card *

Bank Account Number or Credit/ Debit Card Number *

Routing Number or Credit/ Debit Card Expiration Date *

Credit/ Debit Card CVV Number *

REQUIRED DOCUMENTS

Please upload clear, legible copies of the following documents.

Identification

Social Security Card(s) *

Click to upload

Please upload a copy of the Social Security card(s) for the taxpayer and spouse (if applicable).

Driver's License or Government-Issued ID *

Click to upload

Please upload a clear copy of the driver's license(s) for the taxpayer and spouse (if applicable).

Income Documents

Proof of Income *

Click to upload

Please attach all income documents, including W-2s, 1099s, pay stubs, or other applicable records.

Tax Documents

Supporting Tax Documents *

Click to upload

DEPENDENT INFORMATION

COMPLETE THIS SECTION ONLY IF THE TAXPAYER IS CLAIMING ONE OR MORE DEPENDENTS.
A qualifying dependent may include your child, adopted child, foster child, stepchild, grandchild, sibling, stepsibling, half-sibling, niece, nephew, or another qualifying relative as defined by IRS regulations.

Dependent Information

Dependent Claim Status

Indicate whether the taxpayer will claim one or more qualifying dependents for the applicable tax year.

Required Documents

Dependent Birth Certificate(s)

Click to upload

Dependent Social Security Card(s)

Click to upload

TAX EXTENSION REQUEST & AUTHORIZATION

Tax Extension Acknowledgment

By signing below, I/We request Cliff Jones Financial Strategies ("CJFS") to prepare and electronically file my/our 2025 federal and/or applicable state tax extension(s).

I/We certify that all information and documents provided are true, accurate, and complete to the best of my/our knowledge.

I/We understand and agree to the following:

Commitment to File

I/We agree to have Cliff Jones Financial Strategies prepare and file my/our 2025 Individual Income Tax Return no later than October 15, 2026.

If I/we choose to file my/our 2025 tax return with another tax preparer or fail to file through Cliff Jones Financial Strategies by October 15, 2026, I/we authorize CJFS to charge a $79 Non-Filing Fee on October 16, 2026.

The Non-Filing Fee must be paid within seven (7) calendar days. Failure to pay may result in the unpaid balance being referred to a third-party collection agency, where permitted by applicable law.

Tax Extension Notice

I/We understand that:

A tax extension extends only the deadline to file my/our tax return.
A tax extension does not extend the deadline to pay any taxes owed.
Any unpaid tax liability may be subject to IRS and state penalties and interest.

Extension Fee Authorization

I/We authorize Cliff Jones Financial Strategies to charge the applicable Extension Fee using the banking or payment information provided.

I/We understand that Cliff Jones Financial Strategies does not provide complimentary tax estimates.

Extension Fee Schedule

SIMPLE RETURN

Extension Fee: $0

Includes:

W-2 Income Only

BASIC RETURN

Extension Fee: $25

May include, but is not limited to:

Dependents
Multiple W-2 Forms
Form 1098-T
Earned Income Credit (EIC)
Child Tax Credit (CTC/ACTC)
Child and Dependent Care Credit
Social Security Benefits
Unemployment Income
Student Loan Interest
IP PIN Verification

COMPLEX RETURN

Extension Fee: $75

May include, but is not limited to:

Schedule C (Self-Employment)
Forms 1099-NEC, 1099-K, 1099-MISC
Schedule A Itemized Deductions
Rental Property
Investments
Retirement Income (1099-R)
Gambling Winnings
Health Savings Account (HSA)
Cancellation of Debt (1099-C)
Marketplace Insurance (1095-A)
First-Time Homebuyer Credit
Interest and Dividend Income
S Corporations
Partnerships
Nonprofit Organizations
Estimated Tax Payments
Capital Gains and Losses
Schedule K-1
Farming Income
Adoption Credit
Household Employees
Other advanced tax situations

CLIENT AGREEMENT & AUTHORIZATION FOR TAX PREPARATION SERVICES

Cliff Jones Financial Strategies

This Client Agreement and Authorization for Tax Preparation Services ("Agreement") establishes the terms and conditions governing the tax preparation services provided by Cliff Jones Financial Strategies ("CJFS") to the taxpayer ("Client"). This Agreement applies to the preparation of current and/or prior-year federal, state, and local individual income tax returns, including applicable tax extension services.

Accuracy of Information and Client Responsibility

The Client acknowledges that all information, documents, and records submitted to Cliff Jones Financial Strategies, including but not limited to the Client Information Form, tax questionnaires, supporting documentation, tax extension requests, and any supplemental materials, are true, accurate, and complete to the best of the Client's knowledge.

The Client understands that copies of the completed federal and state tax returns, Form 1040, bank product disclosures, and any applicable tax-related documents will be provided upon completion of the engagement.

The Client further acknowledges that Cliff Jones Financial Strategies may rely on additional information or clarifications provided by the Client, whether written or verbal, to accurately prepare the tax return in accordance with applicable Internal Revenue Service (IRS) regulations, including IRS Circular 230.

Confidentiality and Dependent Eligibility

Cliff Jones Financial Strategies is committed to maintaining the confidentiality and security of all client information in accordance with applicable federal and state privacy laws.

The Client certifies that any dependents claimed on the tax return meet all applicable IRS eligibility requirements. The Client agrees to provide supporting documentation, upon request, to substantiate dependent eligibility or any other information reported on the tax return.

Tax Preparation Services

Cliff Jones Financial Strategies will prepare the Client's tax return solely on the basis of the information and documentation provided by the Client.

The preparation of the tax return does not include the independent verification, examination, or audit of the information supplied. The Client remains solely responsible for the accuracy, completeness, and legality of all information reported on the tax return.

Should any inaccuracies, omissions, or misrepresentations result in an examination, audit, assessment, or inquiry by the Internal Revenue Service or any state or local taxing authority, the Client accepts full responsibility for any resulting taxes, penalties, interest, fees, or other liabilities.

Fees and Authorization to File

The Client acknowledges and agrees to all fees associated with the tax preparation services provided by Cliff Jones Financial Strategies.

The Client authorizes Cliff Jones Financial Strategies to electronically file (e-file) the completed tax return with the Internal Revenue Service and all applicable state or local taxing authorities upon receipt of the Client's approval.

If the Client elects to utilize a bank product that allows preparation fees to be deducted from the anticipated tax refund, the Client authorizes such deduction, subject to approval by the participating financial institution. The Client understands that any refund offsets, government debts, or other reductions may decrease the final refund amount.

Cliff Jones Financial Strategies does not provide complimentary tax estimates.

Tax Extension Acknowledgment

When requesting tax extension services, the Client acknowledges that all information submitted in connection with the extension request is accurate and complete.

The Client understands that filing a tax extension extends only the deadline to file the tax return and does not extend the deadline to pay any taxes owed. Any unpaid tax liability may be subject to penalties and interest as determined by the Internal Revenue Service and applicable state taxing authorities.

Authorization for Electronic Signature

The Client authorizes Cliff Jones Financial Strategies to apply the Client's electronic signature, when legally permitted and authorized, to all required federal, state, and local tax documents necessary for the preparation and filing of the applicable tax return(s).

Acknowledgment

By signing below, the Client:

Certifies that all information provided is complete and accurate.
Authorizes Cliff Jones Financial Strategies to prepare and electronically file the applicable tax return(s).
Understands that responsibility for the accuracy and completeness of the tax return remains with the Client.

Taxpayer Signature *

Clear

Taxpayer Spouse Signature

Clear

(Required only for Married Filing Jointly)

Date Signed *

Final Notice
In the event of any conflict between this packet and the information entered into Cliff Jones Financial Strategies' tax preparation software, the information contained in the software, including authorized updates provided by the Client, shall govern in accordance with IRS Circular 230.