Your Name _______________________________________
Spouse's Name ____________________________________
Address  __________________________________________
City  __________________________ ST ____ Zip _________
Phone (_____) _______ - ______ Fax (_____) ______ - _____
Your birthdate _____________ Spouse's birthdate ________
If you are or have been married, are you divorced, separated
or estranged from your spouse? ________________________

Email address ______________________________________
Web site  http://www__________________________________

If you are enquiring on behalf of a business, please provide
the following information and provide a description of the
kind of business and your position with the company.
Company Name ____________________________________
Address  _____________________________Suite_________
City  __________________________ ST ____ Zip ________
Phone (_____) _______ - ______ Fax (_____) ______ - ____
Email address ______________________________________
Web site  http://www_________________________________
Your position with the company ______________________
Form of Business:  __C Corp, __ S Corp,__Partnership, __ LLC

Is the comany involved in any international activities?____
Please Describe what kind of help the company needs
___________________________________________________
___________________________________________________
___________________________________________________

If you wish to retain me to help you, please provide the
following credit card information.  If you prefer, you can
provide this information during our first phone consultation.

Card Number ______ ______ ______ ______ Expir ___ ___
Zip code for billing address on that credit card __________
Name and initials on the card _________________________

If you are seeking personal tax assistance .......

Are either of you self employed or a principal in a business?

Yourself __________________________________________
Spouse __________________________________________

Your Employment Information/Description
___________________________________________________
___________________________________________________
___________________________________________________

Spouse's Employment Information/Description
___________________________________________________
___________________________________________________
___________________________________________________

Children's  Name         Birthdate      Married?    Occupation

________________  ___________    _______    ____________
________________  ___________    _______    ____________
________________  ___________    _______    ____________
________________  ___________    _______    ____________
________________  ___________    _______    ____________

Grandchildren Name  Birthdate      Married?    Occupation

________________  ___________    _______    ____________
________________  ___________    _______    ____________
________________  ___________    _______    ____________
________________  ___________    _______    ____________
________________  ___________    _______    ____________

Should I assume that you have a normal (functional) relationship
with your children or grandchildren for the purpose of any family
tax planning? If not, please comment, as appropriate.
___________________________________________________
___________________________________________________
___________________________________________________
___________________________________________________ 
 

Your Tax and Financial Objectives/Priorities

Please dsescribe what result you would like to achieve from my services.
__________________________________________________________
__________________________________________________________
__________________________________________________________

How did you decide to contact me?
____ My Web Site   ____ Soverign Society ____ Professional referral

Please rank the following in terms of their importance to you, with
one (1) being of primary concern.

____ Foreign tax questions or concerns
____ Emmigration (Expatriation) tax issues
____ Tax services for foreign investments
____ Tax services for a foreign trust
____ Tax services for a foreign corporation/IBC
____ Tax services for a foreign LLC or partnership

____ Selling a business
____ Business succession/estate planning
____ Personal income tax savings
____ Avoiding/deferring capital gains taxes
____ Investment tax concerns (other than capital gains)
____ Saving for college expenses
____ Starting a business
____ Business tax savings on a going business
____ Other business concerns

____ Estate tax planning & preservation
____ Multi-generation estate preservation
____ Asset protection tax issues

____ (Other)________________________________________
____ (Other)________________________________________
____ (Other)________________________________________
   

Additional Information That Will Help Me to Help You

You are welcome to send me as little or as much of the following information as you wish. The more you send me, the better my advice will be in relation to your specific circumstances. I will review this information on a time available basis and will let you know if I feel there is a substantial opportunity for you to save some taxes based on the information you have provided. If not, I will return the documents you send me, with no cost to you other than the cost to send me the information. (I'll even pay the return postage or shipping charges.) If I do believe that I can help you to accomplish the goals you have ranked or commented on above, I will contact you to arrange for a phone consultation. 

If you agree that you want to discuss your tax concerns with me, I will charge you for that time.  If after ten or fifteen minutes, I conclude that I'm not qualified to help you, I will try to provide you with a referral to someone who can help you and I will not charge you for the time on the phone.

Please send me a complete COPY of your latest personal and any business income tax returns. (Please do NOT send me your only copy.)

If you only need limited information based on a specific question about the tax law, you do not need to send me the following information. However, my answers are often dependent on  facts that are specific to you and on  information that I can  obtain from a review of your tax and financial  information.  If you anticipate that you will want personal advice relating to your specific tax and financial situation, then the following information may be needed and it would save time to send it to me initially.

Please send me a copy of any personal financial statement or "financial plan" that shows the value of your assets, your present debts, any substantial income you have that is not on your tax return and any major expenses you may have that are not reflected on your tax return - if you would like to know if there is a way to deduct them. 

If you are concerned about capital gain taxes, I will need to know the present market value of the assets and the tax cost of those assets. 

If you are concerned about estate taxes, I will need a copy of your wills, any trusts that you have established, any power of attorney that you have, any powers of appointment that you hold over any trusts, any inheritances that you are expecting and whether your children or grandchildren already have a substantial estate. I will also need information about your life insurance. 

If you are concerned about the tax rules applicable to any foreign investment, trust or business operation, please send me an explanation of the situation and of your concerns. 

Vernon K. Jacobs 

Note:  Before you decide to retain me as a tax advisor, I suggest that you review my professional disclosure statement and disclaimer statement.