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CLIENT INFORMATION FORM ROOKS CPA PLLC ROOKS WEALTH MANAGEMENT PLLC AND/OR INDIVIDUAL ACCOUNT INFORMATION Name SS Spouse SS D/O/B Spouse D/O/B Number of Dependents Children s NameSS D/O/B Dependent yes no Mailing Address City State Zip Physical Address City State Zip If different from mailing address Home Phone Cell Phone s Work Phone Fax Home Email Address Work Email Address Add l Email Address Add l Email Address Marital Status Anniversary Dat.

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