Tax Return E-filing

Tax Return E-filing Authorization

Taxpayer Information

Taxpayer Identification

Entity Type (check applicable):

Individual / Sole Proprietor C Corporation S Corporation Partnership

Trust / Estate LLC Other

Return Information

Return type (check all that apply):

Federal - Individual Federal - Business Amended Return Extension

Electronic Filing Authorization

By executing this Authorization, the taxpayer authorizes the Electronic Return Originator (ERO) named below to electronically transmit the tax return identified above to the appropriate tax authorities and to act on behalf of the taxpayer for the limited purpose of filing the specified return(s).

The taxpayer certifies, under penalties of perjury, the following:

1. The taxpayer has examined the information provided on the tax return and to the best of the taxpayer's knowledge and belief it is true, correct, and complete.

2. The taxpayer's Taxpayer Identification Number provided above is correct and the taxpayer is not subject to backup withholding unless otherwise indicated on this form.

3. The taxpayer authorizes the ERO to use an electronic signature or personal identification number (PIN) on behalf of the taxpayer as the taxpayer's legally binding signature for filing the return electronically.

4. The taxpayer authorizes the ERO and any third-party processor reasonably necessary to prepare, transmit, and retain the electronic return to disclose return information to the relevant tax authorities and to retain copies as required for recordkeeping and verification.

5. The taxpayer consents to electronic transmission of the return and agrees that paper signatures are not required to complete the filing transaction specified in this Authorization.

6. The taxpayer acknowledges that intentional submission of false or fraudulent information may subject the taxpayer to civil and criminal penalties pursuant to applicable law.

Electronic Signature / PIN Authorization

Method of signature selection (select one):

I will provide my own 5-digit PIN PIN:

I authorize the ERO to use an electronic signature on my behalf

Refund / Payment Options

Direct deposit of refund or electronic payment of tax due (check applicable):

Authorize direct deposit of refund to bank account below

Checking Savings

Authorize electronic funds withdrawal to pay any tax due resulting from this filing

Electronic Return Originator / Preparer

Additional Declarations

The taxpayer authorizes the ERO to communicate with the taxpayer by telephone, email, or other electronic means for the purpose of completing or verifying information necessary to file the return and to resolve issues that may arise in the course of electronic filing.

By signing below, the taxpayer affirms the certifications and authorizations contained in this form and acknowledges that this signed authorization constitutes the taxpayer's consent for electronic filing and for the ERO to use an electronic signature or PIN on the taxpayer's behalf.

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