Tax eFile Document

Tax eFile Document

Taxpayer Identification

Tax Year:    Filing Type:

Entity Type

Select entity type (check one): Individual/Sole Proprietor C Corp S Corp Partnership Trust/Estate LLC Other

Taxpayer Identification Number (TIN)

Contact & Mailing Information

Electronic Filing Authorization

I authorize the electronic transmission of the federal and state income tax return(s) indicated on this document for the tax year specified. I understand that the electronic filing of my return(s) will include my electronically signed return and that the tax preparer or authorized e-file provider will transmit the return(s) to the appropriate tax authorities.

By checking the box below I consent to the following authorization:

I authorize electronic filing and acknowledge that I am responsible for the accuracy and completeness of the information provided on this form and any tax return filed on my behalf.

I authorize the preparer named below to: (a) transmit my electronically signed return, (b) use an electronic signature on my return, and (c) discuss my return with the tax authority for purposes of resolving processing issues.

Direct Deposit Authorization (Optional)

I authorize deposit of any refund directly to the bank account listed below. I certify that the routing and account numbers are correct and that authorization is provided to the financial institution to accept such deposit.

Certification and Perjury Statement

Under penalties of perjury, I declare that I have examined this authorization, including accompanying schedules and statements, and to the best of my knowledge and belief it is true, correct and complete. I further certify the following:

1. The Taxpayer Identification Number provided on this form is correct and I understand that providing an incorrect TIN may subject me to penalties or delays in processing.

2. I authorize the electronic signature of my tax return by the authorized preparer and acknowledge that my electronic signature has the same legal effect as a handwritten signature for the return filed electronically.

3. I understand that I remain responsible for verifying the accuracy of all information reported on my tax return and for any tax, penalties or interest assessed due to errors or omissions in the return.

4. I consent to allow my preparer or e-file provider to receive and retain my electronically filed return and to provide copies to me or my authorized representative upon request.

5. I acknowledge that this authorization remains in effect for the tax year specified above unless revoked in writing prior to transmission of the return, or as otherwise required by law.

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