Tax Submission Authorization Form

Tax Submission Authorization Form

Taxpayer Information

Entity Type (select all that apply)

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

Taxpayer Identification Number

Provide either Social Security Number or Employer Identification Number. Do not enter both.

Authorized Third Party

Scope of Authorization

By signing below, the taxpayer appoints the named Authorized Representative to act on the taxpayer's behalf for the tax matters and periods specified. The authority granted is limited to the items checked below.

Prepare, complete and assemble federal and state tax returns and related schedules
Electronically file tax returns (e-file) on behalf of the taxpayer
Sign tax return e-file authorization forms as my electronic agent where permitted by law
Receive and inspect tax notices, transcripts and communications related to the covered periods
Discuss tax matters with tax authorities, including disclosure of return information
Initiate or coordinate tax payments or refunds on my behalf (does not authorize transfer of funds without separate agreement)
Other:

Revocation; Limitations; Indemnity

This authorization remains in effect until the expiration date above or until revoked in writing by the taxpayer. Revocation is not effective as to any action already taken in reliance on this authorization. The taxpayer acknowledges that this form does not authorize the Authorized Representative to endorse or negotiate checks unless expressly checked above and accompanied by a separate written agreement.

The taxpayer agrees to indemnify and hold harmless the Authorized Representative for actions reasonably taken in good faith pursuant to this authorization, except for conduct resulting from willful misconduct or gross negligence.

Retention of Records

The Authorized Representative may retain copies of returns, schedules and other documents prepared or provided in connection with this authorization as necessary to comply with professional retention requirements and to respond to inquiries relating to the covered periods unless the taxpayer requests in writing that copies be returned.

Certification and Perjury Statement

I certify, under penalties of perjury, that the information provided on this form is true, correct and complete to the best of my knowledge and that I am authorized to execute this authorization on behalf of the taxpayer identified above. By signing this form I specifically authorize the actions checked above and acknowledge the following:

1. That I am the taxpayer or an individual authorized to act for the taxpayer for the tax matters and periods described in this form.
2. That the Authorized Representative may receive and disclose return information to other persons as necessary to perform the authorized services, except where prohibited by law.
3. That I may revoke this authorization at any time by providing written notice to the Authorized Representative, but revocation will not affect actions already taken in reliance on this authorization.
4. That I understand this authorization does not relieve me of any tax filing or payment obligations; I remain responsible for ensuring returns are filed and payments are made timely.

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