Tax E-file Form

TAX E-FILE AUTHORIZATION

Taxpayer Information

Taxpayer Identification Number (TIN)

Provide the taxpayer identification number to be used for electronic filing. Submit either the Social Security Number (SSN) or the Employer Identification Number (EIN). Do not alter formatting of official numbers.

Entity Type

Check the box that describes the taxpayer entity type for the return(s) to be electronically filed.

Authorization to Electronically File

By signing below, the taxpayer certifies and authorizes the following statements under penalty of perjury:

1. The taxpayer has examined the electronic tax return and all accompanying schedules and statements, and to the best of the taxpayer's knowledge and belief, the return is true, correct, and complete.

2. The taxpayer authorizes the designated electronic return originator or tax preparer to transmit the taxpayer's tax return and necessary tax information to the applicable tax authority and to receive acknowledgements on the taxpayer's behalf.

3. The taxpayer consents to the use of an electronic signature to sign the electronically filed return and any accompanying documents; such electronic signature shall have the same force and effect as a handwritten signature.

4. The taxpayer understands and agrees that the taxpayer remains legally responsible for the accuracy of the information provided, and for any penalties or interest resulting from errors, omissions, or fraudulent information.

5. The taxpayer authorizes the preparer to discuss the return with the tax authority and to receive return information; the taxpayer may revoke this authorization in writing prior to filing.

6. The taxpayer acknowledges receipt of a copy of the completed return and supporting documents prior to, or at the time of, electronic transmission, and agrees that copies retained electronically or in hard copy comply with applicable recordkeeping requirements.

Third-Party Designee

Check the box below to authorize an individual to discuss this tax return with the tax authority on behalf of the taxpayer.

Return(s) to be E-Filed

List the form numbers and tax periods for each return to be electronically filed under this authorization.

Preparer / ERO Information (If applicable)

If a paid preparer or Electronic Return Originator (ERO) is assisting, provide preparer information below.

Certification and Signature

Under penalties of perjury, I declare that I have examined this authorization and the accompanying information, and to the best of my knowledge and belief it is true, correct, and complete. I authorize electronic filing of the tax return(s) identified above and consent to the use of an electronic signature for filing. I acknowledge that I am responsible for the accuracy of the return(s) and any tax liability, penalties, or interest that may arise.

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