Tax Lodgement Authority

Tax Lodgement Authority

Taxpayer Name:

Taxpayer Identification

Entity type (check applicable box):
Individual / Sole Proprietor    C Corporation    S Corporation
Partnership    Trust / Estate    LLC    Other:

Representative / Agent Details

Scope of Authority

The representative is authorized to perform the following acts on behalf of the taxpayer (check all that apply):

Lodge and file federal, state, and local tax returns and statements on behalf of the taxpayer
Sign tax returns and forms where permitted by law or regulation
Access tax records, transcripts, and electronic accounts to obtain taxpayer information
Receive notices, correspondence, and assessments relating to tax matters
Prepare, execute, and submit amendments, supporting schedules, and claims for refund
Represent the taxpayer in examinations, audits, and administrative proceedings
Arrange, prepare, and file payments, installment agreements, and payment authorizations
Other authority:

Duration of Authority

This authority commences on and terminates on unless earlier revoked in writing.

This authority remains in effect until revoked in writing by the taxpayer.

Conditions, Liability, and Records

The taxpayer affirms that the agent will act within the scope of authority set forth herein. The agent is authorized to obtain and disclose taxpayer information necessary to carry out the authorized acts. The taxpayer remains responsible for the accuracy of submitted returns and for any tax, penalty, or interest assessed by taxing authorities. The agent is not authorized to bind the taxpayer to contracts or other liabilities except as expressly provided in this document.

Certification and Authority

By signing below, the taxpayer certifies the following:

1. I am authorized to execute this Tax Lodgement Authority on behalf of the taxpayer identified above, and I have authority to appoint the named agent to act as described herein.

2. I authorize the disclosure of tax information as necessary for the agent to perform the duties described in this document, and I consent to electronic lodgement of returns where permitted.

3. I acknowledge that providing false or misleading information may result in penalties under applicable tax laws and that the agent may rely on this authority until revoked in writing.

4. I agree to indemnify and hold the agent harmless for actions taken in good faith under this authority, except for acts of willful misconduct or gross negligence.

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