Tax Electronic Filing

TAX ELECTRONIC FILING AUTHORIZATION

Taxpayer Identification

Entity Type

Select the taxpayer entity type (check applicable box). Only one entry should represent the filing entity.

Individual / Sole Proprietor
C Corporation
S Corporation
Partnership
Trust / Estate
Limited Liability Company (LLC)
Other (describe below)

Taxpayer Identification Number (TIN)

Provide either a Social Security Number or an Employer Identification Number. Enter only one identification number below.

Return Information

Tax Year:    Return/Form Type:

Electronic Return Originator (ERO) Name:

ERO Firm / Preparer:

Electronic Filing Authorization

I, the undersigned taxpayer, authorize the named Electronic Return Originator to electronically transmit the tax return identified above and to correct and resubmit the return if rejected by the receiving agency, provided the corrections do not change the substantive tax positions unless I have been informed and have provided additional authorization.

I instruct the ERO to use my electronic signature in the form of a personal identification number (PIN) in accordance with the terms of this authorization. I consent that the ERO may enter my signature PIN on my electronic return and that such electronic submission shall have the same force and effect as my handwritten signature.

Certification (Perjury Statement)

Under penalties of perjury, I certify the following:

1. The information contained in the tax return and any attachments is true, correct, and complete to the best of my knowledge.
2. I have examined all entries on the tax return and any accompanying schedules and statements, and I am authorized to sign this return on behalf of the taxpayer identified above.
3. I authorize the ERO to transmit the return electronically and to receive electronic acknowledgements and transmissions related to the filing.
4. I authorize the disclosure of tax return information to third parties strictly as necessary to effect electronic filing and receive acknowledgements (for example, clearinghouses and service providers), and I understand that such disclosures are limited to information required to process the electronic filing.
5. I understand that I remain responsible for the accuracy and completeness of the return and for retaining a copy of the return and this authorization for my records.
6. I understand that willful falsification of information may subject me to penalties under applicable law, including criminal penalties for perjury.

PIN Authorization and Signature Method

Select the method by which the taxpayer authorizes the electronic signature to be applied to the return. Check one option and provide required information.

I will provide a self-selected PIN to be used as my signature. PIN (5 digits):

I authorize the preparer/ERO to enter a practitioner PIN on my behalf. Preparer PIN (if applicable):

I authorize use of the prior-year PIN for verification purposes. Prior-year adjusted gross income or prior-year PIN verification (last 5 digits):

Additional Instructions to ERO

By signing below I acknowledge that I have read and understand this authorization and certification, and that I authorize electronic filing and the application of my electronic signature as specified above.

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