Please upload a copy of your Drivers License:

Please enter your first and last name:

Please enter your Social Security Number:

(The Receiving Party agrees to use the Confidential Information solely in connection with the
current or contemplated business relationship between the parties and not for any purpose other
than as authorized by this Agreement without the prior written consent of an authorized
representative of the Disclosing Party. No other right or license, whether expressed or implied,
in the Confidential Information is granted to the Receiving Party hereunder. All use of
Confidential Information by the Receiving Party shall be for the benefit of the Disclosing Party)

 

Leave this empty:

Signature arrow sign here


Signature Certificate
Document name: Identification
lock iconUnique Document ID: 94a7c48e276049c0e10f4935d1fde9b85c7a3c25
Timestamp Audit
May 2, 2023 2:51 pm ESTIdentification Uploaded by Brian Warden - brian@1040taxbiz.com IP 96.72.237.110
May 2, 2023 2:57 pm ESTLisa Martin - Lisa@1040taxbiz.com added by Antonio Alford - antonio@1040taxbiz.com as a CC'd Recipient Ip: 96.72.237.110
May 2, 2023 2:57 pm ESTJodi Pollard - Jodi@1040taxbiz.com added by Antonio Alford - antonio@1040taxbiz.com as a CC'd Recipient Ip: 96.72.237.110
May 16, 2023 2:29 pm ESTLisa Martin - Lisa@1040taxbiz.com added by Antonio Alford - antonio@1040taxbiz.com as a CC'd Recipient Ip: 96.72.237.110
May 16, 2023 2:29 pm ESTJodi Pollard - Jodi@1040taxbiz.com added by Antonio Alford - antonio@1040taxbiz.com as a CC'd Recipient Ip: 96.72.237.110
May 16, 2023 2:50 pm ESTLisa Martin - Lisa@1040taxbiz.com added by Antonio Alford - antonio@1040taxbiz.com as a CC'd Recipient Ip: 96.72.237.110
May 16, 2023 2:50 pm ESTJodi Pollard - Jodi@1040taxbiz.com added by Antonio Alford - antonio@1040taxbiz.com as a CC'd Recipient Ip: 96.72.237.110
May 26, 2023 3:17 pm EST Document owner antonio@1040taxbiz.com has handed over this document to brian@1040taxbiz.com 2023-05-26 15:17:37 - 96.72.237.110
May 26, 2023 3:17 pm ESTLisa Martin - Lisa@1040taxbiz.com added by Brian Warden - brian@1040taxbiz.com as a CC'd Recipient Ip: 96.72.237.110
May 26, 2023 3:17 pm ESTJodi Pollard - Jodi@1040taxbiz.com added by Brian Warden - brian@1040taxbiz.com as a CC'd Recipient Ip: 96.72.237.110
September 26, 2023 1:32 pm ESTLisa Martin - Lisa@1040taxbiz.com added by Brian Warden - brian@1040taxbiz.com as a CC'd Recipient Ip: 2603:300f:e00:c300:4850:aa80:5c73:7ad
September 26, 2023 1:32 pm ESTJodi Pollard - Jodi@1040taxbiz.com added by Brian Warden - brian@1040taxbiz.com as a CC'd Recipient Ip: 2603:300f:e00:c300:4850:aa80:5c73:7ad
September 26, 2023 1:32 pm ESTantonio Alford - antonio@1040taxbiz.com added by Brian Warden - brian@1040taxbiz.com as a CC'd Recipient Ip: 2603:300f:e00:c300:4850:aa80:5c73:7ad
August 18, 2025 11:06 am ESTLisa Martin - Lisa@1040taxbiz.com added by Brian Warden - brian@1040taxbiz.com as a CC'd Recipient Ip: 204.156.181.52
August 18, 2025 11:06 am ESTSusan Holliday - Susanh@1040taxbiz.com added by Brian Warden - brian@1040taxbiz.com as a CC'd Recipient Ip: 204.156.181.52
August 18, 2025 11:06 am ESTantonio Alford - antonio@1040taxbiz.com added by Brian Warden - brian@1040taxbiz.com as a CC'd Recipient Ip: 204.156.181.52
October 21, 2025 12:44 pm ESTadmin admin - admin@1040taxbiz.com added by Brian Warden - brian@1040taxbiz.com as a CC'd Recipient Ip: 73.145.240.244
November 19, 2025 10:51 am ESTLisa Martin - Lisa@1040taxbiz.com added by Brian Warden - brian@1040taxbiz.com as a CC'd Recipient Ip: 96.72.237.110
November 19, 2025 10:51 am ESTBrian Warden - brian@1040taxbiz.com added by Brian Warden - brian@1040taxbiz.com as a CC'd Recipient Ip: 96.72.237.110
Audit trial Qr code
This audit trail report provides a detailed record of the online activity and events recorded for this document.
https://1040taxbiz.com/
Audit Trail Serial# dabdce59836c80a5ab002fb118de45e5