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Charlesworth Financial Services, LLC

Engagement Letter

Investment Year 2025

(Tax Year 2024)



We at Charlesworth Financial Services (CFS) appreciate the opportunity of working with you and advising you regarding your income tax and other financial matters. We strive to be the only Financial Advisor you and your family will ever need. To ensure a complete understanding between us, we are setting forth the pertinent information about the services which we propose to render for you. Work on your return will not commence without this signed Engagement Letter.

We will prepare the Federal and State income tax returns for you for the year ended December 31, 2024 from information you provide. A copy of your returns will be provided to you via pdf in our secure portal, SmartVault, or by email if requested. If you request a printed paper copy, one will be provided to you. By signing this Engagement Letter, I (we) agree to only receive an Electronic copy of our 2024 Income Tax Returns unless I (we) notify CFS in writing. We also agree to sign our returns electronically and that the electronic signature is legally binding and a consent to file electronically. In most cases, your invoice will be emailed to you for Zelle or online payment.

By signing this, we allow the preparers to discuss our tax return with the IRS unless written correspondence is provided stating otherwise. 

I understand that both Justene Charlesworth and Julianne Charlesworth are financial advisors. Included with the 8879 DocuSigns will be form 7216 and/or form 6713. We must obtain form 7216 and/or 6713 consent if we plan to use client's 1040 information for anything other than tax return preparation. Since we are also financial advisors, we are always looking for investment opportunities for our clients which are, in turn, outside of the scope of tax return preparation. 7216/6713 enables tax return preparers to more effectively provide a range of services than taxpayers would ordinarily expect from tax return preparers. 

CFS will not audit, analyze, check or verify the data submitted, although we may ask you to clarify it by written communication. An organizer to assist you in gathering the necessary information for us may be found in your secure portal, SmartVault. Your use of the organizer will help you avoid overlooking important information and assist us in keeping our fee to a minimum. We do our best to accommodate all clients to prepare and file your tax returns on time if all information is received by March 10th. Due to unknown work flow or missing documents, it is best to provide us ALL your documents at once and earlier in the season. The closer to the filing deadline your documents are received, the less we can guarantee they will be timely filed. Please note: an extension extends the time to file until October 15th. Once extended, our workload is such that your return may not be prepared until middle or late summer. If ALL information is not received by September 1, additional fees will apply. Payments to the IRS and states after April 15th will accrue penalty and/or interest and the time to pay cannot be extended. 

We direct your attention to the fact that you have the responsibility for the accuracy and completeness of the information you provide. Our work in connection with the preparation of your income tax returns does not include any procedures designed to discover defalcations or irregularities, should any exist. It is your responsibility to maintain the documentation necessary to support the data used in preparing your tax returns, including but not limited to auto, travel and related business expenses and the required documents to support charitable contributions. It is also your responsibility to carefully examine and approve your completed tax returns. We are authorized to use our judgment in evaluating the best tax return treatment and will be available to discuss this with you.

Our fees are based upon the time necessary to prepare your return and/or specific forms required, plus any additional time required for consulting, compiling or interpreting information. Invoices are due upon receipt and returns will not be filed until the invoice is paid. Any past due balance under this agreement shall bear interest at the rate of 1½% per month (18% annual rate). In the event it becomes necessary to retain an attorney to collect any fee, you agree to pay any attorney's fees and costs regardless of whether suit or mediation is filed. Returned checks (NSF checks) will be assessed an additional fee of $25.00. If you wish an estimate of our fees, please request prior to commencement of our services.

Your returns may be selected for review by the taxing authorities. We have contracted with Tax Protection Plus, a third party specializing in notices and audits, to assist with such. Any proposed adjustments by the examining agent are subject to certain rights of appeal. In the event of a tax examination, we will be available upon request to represent you and will render additional invoices for the time and expenses incurred. We are not responsible for the IRS disallowance of doubtful or unsupported deductions or any resulting taxes, penalties or interest. In the case of the necessity of an amended return, notice from the taxing authorities or an audit, an additional preparation fee will occur.

All returns will be filed electronically when possible after receiving signature authorization, unless written objection is received from the client. We are not responsible for any delays or electronic rejections from the taxing authorities regarding the efiling of your return, or any possible refund, and will not be financially responsible for electronic transmission or other errors arising after your return has been successfully submitted from our office. You have the final responsibility for the returns and should review them carefully before you sign and file and/or give us authority to efile them.

In preparing your individual tax returns, we will rely solely on the information you provide us regarding the CARES Act, Affordable Care Act (ACA), SECURE and other acts or mandates and you agree to accept full responsibility for the accuracy and completeness of this information, as well as your compliance with all laws.  We will also render other accounting, financial services, insurance and consulting services you may request during the year ended December 31, 2025.

CPAs, like all providers of personal financial services, are now required by law to inform their clients of their policies regarding privacy of client information. CPAs have been, and continue to be, bound by professional standards of confidentiality that are even more stringent than those required by law. Therefore, we have always protected your right to privacy.

We collect nonpublic personal information about you that is provided to us by you or obtained by us. For current and former clients, we do not disclose any nonpublic personal information obtained in the course of our practice except as required or permitted by law. Permitted disclosures include, for instance, providing information, in limited situations, to unrelated third parties who need to know that information to assist us in providing services to you. In all such situations, we stress the confidential nature of information being shared. You agree that we shall have no liability for any loss or damage to any person or entity resulting from the use of email or other transmissions, including any consequential, direct, indirect, or special damages, such as loss of sales or anticipated profits, or disclosure or communication of confidential or proprietary information.

Federal law has extended the attorney-client privilege to some, but not all, communications between a client and the client’s accountant. The privilege applies only to noncriminal tax matters that are before the IRS or brought by or against the U.S. Government in a federal court. The communications must be made in connection with tax advice. Communications solely concerning the preparation of a tax return will not be privileged.

In addition, your confidentiality privilege can be inadvertently waived if you discuss the contents of any privileged communication with a third party, such as a lending institution, a friend, or a business associate. We recommend that you contact us before releasing any privileged information to a third party.

If we are asked to disclose any privileged communication, unless we are required to disclose the communication by law, we will not provide such disclosure until you have had an opportunity to argue that the communication is privileged. You agree to pay any and all reasonable expenses that we incur, including legal fees, in the event we are required to respond to a subpoena, court order or other legal process for the production of the documents and/or testimony relative to information we obtained and/or prepared during the course of the engagement.

In the event that we are or may be obligated to pay any cost, settlement, judgment, fine, penalty, or similar award or sanction as a result of a claim, investigation, or other proceeding instituted by any third party, and if such obligation is or may be a direct or indirect result of any inaccurate, incomplete, or misleading information that you provide to us during the course of this engagement (with or without your knowledge or intent), you agree to indemnify us, defend us, and hold us harmless as against such obligation.

We retain records relating to professional services that we provide so that we are better able to assist you with your professional needs and, in some cases, to comply with professional guidelines. In order to guard your nonpublic personal information, we maintain physical, electronic, and procedural safeguards that comply with our professional standards. Please call if you have any questions, because your privacy, our professional ethics, and the ability to provide you with quality financial services are very important to us. When records are returned to you, it is your responsibility to retain your records that form the basis of your income and deductions. The documents may be necessary to prove the accuracy and completeness of the returns to a taxing authority. You have the final responsibility for the income tax returns and, therefore you should review them carefully before you sign. Our firm is not responsible for a taxing authority’s disallowance of deductions or inadequately supported documentation, nor for resulting taxes, penalties, and interest. By your signature below, you acknowledge and agree that upon the expiration of the seven year period Charlesworth Financial Services, LLC shall be free to destroy our records related to this engagement.

By signing this Engagement Letter, you are agreeing that your return may be put on extension, if necessary.

Joint Returns: Because the income tax returns we are to prepare in connection with this engagement are joint returns, and because you will each sign those returns, you are each our client. You each acknowledge that there is no expectation of privacy from the other concerning our services in connection with this engagement, and we are at liberty to share with either of you, without the prior consent of the other, any and all documents and other information concerning preparation of your returns. We will require, however, that any request for documents or other information be communicated to us in written form. You also acknowledge that unless we are notified otherwise in advance and in writing, we may construe an instruction from either of you to be an instruction on your joint behalf. Absent a contrary written instruction in the future, from either or both of you, we will communicate with either or both of you at the mailing address on the tax return.

We have partnered with Protection Plus for Identity Theft Restoration to assist clients with any kind of identity theft incident, even outside of taxes, for a full year. In the event of an identity breach, it will provide 6 months of daily credit monitoring, place fraud alerts on credit records, notify local authorities, and provide a personalized ID Recovery Kit to ensure that the individual’s identity is completely restored. In addition, it provides IRS/state notice and audit services. This upgraded service is included in the tax preparation fee of all 1040s prepared by our office this year. 

Please note that you are affirming to Charlesworth Financial Services, LLC your understanding of, and agreement to, the terms and conditions of this engagement letter by any one of the following actions: electronically signing or returning your signed engagement letter to our firm, providing your income tax information to us for use in the preparation of your returns, the submission of the tax returns we have prepared for you to the taxing authorities, or the payment of our return preparation fees.

We are pleased that you have selected us to prepare your tax returns and are honored to do so. If this engagement letter fairly sets forth your understanding, please sign where indicated and it will be submitted to our office automatically.

The client is solely responsible for ensuring ample funds are in the designated bank account. CFS will not be held liable in the case of an overdraft.

Julianne M. Charlesworth, CPA/PFS

Justene R. Charlesworth, MBA

Charlesworth Financial Services, LLC

219-531-9519 ~ Charlesworth.CPA

College & Retirement Planning, Income Tax Planning & Preparation

Small Business Consulting, Financial Services

Fixed and Variable Annuities*, Life, Disability and Long Term Care Insurance

Securities offered through Avantax Investment ServicesSM, Member FINRA, SIPC. Investment advisory services offered through Avantax Advisory ServicesSM. Insurance services offered through an Avantax affiliated insurance agency.

 

 


Only one person has to fill out this form if filing a joint return. If you answer YES to any of the below questions, please provide documentation of the amounts and details, if applicable when you provide your income tax information.
AdultMinor(s)
1 Minor2 Minors3 Minors4 Minors5 MinorsMore Minors6 Minors7 Minors8 Minors9 Minors10 Minors
Continue
Parent or Guardian's Email Address

Email*

Confirm Email*
Check to receive information, news, and discounts by e-mail.
First Client's Name

First Name*

Last Name*

Phone*
First Client's Age Acknowledgment*
First Client's Date of Birth*
I certify that I am 18 years of age or older
First Client's Information
There will be an electronic copy of your tax return available in SmartVault. I understand that if I want a paper copy I need to request one in writing from Charlesworth Financial Services. *
I understand
I understand that if tax information is received after March 10, 2024 it may be necessary for my (our) returns to go on extension and authorize Charlesworth Financial Services to submit an extension on my (our) behalf. An extension extends the time to file, but not the time to pay and I (we) further understand that any penalties and/or interest that may occur are solely the responsibility of my(our)self . The extension is good until October 15th. Returns that go on extension will likely not be prepared until at least the end of June as other deadlines, etc. receive our attention until then. *
I understand
Did you (or spouse) renew your Driver's License?*
No
Yes - provide copy
  
Please upload a copy of your driver's license here.
Valid file types: JPG, GIF, PNG, and PDF
If you receive a refund, would you like it directly deposited into one or more checking or other accounts?*
No
Yes, Provide account and routing number if not on file or has changed from last year.
If you have a balance due on your return, would you like to set it up to be taken out of your checking account on or before April 15th so you do not have to write a check? *
No
Yes, Provide account and routing number if not on file or has changed from last year.
Estimates - Some clients may be required to send in Quarterly Estimates for 2025 federal and/or state. Please choose:*
I (we) do not generally need to pay Quarterly Estimates.
I (we) will pay our estimates on our own either thru the government website or by mailing in vouchers.
I (we) authorize CFS to schedule and pay Quarterly Estimates from the bank account we provide on or around the due date of the estimate. I (we) affirm adequate funds will be in the account and will not hold CFS liable for any bank overdrafts.
Is the bank account we have on file from last year correct? *
Yes
No - Please provide a copy of a voided check.
What happened in 2024 that may affect your financial or income tax situation? Select all that apply and provide documentation as necessary. *
Invested in Crypto currency
Contributed to a Roth, Traditional or SIMPLE IRA or SEP plan - provide $ amount
Contributed (other than tuition) to an Indiana college or university - provide school, date and $ amount
Contributed to an Indiana 529 college savings account - provide account # and $ amount
Paid for higher income costs (tuition) or paid student loan interest - provide documentation
Contributed to or received a distribution from an HSA (health savings account) or MSA - provide form
Sold stocks, bonds, collectibles or other investments - provide 1099s
Received funds from an IRA, social security or 401(K) - provide 1099s
Invested in or held funds in a foreign bank account - provide documentation
Paid real estate taxes on my home - provide $ amount paid in 2024
Paid rent - provide $ amount, landlord name and address
Received unemployment benefits or taxable disability income - provide forms
Started a business, purchased rental property, or acquired an interest in a partnership, S corporation or trust?
None of the above (please re-read above before confirming)

Who is your current Financial Advisor?

When was the date of the last time you spoke with your financial advisor?
What life changing events occurred in 2024? Or what future events may happen in 2025? Select all that apply and provide documentation as necessary. *
Married
Child graduated (no longer a dependent)
Birth or adoption of a child
Divorced
New Job
Retired
Moved Residences
Death of a loved one
None
I (we) would like to enhance our financial future in 2025 in the following ways: *
Start a traditional or Roth IRA
Start a 529 plan for future education for yourself, your children or grandchildren and possibly receive an income tax benefit
Rollover a 401(K) from a previous employer
Receive information on creating a Trust & Will
Retire within the next two years
Open a Health Savings Account (HSA) - must have HSA qualifying health insurance
Discuss investment options / financial future with someone from Charlesworth Financial Services
None of the above for now, but I (we) will consider for the future
I (we) agree to have any notice from the IRS or state taxing authority submitted to Tax Protection Plus, a third party specializing in tax resolution, if the need arises.*
No
Yes
We agree to open all tax form envelopes, remove non-essential fillers, organize tax papers and NOT use staples. We also agree that is more efficient for both you and us if you wait until you've received ALL documents before dropping any off. Thank you. *
I (We) agree to recycle empty envelopes before submitting information and not use staples
If uploading documents to the portal, SmartVault, I (we) agree to scan all documents combined to a single pdf and not individually as a .jpg or .png *
We agree to scan to SmartVault combined documents to a single .pdf and not use .jpeg, .png or other photo type uploads
First Client's Signature*
Second Client's Name

First Name*

Last Name*
Second Client's Date of Birth*
Second Client's Information
There will be an electronic copy of your tax return available in SmartVault. I understand that if I want a paper copy I need to request one in writing from Charlesworth Financial Services. *
I understand
I understand that if tax information is received after March 10, 2024 it may be necessary for my (our) returns to go on extension and authorize Charlesworth Financial Services to submit an extension on my (our) behalf. An extension extends the time to file, but not the time to pay and I (we) further understand that any penalties and/or interest that may occur are solely the responsibility of my(our)self . The extension is good until October 15th. Returns that go on extension will likely not be prepared until at least the end of June as other deadlines, etc. receive our attention until then. *
I understand
Did you (or spouse) renew your Driver's License?*
No
Yes - provide copy
  
Please upload a copy of your driver's license here.
Valid file types: JPG, GIF, PNG, and PDF
If you receive a refund, would you like it directly deposited into one or more checking or other accounts?*
No
Yes, Provide account and routing number if not on file or has changed from last year.
If you have a balance due on your return, would you like to set it up to be taken out of your checking account on or before April 15th so you do not have to write a check? *
No
Yes, Provide account and routing number if not on file or has changed from last year.
Estimates - Some clients may be required to send in Quarterly Estimates for 2025 federal and/or state. Please choose:*
I (we) do not generally need to pay Quarterly Estimates.
I (we) will pay our estimates on our own either thru the government website or by mailing in vouchers.
I (we) authorize CFS to schedule and pay Quarterly Estimates from the bank account we provide on or around the due date of the estimate. I (we) affirm adequate funds will be in the account and will not hold CFS liable for any bank overdrafts.
Is the bank account we have on file from last year correct? *
Yes
No - Please provide a copy of a voided check.
What happened in 2024 that may affect your financial or income tax situation? Select all that apply and provide documentation as necessary. *
Invested in Crypto currency
Contributed to a Roth, Traditional or SIMPLE IRA or SEP plan - provide $ amount
Contributed (other than tuition) to an Indiana college or university - provide school, date and $ amount
Contributed to an Indiana 529 college savings account - provide account # and $ amount
Paid for higher income costs (tuition) or paid student loan interest - provide documentation
Contributed to or received a distribution from an HSA (health savings account) or MSA - provide form
Sold stocks, bonds, collectibles or other investments - provide 1099s
Received funds from an IRA, social security or 401(K) - provide 1099s
Invested in or held funds in a foreign bank account - provide documentation
Paid real estate taxes on my home - provide $ amount paid in 2024
Paid rent - provide $ amount, landlord name and address
Received unemployment benefits or taxable disability income - provide forms
Started a business, purchased rental property, or acquired an interest in a partnership, S corporation or trust?
None of the above (please re-read above before confirming)

Who is your current Financial Advisor?

When was the date of the last time you spoke with your financial advisor?
What life changing events occurred in 2024? Or what future events may happen in 2025? Select all that apply and provide documentation as necessary. *
Married
Child graduated (no longer a dependent)
Birth or adoption of a child
Divorced
New Job
Retired
Moved Residences
Death of a loved one
None
I (we) would like to enhance our financial future in 2025 in the following ways: *
Start a traditional or Roth IRA
Start a 529 plan for future education for yourself, your children or grandchildren and possibly receive an income tax benefit
Rollover a 401(K) from a previous employer
Receive information on creating a Trust & Will
Retire within the next two years
Open a Health Savings Account (HSA) - must have HSA qualifying health insurance
Discuss investment options / financial future with someone from Charlesworth Financial Services
None of the above for now, but I (we) will consider for the future
I (we) agree to have any notice from the IRS or state taxing authority submitted to Tax Protection Plus, a third party specializing in tax resolution, if the need arises.*
No
Yes
We agree to open all tax form envelopes, remove non-essential fillers, organize tax papers and NOT use staples. We also agree that is more efficient for both you and us if you wait until you've received ALL documents before dropping any off. Thank you. *
I (We) agree to recycle empty envelopes before submitting information and not use staples
If uploading documents to the portal, SmartVault, I (we) agree to scan all documents combined to a single pdf and not individually as a .jpg or .png *
We agree to scan to SmartVault combined documents to a single .pdf and not use .jpeg, .png or other photo type uploads
Third Client's Name

First Name*

Last Name*
Third Client's Date of Birth*
Third Client's Information
There will be an electronic copy of your tax return available in SmartVault. I understand that if I want a paper copy I need to request one in writing from Charlesworth Financial Services. *
I understand
I understand that if tax information is received after March 10, 2024 it may be necessary for my (our) returns to go on extension and authorize Charlesworth Financial Services to submit an extension on my (our) behalf. An extension extends the time to file, but not the time to pay and I (we) further understand that any penalties and/or interest that may occur are solely the responsibility of my(our)self . The extension is good until October 15th. Returns that go on extension will likely not be prepared until at least the end of June as other deadlines, etc. receive our attention until then. *
I understand
Did you (or spouse) renew your Driver's License?*
No
Yes - provide copy
  
Please upload a copy of your driver's license here.
Valid file types: JPG, GIF, PNG, and PDF
If you receive a refund, would you like it directly deposited into one or more checking or other accounts?*
No
Yes, Provide account and routing number if not on file or has changed from last year.
If you have a balance due on your return, would you like to set it up to be taken out of your checking account on or before April 15th so you do not have to write a check? *
No
Yes, Provide account and routing number if not on file or has changed from last year.
Estimates - Some clients may be required to send in Quarterly Estimates for 2025 federal and/or state. Please choose:*
I (we) do not generally need to pay Quarterly Estimates.
I (we) will pay our estimates on our own either thru the government website or by mailing in vouchers.
I (we) authorize CFS to schedule and pay Quarterly Estimates from the bank account we provide on or around the due date of the estimate. I (we) affirm adequate funds will be in the account and will not hold CFS liable for any bank overdrafts.
Is the bank account we have on file from last year correct? *
Yes
No - Please provide a copy of a voided check.
What happened in 2024 that may affect your financial or income tax situation? Select all that apply and provide documentation as necessary. *
Invested in Crypto currency
Contributed to a Roth, Traditional or SIMPLE IRA or SEP plan - provide $ amount
Contributed (other than tuition) to an Indiana college or university - provide school, date and $ amount
Contributed to an Indiana 529 college savings account - provide account # and $ amount
Paid for higher income costs (tuition) or paid student loan interest - provide documentation
Contributed to or received a distribution from an HSA (health savings account) or MSA - provide form
Sold stocks, bonds, collectibles or other investments - provide 1099s
Received funds from an IRA, social security or 401(K) - provide 1099s
Invested in or held funds in a foreign bank account - provide documentation
Paid real estate taxes on my home - provide $ amount paid in 2024
Paid rent - provide $ amount, landlord name and address
Received unemployment benefits or taxable disability income - provide forms
Started a business, purchased rental property, or acquired an interest in a partnership, S corporation or trust?
None of the above (please re-read above before confirming)

Who is your current Financial Advisor?

When was the date of the last time you spoke with your financial advisor?
What life changing events occurred in 2024? Or what future events may happen in 2025? Select all that apply and provide documentation as necessary. *
Married
Child graduated (no longer a dependent)
Birth or adoption of a child
Divorced
New Job
Retired
Moved Residences
Death of a loved one
None
I (we) would like to enhance our financial future in 2025 in the following ways: *
Start a traditional or Roth IRA
Start a 529 plan for future education for yourself, your children or grandchildren and possibly receive an income tax benefit
Rollover a 401(K) from a previous employer
Receive information on creating a Trust & Will
Retire within the next two years
Open a Health Savings Account (HSA) - must have HSA qualifying health insurance
Discuss investment options / financial future with someone from Charlesworth Financial Services
None of the above for now, but I (we) will consider for the future
I (we) agree to have any notice from the IRS or state taxing authority submitted to Tax Protection Plus, a third party specializing in tax resolution, if the need arises.*
No
Yes
We agree to open all tax form envelopes, remove non-essential fillers, organize tax papers and NOT use staples. We also agree that is more efficient for both you and us if you wait until you've received ALL documents before dropping any off. Thank you. *
I (We) agree to recycle empty envelopes before submitting information and not use staples
If uploading documents to the portal, SmartVault, I (we) agree to scan all documents combined to a single pdf and not individually as a .jpg or .png *
We agree to scan to SmartVault combined documents to a single .pdf and not use .jpeg, .png or other photo type uploads
Fourth Client's Name

First Name*

Last Name*
Fourth Client's Date of Birth*
Fourth Client's Information
There will be an electronic copy of your tax return available in SmartVault. I understand that if I want a paper copy I need to request one in writing from Charlesworth Financial Services. *
I understand
I understand that if tax information is received after March 10, 2024 it may be necessary for my (our) returns to go on extension and authorize Charlesworth Financial Services to submit an extension on my (our) behalf. An extension extends the time to file, but not the time to pay and I (we) further understand that any penalties and/or interest that may occur are solely the responsibility of my(our)self . The extension is good until October 15th. Returns that go on extension will likely not be prepared until at least the end of June as other deadlines, etc. receive our attention until then. *
I understand
Did you (or spouse) renew your Driver's License?*
No
Yes - provide copy
  
Please upload a copy of your driver's license here.
Valid file types: JPG, GIF, PNG, and PDF
If you receive a refund, would you like it directly deposited into one or more checking or other accounts?*
No
Yes, Provide account and routing number if not on file or has changed from last year.
If you have a balance due on your return, would you like to set it up to be taken out of your checking account on or before April 15th so you do not have to write a check? *
No
Yes, Provide account and routing number if not on file or has changed from last year.
Estimates - Some clients may be required to send in Quarterly Estimates for 2025 federal and/or state. Please choose:*
I (we) do not generally need to pay Quarterly Estimates.
I (we) will pay our estimates on our own either thru the government website or by mailing in vouchers.
I (we) authorize CFS to schedule and pay Quarterly Estimates from the bank account we provide on or around the due date of the estimate. I (we) affirm adequate funds will be in the account and will not hold CFS liable for any bank overdrafts.
Is the bank account we have on file from last year correct? *
Yes
No - Please provide a copy of a voided check.
What happened in 2024 that may affect your financial or income tax situation? Select all that apply and provide documentation as necessary. *
Invested in Crypto currency
Contributed to a Roth, Traditional or SIMPLE IRA or SEP plan - provide $ amount
Contributed (other than tuition) to an Indiana college or university - provide school, date and $ amount
Contributed to an Indiana 529 college savings account - provide account # and $ amount
Paid for higher income costs (tuition) or paid student loan interest - provide documentation
Contributed to or received a distribution from an HSA (health savings account) or MSA - provide form
Sold stocks, bonds, collectibles or other investments - provide 1099s
Received funds from an IRA, social security or 401(K) - provide 1099s
Invested in or held funds in a foreign bank account - provide documentation
Paid real estate taxes on my home - provide $ amount paid in 2024
Paid rent - provide $ amount, landlord name and address
Received unemployment benefits or taxable disability income - provide forms
Started a business, purchased rental property, or acquired an interest in a partnership, S corporation or trust?
None of the above (please re-read above before confirming)

Who is your current Financial Advisor?

When was the date of the last time you spoke with your financial advisor?
What life changing events occurred in 2024? Or what future events may happen in 2025? Select all that apply and provide documentation as necessary. *
Married
Child graduated (no longer a dependent)
Birth or adoption of a child
Divorced
New Job
Retired
Moved Residences
Death of a loved one
None
I (we) would like to enhance our financial future in 2025 in the following ways: *
Start a traditional or Roth IRA
Start a 529 plan for future education for yourself, your children or grandchildren and possibly receive an income tax benefit
Rollover a 401(K) from a previous employer
Receive information on creating a Trust & Will
Retire within the next two years
Open a Health Savings Account (HSA) - must have HSA qualifying health insurance
Discuss investment options / financial future with someone from Charlesworth Financial Services
None of the above for now, but I (we) will consider for the future
I (we) agree to have any notice from the IRS or state taxing authority submitted to Tax Protection Plus, a third party specializing in tax resolution, if the need arises.*
No
Yes
We agree to open all tax form envelopes, remove non-essential fillers, organize tax papers and NOT use staples. We also agree that is more efficient for both you and us if you wait until you've received ALL documents before dropping any off. Thank you. *
I (We) agree to recycle empty envelopes before submitting information and not use staples
If uploading documents to the portal, SmartVault, I (we) agree to scan all documents combined to a single pdf and not individually as a .jpg or .png *
We agree to scan to SmartVault combined documents to a single .pdf and not use .jpeg, .png or other photo type uploads
Fifth Client's Name

First Name*

Last Name*
Fifth Client's Date of Birth*
Fifth Client's Information
There will be an electronic copy of your tax return available in SmartVault. I understand that if I want a paper copy I need to request one in writing from Charlesworth Financial Services. *
I understand
I understand that if tax information is received after March 10, 2024 it may be necessary for my (our) returns to go on extension and authorize Charlesworth Financial Services to submit an extension on my (our) behalf. An extension extends the time to file, but not the time to pay and I (we) further understand that any penalties and/or interest that may occur are solely the responsibility of my(our)self . The extension is good until October 15th. Returns that go on extension will likely not be prepared until at least the end of June as other deadlines, etc. receive our attention until then. *
I understand
Did you (or spouse) renew your Driver's License?*
No
Yes - provide copy
  
Please upload a copy of your driver's license here.
Valid file types: JPG, GIF, PNG, and PDF
If you receive a refund, would you like it directly deposited into one or more checking or other accounts?*
No
Yes, Provide account and routing number if not on file or has changed from last year.
If you have a balance due on your return, would you like to set it up to be taken out of your checking account on or before April 15th so you do not have to write a check? *
No
Yes, Provide account and routing number if not on file or has changed from last year.
Estimates - Some clients may be required to send in Quarterly Estimates for 2025 federal and/or state. Please choose:*
I (we) do not generally need to pay Quarterly Estimates.
I (we) will pay our estimates on our own either thru the government website or by mailing in vouchers.
I (we) authorize CFS to schedule and pay Quarterly Estimates from the bank account we provide on or around the due date of the estimate. I (we) affirm adequate funds will be in the account and will not hold CFS liable for any bank overdrafts.
Is the bank account we have on file from last year correct? *
Yes
No - Please provide a copy of a voided check.
What happened in 2024 that may affect your financial or income tax situation? Select all that apply and provide documentation as necessary. *
Invested in Crypto currency
Contributed to a Roth, Traditional or SIMPLE IRA or SEP plan - provide $ amount
Contributed (other than tuition) to an Indiana college or university - provide school, date and $ amount
Contributed to an Indiana 529 college savings account - provide account # and $ amount
Paid for higher income costs (tuition) or paid student loan interest - provide documentation
Contributed to or received a distribution from an HSA (health savings account) or MSA - provide form
Sold stocks, bonds, collectibles or other investments - provide 1099s
Received funds from an IRA, social security or 401(K) - provide 1099s
Invested in or held funds in a foreign bank account - provide documentation
Paid real estate taxes on my home - provide $ amount paid in 2024
Paid rent - provide $ amount, landlord name and address
Received unemployment benefits or taxable disability income - provide forms
Started a business, purchased rental property, or acquired an interest in a partnership, S corporation or trust?
None of the above (please re-read above before confirming)

Who is your current Financial Advisor?

When was the date of the last time you spoke with your financial advisor?
What life changing events occurred in 2024? Or what future events may happen in 2025? Select all that apply and provide documentation as necessary. *
Married
Child graduated (no longer a dependent)
Birth or adoption of a child
Divorced
New Job
Retired
Moved Residences
Death of a loved one
None
I (we) would like to enhance our financial future in 2025 in the following ways: *
Start a traditional or Roth IRA
Start a 529 plan for future education for yourself, your children or grandchildren and possibly receive an income tax benefit
Rollover a 401(K) from a previous employer
Receive information on creating a Trust & Will
Retire within the next two years
Open a Health Savings Account (HSA) - must have HSA qualifying health insurance
Discuss investment options / financial future with someone from Charlesworth Financial Services
None of the above for now, but I (we) will consider for the future
I (we) agree to have any notice from the IRS or state taxing authority submitted to Tax Protection Plus, a third party specializing in tax resolution, if the need arises.*
No
Yes
We agree to open all tax form envelopes, remove non-essential fillers, organize tax papers and NOT use staples. We also agree that is more efficient for both you and us if you wait until you've received ALL documents before dropping any off. Thank you. *
I (We) agree to recycle empty envelopes before submitting information and not use staples
If uploading documents to the portal, SmartVault, I (we) agree to scan all documents combined to a single pdf and not individually as a .jpg or .png *
We agree to scan to SmartVault combined documents to a single .pdf and not use .jpeg, .png or other photo type uploads
Sixth Client's Name

First Name*

Last Name*
Sixth Client's Date of Birth*
Sixth Client's Information
There will be an electronic copy of your tax return available in SmartVault. I understand that if I want a paper copy I need to request one in writing from Charlesworth Financial Services. *
I understand
I understand that if tax information is received after March 10, 2024 it may be necessary for my (our) returns to go on extension and authorize Charlesworth Financial Services to submit an extension on my (our) behalf. An extension extends the time to file, but not the time to pay and I (we) further understand that any penalties and/or interest that may occur are solely the responsibility of my(our)self . The extension is good until October 15th. Returns that go on extension will likely not be prepared until at least the end of June as other deadlines, etc. receive our attention until then. *
I understand
Did you (or spouse) renew your Driver's License?*
No
Yes - provide copy
  
Please upload a copy of your driver's license here.
Valid file types: JPG, GIF, PNG, and PDF
If you receive a refund, would you like it directly deposited into one or more checking or other accounts?*
No
Yes, Provide account and routing number if not on file or has changed from last year.
If you have a balance due on your return, would you like to set it up to be taken out of your checking account on or before April 15th so you do not have to write a check? *
No
Yes, Provide account and routing number if not on file or has changed from last year.
Estimates - Some clients may be required to send in Quarterly Estimates for 2025 federal and/or state. Please choose:*
I (we) do not generally need to pay Quarterly Estimates.
I (we) will pay our estimates on our own either thru the government website or by mailing in vouchers.
I (we) authorize CFS to schedule and pay Quarterly Estimates from the bank account we provide on or around the due date of the estimate. I (we) affirm adequate funds will be in the account and will not hold CFS liable for any bank overdrafts.
Is the bank account we have on file from last year correct? *
Yes
No - Please provide a copy of a voided check.
What happened in 2024 that may affect your financial or income tax situation? Select all that apply and provide documentation as necessary. *
Invested in Crypto currency
Contributed to a Roth, Traditional or SIMPLE IRA or SEP plan - provide $ amount
Contributed (other than tuition) to an Indiana college or university - provide school, date and $ amount
Contributed to an Indiana 529 college savings account - provide account # and $ amount
Paid for higher income costs (tuition) or paid student loan interest - provide documentation
Contributed to or received a distribution from an HSA (health savings account) or MSA - provide form
Sold stocks, bonds, collectibles or other investments - provide 1099s
Received funds from an IRA, social security or 401(K) - provide 1099s
Invested in or held funds in a foreign bank account - provide documentation
Paid real estate taxes on my home - provide $ amount paid in 2024
Paid rent - provide $ amount, landlord name and address
Received unemployment benefits or taxable disability income - provide forms
Started a business, purchased rental property, or acquired an interest in a partnership, S corporation or trust?
None of the above (please re-read above before confirming)

Who is your current Financial Advisor?

When was the date of the last time you spoke with your financial advisor?
What life changing events occurred in 2024? Or what future events may happen in 2025? Select all that apply and provide documentation as necessary. *
Married
Child graduated (no longer a dependent)
Birth or adoption of a child
Divorced
New Job
Retired
Moved Residences
Death of a loved one
None
I (we) would like to enhance our financial future in 2025 in the following ways: *
Start a traditional or Roth IRA
Start a 529 plan for future education for yourself, your children or grandchildren and possibly receive an income tax benefit
Rollover a 401(K) from a previous employer
Receive information on creating a Trust & Will
Retire within the next two years
Open a Health Savings Account (HSA) - must have HSA qualifying health insurance
Discuss investment options / financial future with someone from Charlesworth Financial Services
None of the above for now, but I (we) will consider for the future
I (we) agree to have any notice from the IRS or state taxing authority submitted to Tax Protection Plus, a third party specializing in tax resolution, if the need arises.*
No
Yes
We agree to open all tax form envelopes, remove non-essential fillers, organize tax papers and NOT use staples. We also agree that is more efficient for both you and us if you wait until you've received ALL documents before dropping any off. Thank you. *
I (We) agree to recycle empty envelopes before submitting information and not use staples
If uploading documents to the portal, SmartVault, I (we) agree to scan all documents combined to a single pdf and not individually as a .jpg or .png *
We agree to scan to SmartVault combined documents to a single .pdf and not use .jpeg, .png or other photo type uploads
Seventh Client's Name

First Name*

Last Name*
Seventh Client's Date of Birth*
Seventh Client's Information
There will be an electronic copy of your tax return available in SmartVault. I understand that if I want a paper copy I need to request one in writing from Charlesworth Financial Services. *
I understand
I understand that if tax information is received after March 10, 2024 it may be necessary for my (our) returns to go on extension and authorize Charlesworth Financial Services to submit an extension on my (our) behalf. An extension extends the time to file, but not the time to pay and I (we) further understand that any penalties and/or interest that may occur are solely the responsibility of my(our)self . The extension is good until October 15th. Returns that go on extension will likely not be prepared until at least the end of June as other deadlines, etc. receive our attention until then. *
I understand
Did you (or spouse) renew your Driver's License?*
No
Yes - provide copy
  
Please upload a copy of your driver's license here.
Valid file types: JPG, GIF, PNG, and PDF
If you receive a refund, would you like it directly deposited into one or more checking or other accounts?*
No
Yes, Provide account and routing number if not on file or has changed from last year.
If you have a balance due on your return, would you like to set it up to be taken out of your checking account on or before April 15th so you do not have to write a check? *
No
Yes, Provide account and routing number if not on file or has changed from last year.
Estimates - Some clients may be required to send in Quarterly Estimates for 2025 federal and/or state. Please choose:*
I (we) do not generally need to pay Quarterly Estimates.
I (we) will pay our estimates on our own either thru the government website or by mailing in vouchers.
I (we) authorize CFS to schedule and pay Quarterly Estimates from the bank account we provide on or around the due date of the estimate. I (we) affirm adequate funds will be in the account and will not hold CFS liable for any bank overdrafts.
Is the bank account we have on file from last year correct? *
Yes
No - Please provide a copy of a voided check.
What happened in 2024 that may affect your financial or income tax situation? Select all that apply and provide documentation as necessary. *
Invested in Crypto currency
Contributed to a Roth, Traditional or SIMPLE IRA or SEP plan - provide $ amount
Contributed (other than tuition) to an Indiana college or university - provide school, date and $ amount
Contributed to an Indiana 529 college savings account - provide account # and $ amount
Paid for higher income costs (tuition) or paid student loan interest - provide documentation
Contributed to or received a distribution from an HSA (health savings account) or MSA - provide form
Sold stocks, bonds, collectibles or other investments - provide 1099s
Received funds from an IRA, social security or 401(K) - provide 1099s
Invested in or held funds in a foreign bank account - provide documentation
Paid real estate taxes on my home - provide $ amount paid in 2024
Paid rent - provide $ amount, landlord name and address
Received unemployment benefits or taxable disability income - provide forms
Started a business, purchased rental property, or acquired an interest in a partnership, S corporation or trust?
None of the above (please re-read above before confirming)

Who is your current Financial Advisor?

When was the date of the last time you spoke with your financial advisor?
What life changing events occurred in 2024? Or what future events may happen in 2025? Select all that apply and provide documentation as necessary. *
Married
Child graduated (no longer a dependent)
Birth or adoption of a child
Divorced
New Job
Retired
Moved Residences
Death of a loved one
None
I (we) would like to enhance our financial future in 2025 in the following ways: *
Start a traditional or Roth IRA
Start a 529 plan for future education for yourself, your children or grandchildren and possibly receive an income tax benefit
Rollover a 401(K) from a previous employer
Receive information on creating a Trust & Will
Retire within the next two years
Open a Health Savings Account (HSA) - must have HSA qualifying health insurance
Discuss investment options / financial future with someone from Charlesworth Financial Services
None of the above for now, but I (we) will consider for the future
I (we) agree to have any notice from the IRS or state taxing authority submitted to Tax Protection Plus, a third party specializing in tax resolution, if the need arises.*
No
Yes
We agree to open all tax form envelopes, remove non-essential fillers, organize tax papers and NOT use staples. We also agree that is more efficient for both you and us if you wait until you've received ALL documents before dropping any off. Thank you. *
I (We) agree to recycle empty envelopes before submitting information and not use staples
If uploading documents to the portal, SmartVault, I (we) agree to scan all documents combined to a single pdf and not individually as a .jpg or .png *
We agree to scan to SmartVault combined documents to a single .pdf and not use .jpeg, .png or other photo type uploads
Eighth Client's Name

First Name*

Last Name*
Eighth Client's Date of Birth*
Eighth Client's Information
There will be an electronic copy of your tax return available in SmartVault. I understand that if I want a paper copy I need to request one in writing from Charlesworth Financial Services. *
I understand
I understand that if tax information is received after March 10, 2024 it may be necessary for my (our) returns to go on extension and authorize Charlesworth Financial Services to submit an extension on my (our) behalf. An extension extends the time to file, but not the time to pay and I (we) further understand that any penalties and/or interest that may occur are solely the responsibility of my(our)self . The extension is good until October 15th. Returns that go on extension will likely not be prepared until at least the end of June as other deadlines, etc. receive our attention until then. *
I understand
Did you (or spouse) renew your Driver's License?*
No
Yes - provide copy
  
Please upload a copy of your driver's license here.
Valid file types: JPG, GIF, PNG, and PDF
If you receive a refund, would you like it directly deposited into one or more checking or other accounts?*
No
Yes, Provide account and routing number if not on file or has changed from last year.
If you have a balance due on your return, would you like to set it up to be taken out of your checking account on or before April 15th so you do not have to write a check? *
No
Yes, Provide account and routing number if not on file or has changed from last year.
Estimates - Some clients may be required to send in Quarterly Estimates for 2025 federal and/or state. Please choose:*
I (we) do not generally need to pay Quarterly Estimates.
I (we) will pay our estimates on our own either thru the government website or by mailing in vouchers.
I (we) authorize CFS to schedule and pay Quarterly Estimates from the bank account we provide on or around the due date of the estimate. I (we) affirm adequate funds will be in the account and will not hold CFS liable for any bank overdrafts.
Is the bank account we have on file from last year correct? *
Yes
No - Please provide a copy of a voided check.
What happened in 2024 that may affect your financial or income tax situation? Select all that apply and provide documentation as necessary. *
Invested in Crypto currency
Contributed to a Roth, Traditional or SIMPLE IRA or SEP plan - provide $ amount
Contributed (other than tuition) to an Indiana college or university - provide school, date and $ amount
Contributed to an Indiana 529 college savings account - provide account # and $ amount
Paid for higher income costs (tuition) or paid student loan interest - provide documentation
Contributed to or received a distribution from an HSA (health savings account) or MSA - provide form
Sold stocks, bonds, collectibles or other investments - provide 1099s
Received funds from an IRA, social security or 401(K) - provide 1099s
Invested in or held funds in a foreign bank account - provide documentation
Paid real estate taxes on my home - provide $ amount paid in 2024
Paid rent - provide $ amount, landlord name and address
Received unemployment benefits or taxable disability income - provide forms
Started a business, purchased rental property, or acquired an interest in a partnership, S corporation or trust?
None of the above (please re-read above before confirming)

Who is your current Financial Advisor?

When was the date of the last time you spoke with your financial advisor?
What life changing events occurred in 2024? Or what future events may happen in 2025? Select all that apply and provide documentation as necessary. *
Married
Child graduated (no longer a dependent)
Birth or adoption of a child
Divorced
New Job
Retired
Moved Residences
Death of a loved one
None
I (we) would like to enhance our financial future in 2025 in the following ways: *
Start a traditional or Roth IRA
Start a 529 plan for future education for yourself, your children or grandchildren and possibly receive an income tax benefit
Rollover a 401(K) from a previous employer
Receive information on creating a Trust & Will
Retire within the next two years
Open a Health Savings Account (HSA) - must have HSA qualifying health insurance
Discuss investment options / financial future with someone from Charlesworth Financial Services
None of the above for now, but I (we) will consider for the future
I (we) agree to have any notice from the IRS or state taxing authority submitted to Tax Protection Plus, a third party specializing in tax resolution, if the need arises.*
No
Yes
We agree to open all tax form envelopes, remove non-essential fillers, organize tax papers and NOT use staples. We also agree that is more efficient for both you and us if you wait until you've received ALL documents before dropping any off. Thank you. *
I (We) agree to recycle empty envelopes before submitting information and not use staples
If uploading documents to the portal, SmartVault, I (we) agree to scan all documents combined to a single pdf and not individually as a .jpg or .png *
We agree to scan to SmartVault combined documents to a single .pdf and not use .jpeg, .png or other photo type uploads
Ninth Client's Name

First Name*

Last Name*
Ninth Client's Date of Birth*
Ninth Client's Information
There will be an electronic copy of your tax return available in SmartVault. I understand that if I want a paper copy I need to request one in writing from Charlesworth Financial Services. *
I understand
I understand that if tax information is received after March 10, 2024 it may be necessary for my (our) returns to go on extension and authorize Charlesworth Financial Services to submit an extension on my (our) behalf. An extension extends the time to file, but not the time to pay and I (we) further understand that any penalties and/or interest that may occur are solely the responsibility of my(our)self . The extension is good until October 15th. Returns that go on extension will likely not be prepared until at least the end of June as other deadlines, etc. receive our attention until then. *
I understand
Did you (or spouse) renew your Driver's License?*
No
Yes - provide copy
  
Please upload a copy of your driver's license here.
Valid file types: JPG, GIF, PNG, and PDF
If you receive a refund, would you like it directly deposited into one or more checking or other accounts?*
No
Yes, Provide account and routing number if not on file or has changed from last year.
If you have a balance due on your return, would you like to set it up to be taken out of your checking account on or before April 15th so you do not have to write a check? *
No
Yes, Provide account and routing number if not on file or has changed from last year.
Estimates - Some clients may be required to send in Quarterly Estimates for 2025 federal and/or state. Please choose:*
I (we) do not generally need to pay Quarterly Estimates.
I (we) will pay our estimates on our own either thru the government website or by mailing in vouchers.
I (we) authorize CFS to schedule and pay Quarterly Estimates from the bank account we provide on or around the due date of the estimate. I (we) affirm adequate funds will be in the account and will not hold CFS liable for any bank overdrafts.
Is the bank account we have on file from last year correct? *
Yes
No - Please provide a copy of a voided check.
What happened in 2024 that may affect your financial or income tax situation? Select all that apply and provide documentation as necessary. *
Invested in Crypto currency
Contributed to a Roth, Traditional or SIMPLE IRA or SEP plan - provide $ amount
Contributed (other than tuition) to an Indiana college or university - provide school, date and $ amount
Contributed to an Indiana 529 college savings account - provide account # and $ amount
Paid for higher income costs (tuition) or paid student loan interest - provide documentation
Contributed to or received a distribution from an HSA (health savings account) or MSA - provide form
Sold stocks, bonds, collectibles or other investments - provide 1099s
Received funds from an IRA, social security or 401(K) - provide 1099s
Invested in or held funds in a foreign bank account - provide documentation
Paid real estate taxes on my home - provide $ amount paid in 2024
Paid rent - provide $ amount, landlord name and address
Received unemployment benefits or taxable disability income - provide forms
Started a business, purchased rental property, or acquired an interest in a partnership, S corporation or trust?
None of the above (please re-read above before confirming)

Who is your current Financial Advisor?

When was the date of the last time you spoke with your financial advisor?
What life changing events occurred in 2024? Or what future events may happen in 2025? Select all that apply and provide documentation as necessary. *
Married
Child graduated (no longer a dependent)
Birth or adoption of a child
Divorced
New Job
Retired
Moved Residences
Death of a loved one
None
I (we) would like to enhance our financial future in 2025 in the following ways: *
Start a traditional or Roth IRA
Start a 529 plan for future education for yourself, your children or grandchildren and possibly receive an income tax benefit
Rollover a 401(K) from a previous employer
Receive information on creating a Trust & Will
Retire within the next two years
Open a Health Savings Account (HSA) - must have HSA qualifying health insurance
Discuss investment options / financial future with someone from Charlesworth Financial Services
None of the above for now, but I (we) will consider for the future
I (we) agree to have any notice from the IRS or state taxing authority submitted to Tax Protection Plus, a third party specializing in tax resolution, if the need arises.*
No
Yes
We agree to open all tax form envelopes, remove non-essential fillers, organize tax papers and NOT use staples. We also agree that is more efficient for both you and us if you wait until you've received ALL documents before dropping any off. Thank you. *
I (We) agree to recycle empty envelopes before submitting information and not use staples
If uploading documents to the portal, SmartVault, I (we) agree to scan all documents combined to a single pdf and not individually as a .jpg or .png *
We agree to scan to SmartVault combined documents to a single .pdf and not use .jpeg, .png or other photo type uploads
Tenth Client's Name

First Name*

Last Name*
Tenth Client's Date of Birth*
Tenth Client's Information
There will be an electronic copy of your tax return available in SmartVault. I understand that if I want a paper copy I need to request one in writing from Charlesworth Financial Services. *
I understand
I understand that if tax information is received after March 10, 2024 it may be necessary for my (our) returns to go on extension and authorize Charlesworth Financial Services to submit an extension on my (our) behalf. An extension extends the time to file, but not the time to pay and I (we) further understand that any penalties and/or interest that may occur are solely the responsibility of my(our)self . The extension is good until October 15th. Returns that go on extension will likely not be prepared until at least the end of June as other deadlines, etc. receive our attention until then. *
I understand
Did you (or spouse) renew your Driver's License?*
No
Yes - provide copy
  
Please upload a copy of your driver's license here.
Valid file types: JPG, GIF, PNG, and PDF
If you receive a refund, would you like it directly deposited into one or more checking or other accounts?*
No
Yes, Provide account and routing number if not on file or has changed from last year.
If you have a balance due on your return, would you like to set it up to be taken out of your checking account on or before April 15th so you do not have to write a check? *
No
Yes, Provide account and routing number if not on file or has changed from last year.
Estimates - Some clients may be required to send in Quarterly Estimates for 2025 federal and/or state. Please choose:*
I (we) do not generally need to pay Quarterly Estimates.
I (we) will pay our estimates on our own either thru the government website or by mailing in vouchers.
I (we) authorize CFS to schedule and pay Quarterly Estimates from the bank account we provide on or around the due date of the estimate. I (we) affirm adequate funds will be in the account and will not hold CFS liable for any bank overdrafts.
Is the bank account we have on file from last year correct? *
Yes
No - Please provide a copy of a voided check.
What happened in 2024 that may affect your financial or income tax situation? Select all that apply and provide documentation as necessary. *
Invested in Crypto currency
Contributed to a Roth, Traditional or SIMPLE IRA or SEP plan - provide $ amount
Contributed (other than tuition) to an Indiana college or university - provide school, date and $ amount
Contributed to an Indiana 529 college savings account - provide account # and $ amount
Paid for higher income costs (tuition) or paid student loan interest - provide documentation
Contributed to or received a distribution from an HSA (health savings account) or MSA - provide form
Sold stocks, bonds, collectibles or other investments - provide 1099s
Received funds from an IRA, social security or 401(K) - provide 1099s
Invested in or held funds in a foreign bank account - provide documentation
Paid real estate taxes on my home - provide $ amount paid in 2024
Paid rent - provide $ amount, landlord name and address
Received unemployment benefits or taxable disability income - provide forms
Started a business, purchased rental property, or acquired an interest in a partnership, S corporation or trust?
None of the above (please re-read above before confirming)

Who is your current Financial Advisor?

When was the date of the last time you spoke with your financial advisor?
What life changing events occurred in 2024? Or what future events may happen in 2025? Select all that apply and provide documentation as necessary. *
Married
Child graduated (no longer a dependent)
Birth or adoption of a child
Divorced
New Job
Retired
Moved Residences
Death of a loved one
None
I (we) would like to enhance our financial future in 2025 in the following ways: *
Start a traditional or Roth IRA
Start a 529 plan for future education for yourself, your children or grandchildren and possibly receive an income tax benefit
Rollover a 401(K) from a previous employer
Receive information on creating a Trust & Will
Retire within the next two years
Open a Health Savings Account (HSA) - must have HSA qualifying health insurance
Discuss investment options / financial future with someone from Charlesworth Financial Services
None of the above for now, but I (we) will consider for the future
I (we) agree to have any notice from the IRS or state taxing authority submitted to Tax Protection Plus, a third party specializing in tax resolution, if the need arises.*
No
Yes
We agree to open all tax form envelopes, remove non-essential fillers, organize tax papers and NOT use staples. We also agree that is more efficient for both you and us if you wait until you've received ALL documents before dropping any off. Thank you. *
I (We) agree to recycle empty envelopes before submitting information and not use staples
If uploading documents to the portal, SmartVault, I (we) agree to scan all documents combined to a single pdf and not individually as a .jpg or .png *
We agree to scan to SmartVault combined documents to a single .pdf and not use .jpeg, .png or other photo type uploads
Parent(s) or court-appointed legal guardian(s) must sign for any participating minor (those under 18 years of age) and agree that they and the minor are subject to all the terms of this document, as set forth above.


By signing below the parent or court-appointed legal guardian agrees that they are also subject to all the terms of this document, as set forth above.
Parent or Guardian's Name

First Name*

Last Name*

Phone*
Parent or Guardian's Age Acknowledgment*
Parent or Guardian's Date of Birth*
I certify that I am 18 years of age or older
Parent or Guardian's Information
There will be an electronic copy of your tax return available in SmartVault. I understand that if I want a paper copy I need to request one in writing from Charlesworth Financial Services. *
I understand
I understand that if tax information is received after March 10, 2024 it may be necessary for my (our) returns to go on extension and authorize Charlesworth Financial Services to submit an extension on my (our) behalf. An extension extends the time to file, but not the time to pay and I (we) further understand that any penalties and/or interest that may occur are solely the responsibility of my(our)self . The extension is good until October 15th. Returns that go on extension will likely not be prepared until at least the end of June as other deadlines, etc. receive our attention until then. *
I understand
Did you (or spouse) renew your Driver's License?*
No
Yes - provide copy
  
Please upload a copy of your driver's license here.
Valid file types: JPG, GIF, PNG, and PDF
If you receive a refund, would you like it directly deposited into one or more checking or other accounts?*
No
Yes, Provide account and routing number if not on file or has changed from last year.
If you have a balance due on your return, would you like to set it up to be taken out of your checking account on or before April 15th so you do not have to write a check? *
No
Yes, Provide account and routing number if not on file or has changed from last year.
Estimates - Some clients may be required to send in Quarterly Estimates for 2025 federal and/or state. Please choose:*
I (we) do not generally need to pay Quarterly Estimates.
I (we) will pay our estimates on our own either thru the government website or by mailing in vouchers.
I (we) authorize CFS to schedule and pay Quarterly Estimates from the bank account we provide on or around the due date of the estimate. I (we) affirm adequate funds will be in the account and will not hold CFS liable for any bank overdrafts.
Is the bank account we have on file from last year correct? *
Yes
No - Please provide a copy of a voided check.
What happened in 2024 that may affect your financial or income tax situation? Select all that apply and provide documentation as necessary. *
Invested in Crypto currency
Contributed to a Roth, Traditional or SIMPLE IRA or SEP plan - provide $ amount
Contributed (other than tuition) to an Indiana college or university - provide school, date and $ amount
Contributed to an Indiana 529 college savings account - provide account # and $ amount
Paid for higher income costs (tuition) or paid student loan interest - provide documentation
Contributed to or received a distribution from an HSA (health savings account) or MSA - provide form
Sold stocks, bonds, collectibles or other investments - provide 1099s
Received funds from an IRA, social security or 401(K) - provide 1099s
Invested in or held funds in a foreign bank account - provide documentation
Paid real estate taxes on my home - provide $ amount paid in 2024
Paid rent - provide $ amount, landlord name and address
Received unemployment benefits or taxable disability income - provide forms
Started a business, purchased rental property, or acquired an interest in a partnership, S corporation or trust?
None of the above (please re-read above before confirming)

Who is your current Financial Advisor?

When was the date of the last time you spoke with your financial advisor?
What life changing events occurred in 2024? Or what future events may happen in 2025? Select all that apply and provide documentation as necessary. *
Married
Child graduated (no longer a dependent)
Birth or adoption of a child
Divorced
New Job
Retired
Moved Residences
Death of a loved one
None
I (we) would like to enhance our financial future in 2025 in the following ways: *
Start a traditional or Roth IRA
Start a 529 plan for future education for yourself, your children or grandchildren and possibly receive an income tax benefit
Rollover a 401(K) from a previous employer
Receive information on creating a Trust & Will
Retire within the next two years
Open a Health Savings Account (HSA) - must have HSA qualifying health insurance
Discuss investment options / financial future with someone from Charlesworth Financial Services
None of the above for now, but I (we) will consider for the future
I (we) agree to have any notice from the IRS or state taxing authority submitted to Tax Protection Plus, a third party specializing in tax resolution, if the need arises.*
No
Yes
We agree to open all tax form envelopes, remove non-essential fillers, organize tax papers and NOT use staples. We also agree that is more efficient for both you and us if you wait until you've received ALL documents before dropping any off. Thank you. *
I (We) agree to recycle empty envelopes before submitting information and not use staples
If uploading documents to the portal, SmartVault, I (we) agree to scan all documents combined to a single pdf and not individually as a .jpg or .png *
We agree to scan to SmartVault combined documents to a single .pdf and not use .jpeg, .png or other photo type uploads
Parent or Guardian's Signature*
Electronic Signature Consent*
 By checking here, you are consenting to the use of your electronic signature in lieu of an original signature on paper. You have the right to request that you sign a paper copy instead. By checking here, you are waiving that right. After consent, you may, upon written request to us, obtain a paper copy of an electronic record. No fee will be charged for such copy and no special hardware or software is required to view it. Your agreement to use an electronic signature with us for any documents will continue until such time as you notify us in writing that you no longer wish to use an electronic signature. There is no penalty for withdrawing your consent. You should always make sure that we have a current email address in order to contact you regarding any changes, if necessary.


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