Client Interview Form FEMI by tkj21449


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									FEMI CO.
Tax Client Interview Form                                                              Tax Year:_________

Please fill out this form with correct and complete information and bring it with you along with other
important documents listed previously in this website.

Primary Tax Payer’s FULL Name: ___________________            ____________ _____________________
                                   (First)                    (Middle)              (Last)

Primary Tax Payer’s SSN: ___________________________________                Date of Birth: ______________
Primary Tax Payer’s Occupation: ______________________________              Work Ph. # ________________

Please circle your Filing Status (All of the categories are based upon your status as of 12/31/2007)
  1) Single - You are single if you were not married and you are claiming no dependents.
  2) Married Filing Joint – You are MFJ if both you and your spouse have agreed to file a joint return.
  3) Married Filing Separate – You are MFS if you would like to be responsible for your own tax
  4) Head of Household - You are not married (or are legally separated) & you are claiming at least 1
  5) Qualifying Widow(er) with dependent child – You can claim this filing status if your spouse died in
      2005 or 2006 and you have not remarried and you have a qualifying dependent.

If married, please provide: Spouse’s Name: ___________________ __________ ________________
                                               (First)                   (Middle)            (Last)

Spouse’s SSN: __________ Date of Birth: __________ Occupation: ___________ Work Ph.#: ________

Current Address: __________________________________________ Home Ph. #:_________________

If you have dependents that you supported in 2007, please provide the following information:
Name (EXACTLY as on SSN Card)/       SSN         / Date of Birth / Relationship / # Months lived w/you
_____________________________ / _____________ / _____________/ _____________ /__________________
_____________________________ / _____________ / _____________/ _____________ /__________________
_____________________________ / _____________ / _____________/ _____________ /__________________
_____________________________ / _____________ / _____________/ _____________ /__________________
_____________________________ / _____________ / _____________/ _____________ /__________________

Please answer the following tax credit questions:
    1)  Did you pay Alimony or Spousal Support?                                                        __Yes    __No
    2)  Did you receive Alimony?                                                                       __Yes    __No
    3)  If you have children, did you send your children to a child care provider?                     __Yes    __No
    4)  Did you/ spouse/ your dependent pay for Higher Education?                                      __Yes    __No
    5)  Did you pay interest on Student Loan?                                                          __Yes    __No
    6)  Did you contribute to a Retirement plan in 2006?
        (If Yes, how much did you contribute? $_____
    7) Do you own life insurance?                                                                      __Yes    __No
        (If Yes, who paid for it? ____you      ____your employer)
    8) Are you self-employed?                                                                          __Yes    __No
    9) Did you hire household employees in 2007?                                                       __Yes    __No
    10) Did you move from another state in 2007?                                                       __Yes    __No

Signature       __________________________                                             Date            _____________

Spouse Signature________________________                                               Date            _____________
Client Privacy Statement

We value the trust you place in us when you share your personal information with us to provide you with
our tax and related financial services. Information we receive from you may include, but is not limited
to, social security number, date of birth, marital status, source and amounts of income, deductions and
taxes paid and payable, and information concerning your residence, dependents, pensions, medical
deductions and charitable contributions. This information is collected from you in written form, by phone,
on line, by mail and in personal interviews and consultations conducted by us, as well as by information
we collect from others with your authorization.

How Is My Personal Information Protected?
At FEMI CO., we are committed to maintaining the confidentiality, accuracy, and security of your
personal information. We restrict access to Nonpublic Personal Information about you to our employees
who must use that information to provide tax and related financial services to you. We also maintain
physical, technical and procedural safeguards in compliance with applicable laws and regulations to guard
your Nonpublic Personal Information.

How Do We Use and Disclose your Personal Information?
We may use or disclose your Nonpublic Personal Information for the purposes described in this Privacy
Policy and/or for any additional purposes which we have obtained your consent to the use or disclosure of
this personal information. In addition, your personal information may be used and disclosed only under
the following limited circumstances:
       with your authorization.
       otherwise, as permitted by law.

Changes to the Privacy Statement
We may change this Privacy Statement from time to time and without notice. Changes to this Privacy
Statement will be posted to this site accordingly. Please contact us if you have any questions.

Thank you for doing business with FEMI CO.

Signature       __________________________                                         Date    _____________

Spouse Signature________________________                                           Date    _____________

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