Tax Representation Portfolio

TAX REPRESENTATION PORTFOLIO

Taxpayer Identification

Taxpayer Name:

Entity Type

Select the taxpayer's entity type (check all that apply):

Taxpayer Identification Number (TIN)

Enter the Taxpayer Identification Number applicable to the taxpayer. Provide only one.

Representation Portfolio — Matters Listed

Describe each tax matter for which representation is authorized. Include tax authority, tax type, tax years or periods, and any identifying reference numbers.

Scope of Representative Authority

The taxpayer hereby authorizes the designated representative to undertake the following actions related to the matters listed above. Check the actions expressly authorized.

Document and Records

The representative is authorized to obtain copies of and to retain documents and records relating to the matters described. The taxpayer shall promptly provide all requested documentation to the representative. The representative's retention of original documents is subject to express written agreement.

Fees, Billing, and Indemnity

The representative's fees and billing arrangements shall be governed by a separate engagement letter unless otherwise stated below. The taxpayer agrees to indemnify and hold harmless the representative for costs, expenses, and reasonable attorneys' fees incurred in defending claims arising from the taxpayer's failure to disclose material information or from representations made by the taxpayer to tax authorities.

Duration; Termination; Revocation

This representation portfolio shall remain in effect until revoked in writing by the taxpayer, until the matter(s) listed are concluded, or until terminated by the representative upon reasonable notice. Revocation will not affect actions already taken by the representative in reliance on this authorization prior to receipt of the revocation.

Certification and Perjury Statement

By signing below, the taxpayer certifies under penalty of perjury the following representations and acknowledgements:

1. The taxpayer identification number provided above is correct to the best of the taxpayer's knowledge.
2. The taxpayer authorizes the representative to pursue the specific matters and actions checked or described in this portfolio and understands that such authority is limited to the matters listed unless otherwise amended in writing.
3. The taxpayer affirms that all information provided to the representative necessary for the proper representation has been disclosed and that no material facts have been knowingly omitted.
4. The taxpayer understands that certain actions (including binding settlement or execution of certain forms) may require additional written authorization and that the representative will obtain such authorization when required by law or professional standards.
5. The taxpayer acknowledges potential consequences of false statements, including penalties under applicable tax laws and other sanctions.

Additional Notes or Instructions

Sign Now