Tax Credit Liability Waiver – Tax Credit Funder

Sign and Complete:

Fact Finding Questionairre

"*" indicates required fields

Name*

First Last

Address*

Street Address City State / Province / Region ZIP / Postal Code

Email*

Cell Phone*

First, let's talk about "caring for yourself" and how Covid-19 affected your ability to perform your business related services:

1. Between the dates of 01/01/21 to 3/31/21 please list all the dates below when you were unable to perform services as a self-employed individual. NOTE: You can claim up to 10 days during this period: Hover help icon for example*

Did you miss work due to:
Quarantine
- Federal, state, or local lockdown orders related to COVID-19
- Quarantining or isolation order related to COVID-19
Illness
- Symptoms of COVID-19 or seeking a medical diagnosis
- Sickness due to vaccination side effects
- Caring for someone with COVID symptoms
Vaccination
- A COVID-19 vaccination appointment
- Side effects due to vaccination

NOTE: The IRS does not require you to have a positive test or PROOF that you had Covid-19. You simply need to affirm with the IRS that you did in fact have Covid-19 (in good faith) or were quarantined due to the virus and lost work (lost wages) and provide the dates you were out of work.

2. Between the dates of 4/1/21 to 9/30/21 please list all the dates below when you were unable to perform services as a self-employed individual. NOTE: You can claim up to 10 days during this period: Hover help icon for example*

Did you miss work due to:
Quarantine
- Federal, state, or local lockdown orders related to COVID-19
- Quarantining or isolation order related to COVID-19
Illness
- Symptoms of COVID-19 or seeking a medical diagnosis
- Sickness due to vaccination side effects
- Caring for someone with COVID symptoms
Vaccination
- A COVID-19 vaccination appointment
- Side effects due to vaccination

Next, let's talk about "caring for your dependents" and how Covid-19 affected your ability to perform your business related services:

3. Between the dates of 01/01/21 to 3/31/21 Were you unable to work because you were taking care of your child whose school or childcare provider was closed or switched to virtual/remote learning due to COVID-19, your child (or dependent) had COVID-19, or other COVID-related issues for a combined total of 50 days or more? Hover help icon for examples of qualifying dependents*

The IRS defines a dependent as either a qualifying child or relative of the taxpayer. The Child Tax Credit helps families with qualifying children and/or dependent get a tax break.

NOTE: The IRS does not require you to have PROOF that you cared for a minor child under the age of 18 (or dependent). You simply need to affirm with the IRS that you did in fact lose time from work or business because you cared for the dependent (in good faith).

4. Between the dates of 4/1/21 to 9/30/21 Were you unable to work because you were taking care of your child whose school or childcare provider was closed or switched to virtual/remote learning due to COVID-19, your child (or dependent) had COVID-19, or other COVID-related issues for a combined total of 50 days or more? Hover help icon for examples of qualifying dependents*

The IRS defines a dependent as either a qualifying child or relative of the taxpayer. The Child Tax Credit helps families with qualifying children and/or dependent get a tax break.

Have you or your CPA ever submitted a tax amendment for 2020 or 2021? If so, please provide us with the full package of 1040-X (Tax amendment) for further review*

Your Digital Signature*

Today's Date*

Name

This field is for validation purposes and should be left unchanged.

Sign and Complete:

First, let's talk about "caring for yourself" and how Covid-19 affected your ability to perform your business related services:

Next, let's talk about "caring for your dependents" and how Covid-19 affected your ability to perform your business related services:

SITE LINKS

LEGAL