Is an electronic Form 500 valid?

Yes. Electronic signatures are generally valid under the ESIGN Act (15 U.S.C. ch. 96) and UETA where adopted, provided the signer demonstrates intent, consents to electronic records, and the record is retained in a reproducible form.

What if the taxpayer changes their mind?

To revoke, submit a written revocation to the recipient and tax authority as specified in the form; revocation is typically effective upon receipt, but check recipient processing rules to stop further disclosures.

Is notarization required?

Not usually required for a disclosure authorization, but some recipients or state-specific processes may ask for notarization or RON; verify recipient requirements before execution.

What if names or TINs do not match?

Mismatched names or incorrect TINs can prevent record retrieval and may trigger backup withholding or processing delays; correct errors and re-submit promptly.

How do I confirm the recipient received the authorization?

Use authenticated delivery and retain the signing platform’s audit trail or delivery receipt showing timestamps, IP addresses, and access events for proof of transmission and acceptance.

Can healthcare tax data be shared?

Only with proper safeguards. If tax records include protected health information, ensure HIPAA compliance and execute a Business Associate Agreement when required before disclosure.

Electronic Signature
Templates
Tax
Form 500 Authorization to Disclose Tax Information

Form 500 Authorization to Disclose Tax Information

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AUTHORIZATION TO DISCLOSE TAX INFORMATION & DESIGNATION OF REPRESENTATIVE

OFFICE OF STATE TAX COMMISSIONER

SFN 28258 (12-2023) Form 500

Taxpayer Information

Designated Individual or Firm

Authorization or Revocation - Check the applicable box(es):

• An authorization to disclose tax information or designation of representative on Form 500 does not apply to the routine mailing of tax forms, refund checks, original notices (e.g., Notice of Determination), or other original written communications, which are always mailed to the taxpayer.

• Form 500 takes effect upon receipt by the Office of State Tax Commissioner and remains in effect until revoked by the taxpayer.

A. Authorization To Disclose Tax Information. The Tax Commissioner is authorized to disclose confidential tax information on file with the Office of State Tax Commissioner to the above-designated individual or firm with respect to the following matters:

B. Designation of Representative. The Tax Commissioner is notified that the above-designated individual or firm has been authorized to represent the above-named taxpayer(s) before the Office of State Tax Commissioner with respect to the following matters:

This designation of representative also authorizes the Tax Commissioner to disclose confidential tax information on file with the Office of State Tax Commissioner to the representative. The representative is authorized to perform all acts that the taxpayer can perform except that only an individual admitted and licensed to practice law in North Dakota may sign a complaint, represent the taxpayer in a formal administrative review under North Dakota Century Code Ch. 28-32, or represent the taxpayer in any court proceeding.

C. Authorization To Disclose Tax Information Using Facsimile (Fax) or E-mail. The Tax Commissioner is authorized to use facsimile or email, or both, to disclose confidential tax information on file with the Office of State Tax Commissioner to the above-designated individual or firm with respect to the above-identified matters.

D. Revocation. The Tax Commissioner is notified that all authorizations previously made are revoked for all previously designated individuals or firms. To revoke authorizations for only a specified individual or firm, complete the designated individual or firm information section above. (If this box is checked, do not check Box A, Box B, or Box C.)

Signature of Taxpayer(s)

Privacy Act Notification

For Office Use Only

Form 500 Instructions

SFN 28258 (12-2023)

General Instructions

Form 500 may be used by a taxpayer to do one of the following: authorize the North Dakota Office of State Tax Commissioner to disclose the taxpayer’s confidential tax information to another individual or firm not otherwise entitled to the information; designate another individual or firm to represent or act on behalf of the taxpayer before the Office of State Tax Commissioner, and to authorize the North Dakota Office of State Tax Commissioner to disclose the taxpayer’s confidential tax information to the designated representative or firm.

Form 500 does not apply to the routine mailing of tax forms, refund checks, original notices, or other original written communications, which are always mailed to the taxpayer.

Unless Box C on Form 500 is checked to authorize the sending of confidential tax information by facsimile (fax) transmission or email, the Office of State Tax Commissioner will send confidential tax information authorized by Form 500 to the designated individual or firm only by letter or telephone.

Changing a previously filed Form 500. To change a Form 500 previously filed with respect to a particular designated individual or firm, complete and file a new Form 500 for that designated individual or firm. The new Form 500 automatically revokes and replaces the previously filed Form(s) 500.

Revoking a previously filed Form 500. To revoke a previously filed Form 500, see instructions to Box D under “Authorization or Revocation.”

When Form 500 takes effect. Form 500 takes effect upon receipt by the Office of State Tax Commissioner and remains in effect until revoked by the taxpayer.

Specific Instructions

Taxpayer Information

Enter the taxpayer’s name, social security number or federal employer identification number (FEIN), mailing address, and contact information.

For a trust, enter the trust’s name and FEIN, and the name, mailing address, and contact information of the fiduciary.

For an estate, enter the decedent’s name and social security number, and the name, mailing address, and contact information of the decedent’s personal representative or fiduciary.

Designated Individual or Firm

Enter the name, social security number or federal employer identification number (FEIN), mailing address, and contact information for the designated individual or firm. If designating more than one individual or firm, attach a statement listing each one.

Note: Do not complete this section of the form if filing this form to revoke previously filed Forms 500 and the revocation is intended to apply to all previously designated individuals and firms.

Authorization or Revocation

For Box A and Box B, the authorization to disclose or the designation of representative can be limited to a certain tax type, form number, or taxable year or period by entering that information in the spaces provided.

If attaching a statement to identify additional designated individuals or firms, indicate the authority being given to each one by entering “Box A” or “Box B” (and “Box C” if desired) next to each one listed on the statement.

Box A - Check this box to authorize the Office of State Tax Commissioner to disclose confidential tax information to the designated individual or firm.

Box B - Check this box to designate an individual or firm to represent or act on behalf of the taxpayer before the Office of State Tax Commissioner, and to authorize the Office of State Tax Commissioner to disclose confidential tax information to the designated individual or firm.

Box C - Check this box to authorize the Office of State Tax Commissioner to send confidential tax information to the designated individual or firm by facsimile (fax) transmission or email.

Box D - Check this box to revoke all previously filed Forms 500. To limit the revocation to a specific designated individual or firm, identify that individual or firm by completing the “Designated Individual or Firm” section of the form. Otherwise, leave that section of the form blank to apply the revocation to all previously designated individuals and firms. If checking this box, do not check any of the other boxes (A, B, or C) on the form.

Signature of Taxpayer(s)

Partnership (all types). One of the general partners must sign.

Corporation. An officer having authority to bind the corporation must sign.

Limited liability company. A governor or manager must sign.

Estate, trust, or any other situation where there is a fiduciary relationship. The personal representative, trustee, guardian, conservator, or other fiduciary must sign.

Where to Send Form 500

Form 500 may be submitted to the North Dakota Office of State Tax Commissioner by fax, email, or regular mail.

Fax or email

Individual Income Tax— Fax 701-328-1942 Email individualtax@nd.gov

Business Registration— Fax 701-328-0332 Email taxregistration@nd.gov

General (other tax or purpose)— Fax 701-328-3700 Email taxinfo@nd.gov

Regular mail

Office of State Tax Commissioner, 600 E. Boulevard Ave., Dept. 127, Bismarck, ND 58505-0599

What the Form 500 Authorization to Disclose Tax Information Is

The Form 500 Authorization to Disclose Tax Information is a written consent that lets a taxpayer authorize a third party to receive specific tax records or communications from a tax authority, payer, or preparer. It typically identifies the taxpayer, names the recipient, specifies the categories of tax information that may be shared, and sets a start and end date for the authorization. Organizations use this form to enable payroll providers, CPAs, lenders, or government agencies to access tax details without repeatedly requesting separate releases from the taxpayer.

Why a Clear Authorization Matters

A properly completed Form 500 reduces delays, documents consent for disclosure, and helps the receiving party obtain necessary tax records lawfully. It clarifies scope, duration, and permitted recipients to limit unnecessary access while creating an auditable record of consent.

Who Typically Completes This Authorization

The form is used by individuals and businesses that need to let an agent, preparer, lender, or government office access tax information on their behalf.

Individual taxpayers who appoint tax preparers or financial advisors to obtain tax transcripts or filings.
Businesses granting payroll providers, lenders, or escrow agents permission to access corporate tax documents.
Legal counsel, trustees, or executors who need tax records for litigation, estate settlement, or compliance purposes.

Use this form when a third party requires documented consent to obtain tax records, or when you want a clear paper trail for privacy and compliance.

Core Elements to Include in a Professional Form 500

A professional Form 500 clearly defines the parties, scope, time limits, signature blocks, and revocation mechanics so recipients and recordkeepers can apply the authorization without ambiguity.

Authorization Details

State the precise authorization language showing who is allowed to disclose which tax records and to whom, avoiding vague phrases that create interpretive gaps.

Recipient Identity

Provide the full legal name, mailing and email address, and an organizational identifier (EIN or state registration number) for the authorized recipient to prevent misrouting.

Scope of Records

List specific record types (tax returns, transcripts, notices, payment history) and limit authorization to only what is necessary for the intended purpose.

Effective Period

Include a clear start date and an expiration date or event-based termination so access ends automatically without further action.

Signature and Date

Require the taxpayer's handwritten or electronic signature and date; include printed name and capacity (individual, corporate officer, trustee) for attribution.

Revocation Clause

Explain how the taxpayer may revoke the authorization, the effective date of revocation, and any notice method required to notify recipients and the tax authority.

Security and Compliance Considerations

Encryption: TLS 1.2/1.3 in transit; AES-256 at rest.

Audit Trail: Complete signing history and timestamps retained.

Authentication: Options: email, SMS code, or stronger methods.

HIPAA BAA: BAA required for protected health information.

Regulatory Standards: ESIGN and UETA compliance supported.

Access Controls: Role-based permissions and user management.

Penalties and Risks to Watch For

Unauthorized Disclosure: May violate privacy laws and agreements.

IRS Penalties: Errors can trigger reporting penalties.

HIPAA Exposure: Improper PHI sharing risks civil penalties.

Contractual Liability: Breach of confidentiality obligations possible.

Revocation Failures: Delayed revocation notice can cause continued access.

Invalid Authorization: Mismatched names or missing signature may invalidate.

Common Preparation Errors to Avoid

Entering an incorrect Taxpayer Identification Number (TIN) which prevents matching records and can trigger backup withholding or information-request delays.
Leaving the recipient or scope fields vague, leading to rejected requests or excessive disclosure beyond the taxpayer’s intent.
Using an expired or open-ended effective period that unintentionally allows prolonged access after the original need has passed.
Failing to attach identification or supporting documentation required by the responding agency, which slows processing or causes denials.

Step-by-Step: Complete the Form 500 Accurately

Follow these sequential steps to prepare, execute, and distribute a valid authorization that can be used by payers, tax authorities, or third-party recipients.

01

Collect Records: Gather taxpayer ID, prior returns, and recipient contact details.
02

Specify Scope: List exact record types and tax years covered.
03

Set Dates: Enter effective and expiration dates in MM/DD/YYYY format.
04

Sign and Deliver: Sign, date, and send to the recipient and tax authority if required.

How to Configure an Online Authorization Workflow

Set up an electronic workflow that enforces authentication, expiration, and copy distribution so all parties receive the signed authorization.

Field	Configuration
Authentication Method	Email link plus optional SMS code verification for signer identity.
Expiration	Set automatic expiry (e.g., 30 days) to limit access after the need ends.
Notifications	Enable sender and recipient email notifications and reminders.
Archiving	Save signed PDF/A copy to secure storage for compliance.

Digital Formats and Integrations for eSubmission

Choose a platform that supports PDF and DOCX workflows, secure authentication, and audit trails for admissible electronic records.

File Formats: PDF, DOCX, and HTML accepted for upload.
Integrations: Common integrations include Salesforce, NetSuite, and Google Workspace.
Authentication: Choose SMS, email, or stronger verification as required.

Filing and Submission Flow at a Glance

A typical submission follows upload, field placement, signer authentication, execution, and delivery — each step leaves a timestamped audit record.

Upload Document: Upload the Form 500 PDF or template to the signing platform.
Place Fields: Add signer, date, and optional attachment fields for supporting documents.
Send to Signer: Deliver via secure email link and request authentication.
Receive Signed Copy: Signed PDF and audit trail are returned to sender and recipient.

Timing, Deadlines, and What to Expect

Timing depends on the recipient and method of delivery; e-signed authorizations are typically processed faster than paper versions but processing windows vary by agency.

Provide Upon Request:

Give the completed authorization to a payer or agency when they request it.

Processing Time:

Expect 3–15 business days depending on agency and verification steps.

Effective Date Rule:

Authorization becomes effective on the date signed unless otherwise specified.

Revocation Timing:

Revocation is usually effective upon receipt by the recipient.

Record Retention:

Keep copies for the applicable retention period for audit purposes.

Key Processing Milestones

Track these stages when you submit a Form 500 so each milestone can be confirmed and recorded for compliance and troubleshooting.

01

Request Received

Recipient or agency logs the incoming authorization and assigns a processing ticket.

02

Authorization Validated

Staff verify signer identity, scope, and effective dates against records.

03

Records Retrieved

Requested tax documents are collected from archives or tax systems for release.

04

Delivery Confirmed

Signed copies and any responsive documents are delivered and audit-trail entries finalized.

Comparing eSignature Vendor Pricing and Key Features

Price and capability influence how you collect signed Form 500 authorizations; the table compares entry pricing and common features across vendors.

	signNow	DocuSign	Adobe Sign	PandaDoc	HelloSign
Starting Price	$8/user/mo	$15/user/mo	$14/user/mo	$19/user/mo	$15/user/mo
Free Trial	Yes, 7-day free trial	Varies by vendor	Varies by vendor	Varies by vendor	Varies by vendor
Bulk Send	Yes	Yes	Yes	Yes	No
Audit Trail	Yes	Yes	Yes	Yes	Yes
HIPAA Compliant	Yes	Yes	Yes	No	No
Envelope Cap	No envelope cap	100 envelopes/user/year	Varies by plan	Varies by plan	Varies by plan

Frequently Asked Questions and Troubleshooting

Answers to common questions about validity, revocation, electronic signing, and handling errors when using Form 500 authorizations.

Need help? Contact support

Is an electronic Form 500 valid?
Yes. Electronic signatures are generally valid under the ESIGN Act (15 U.S.C. ch. 96) and UETA where adopted, provided the signer demonstrates intent, consents to electronic records, and the record is retained in a reproducible form.
What if the taxpayer changes their mind?
To revoke, submit a written revocation to the recipient and tax authority as specified in the form; revocation is typically effective upon receipt, but check recipient processing rules to stop further disclosures.
Is notarization required?
Not usually required for a disclosure authorization, but some recipients or state-specific processes may ask for notarization or RON; verify recipient requirements before execution.
What if names or TINs do not match?
Mismatched names or incorrect TINs can prevent record retrieval and may trigger backup withholding or processing delays; correct errors and re-submit promptly.
How do I confirm the recipient received the authorization?
Use authenticated delivery and retain the signing platform’s audit trail or delivery receipt showing timestamps, IP addresses, and access events for proof of transmission and acceptance.
Can healthcare tax data be shared?
Only with proper safeguards. If tax records include protected health information, ensure HIPAA compliance and execute a Business Associate Agreement when required before disclosure.

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