Tax ATO Application

Tax ATO Application

This application authorizes an appointed third party (Authorized Representative) to obtain tax information, inspect taxpayer records, and act on behalf of the taxpayer with respect to the tax matters and periods described below. Completion of this form constitutes a written authorization governed by applicable law, and creates binding obligations and liabilities for the signer as specified in the certification below.

Taxpayer Identification

Taxpayer Name:

Business Name (if different):

Individual / Sole Proprietor C Corporation S Corporation Partnership Trust / Estate LLC Other

If Other or LLC classification, describe:

Taxpayer Identification Number (TIN)

Provide Social Security Number or Employer Identification Number (enter one):

Authorized Representative

Scope of Authorization

The Authorized Representative is authorized to perform the following actions on behalf of the taxpayer (select all that apply):

Obtain copies of tax returns and related documents Receive and inspect taxpayer records and communications Discuss matters with tax authorities and their representatives Represent taxpayer in audits, appeals, and administrative hearings Sign consents, extensions, and similar routine forms on taxpayer's behalf Other

Tax Matters and Periods

Tax matters for which authority is granted (select all that apply):

Income Tax Payroll / Employment Taxes Sales / Use Tax Excise Tax Property Tax Other

From:    To:

Authorization remains in effect until expressly revoked in writing by the taxpayer.

Certification and Declaration

By signing below, the taxpayer certifies and declares the following:

1. I am the taxpayer identified above or I am authorized to sign on behalf of the taxpayer under applicable law. I have the authority to grant the rights set forth in this authorization and to execute this form on behalf of the taxpayer.

2. I authorize the Authorized Representative to receive and inspect confidential tax information, to request copies of returns and related documents, and to represent the taxpayer with respect to the tax matters and periods specified above to the extent indicated.

3. I understand that this authorization does not relieve the taxpayer of obligations to file returns or pay taxes, and that the taxpayer remains responsible for compliance unless otherwise provided by law.

4. I understand that this authorization may be revoked by delivering a written revocation to the tax authority and to the Authorized Representative. Revocation is effective as provided by applicable law, but does not affect actions taken by the Authorized Representative prior to receipt of revocation.

5. I certify, under penalty of perjury, that the information provided on this form is true, correct, and complete to the best of my knowledge and belief. I acknowledge that making a false statement on this form may subject me to civil or criminal penalties under applicable law.

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