Tax E-file Permission Form

TAX E-FILE PERMISSION FORM

Taxpayer Information

Entity Type

Select the entity type (check all that apply):

Individual / Sole Proprietor

C Corporation

S Corporation

Partnership

Trust / Estate

Limited Liability Company (LLC)

Other:

Taxpayer Identification Number

Provide Social Security Number or Employer Identification Number. Do not provide both unless applicable.

Returns To Be E-filed

Tax year(s) covered by this authorization:

Individual Income Tax Return (Form 1040 series)

U.S. Corporation Income Tax Return (Form 1120 series)

Partnership Return (Form 1065)

Fiduciary Return (Form 1041)

Other:

Authorization and Consent

I hereby authorize and instruct the preparer, practitioner or authorized agent identified below to electronically file the tax return(s) identified above on my behalf. I consent to the electronic transmission of all tax return information necessary to complete filing and to receive electronic acknowledgements and transcripts related to the e-filed return(s).

Practitioner/Firm:    Preparer Phone:

I authorize my preparer to: (a) select the method of e-filing; (b) electronically sign the tax return and related forms using my personal identification number (PIN) as my signature when permitted; and (c) receive and transmit any IRS or state agency acknowledgement on my behalf.

I understand that by authorizing use of my PIN I am consenting to the use of an electronic signature and that I remain legally responsible for the information contained on the tax return(s). I also acknowledge that I have received or will receive a copy of the completed return prior to filing.

I authorize the preparer to transmit payment information (if applicable) and to provide any additional documents required for successful transmission and acceptance of the electronic return.

I revoke any prior tax e-file authorizations for the returns listed above:

Certification (Perjury Statement)

Under penalties of perjury, I certify the following:

1. I have examined the information provided on this form and on the tax return(s) to be filed and, to the best of my knowledge and belief, it is true, correct and complete.

2. I consent to the electronic filing of the tax return(s) listed above and authorize the practitioner to transmit the return(s) and related forms to the appropriate taxing authorities.

3. If I have authorized the use of my PIN as my signature, I accept that my PIN, together with the preparer's credentials as permitted, constitutes my signature for electronic filing purposes.

4. I understand that acceptance of an electronically filed return is determined by the taxing authority, and that the preparer will attempt to correct transmission errors and resubmit as necessary unless I instruct otherwise.

5. I agree to retain copies of records and supporting documentation necessary to substantiate the information on the tax return(s) and to provide those records to the preparer or taxing authority upon request.

6. I understand that this authorization remains in effect for the tax year(s) specified above unless revoked in writing by me and delivered to the preparer. Revocation will not affect disclosures or actions taken by the preparer prior to receiving the revocation.

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