Form It-10 - Subcontractor Tax Information Authorization
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1
2IT-10
City of Columbus, Income Tax Division
Subcontractor Tax Information Authorization
PROJECT NAME:__________________________________________
CITY CONTRACT NO. _____________________
Part A
TAXPAYER INFORMATION. Taxpayer(s) must sign and date this form
1. Taxpayer name(s) and address (type or print)
E
Social secuirty number(s)
mployer identification number
Daytime telephone number
(
)
2. Appointee name and address
Employer Identification number
Telephone number
Fax number
(
)
(
)
3.
The appointee is authorized to inspect and/or receive confidential tax information with regard to the status current/
delinquent of any and all accounts of the taxpayer, in or from the City of Columbus, Income Tax Division from the date
of bid submission until the final payment is made by the City on the contract referenced above.
4.
Retention/revocation of tax information authorization. If you want to revoke this authorization, send a copy of this
executed form with a current date and taxpayer signature. Under the original signature Write
“REVOKE”
across the
top of the form.
Part B
SIGNATURE OF TAXPAYER(s)
If a tax matter applies to a joint return, either husband or wife must sign. If signed by a corporate officer, partner, receiver,
administrator, trustee, or party other than the taxpayer, I certify that I have the authority to execute this form.
IF NOT SIGNED AND DATED, THIS TAX INFORMATION AUTHORIZATION WILL BE RETURNED
DO NOT SIGN THIS FORM IF IT IS BLANK OR INCOMPLETE.
Sign
Here
Signature
Date
Signature
Date
Print Name
Title (if applicable)
Print Name
Title (if applicable)
Rev. 9/3/11
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Parent category: Financial