Form 8821 - Tax Information Authorization printable pdf download

8821

OMB No. 1545-1165

For IRS Use Only

Tax Information Authorization

Form

Received by:

(Rev. April 2004)

Do not use this form to request a copy or transcript of your tax return.

Name

Department of the Treasury

(

)

Instead, use Form 4506 or Form 4506-T.

Telephone

Internal Revenue Service

Function

Date

Taxpayer information. Taxpayer(s) must sign and date this form on line 7.

Social security number(s)

Employer identification number

Taxpayer name(s) and address (type or print)

Daytime telephone number

Plan number (if applicable)

(

)

Appointee. If you wish to name more than one appointee, attach a list to this form.

Name and address

CAF No.

Telephone No.

Fax No.

Check if new: Address

Telephone No.

Fax No.

3 Tax matters. The appointee is authorized to inspect and/or receive confidential tax information in any office of the IRS for

the tax matters listed on this line. Do not use Form 8821 to request copies of tax returns.

(a)

(b)

(c)

Type of Tax

(d)

Tax Form Number

Year(s) or Period(s)

(Income, Employment, Excise, etc.)

Specific Tax Matters (see instr.)

(1040, 941, 720, etc.)

(see the instructions for line 3)

or Civil Penalty

Specific use not recorded on Centralized Authorization File (CAF). If the tax information authorization is for a specific

use not recorded on CAF, check this box. See the instructions on page 3. If you check this box, skip lines 5 and 6

Disclosure of tax information (you must check a box on line 5a or 5b unless the box on line 4 is checked):

a If you want copies of tax information, notices, and other written communications sent to the appointee on an ongoing

basis, check this box

b If you do not want any copies of notices or communications sent to your appointee, check this box

Retention/revocation of tax information authorizations. This tax information authorization automatically revokes all

prior authorizations for the same tax matters you listed on line 3 above unless you checked the box on line 4. If you do

not want to revoke a prior tax information authorization, you must attach a copy of any authorizations you want to remain

in effect and check this box

To revoke this tax information authorization, see the instructions on page 3.

7 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, guardian, executor, receiver, administrator, trustee, or party other than the taxpayer, I certify

that I have the authority to execute this form with respect to the tax matters/periods on line 3 above.

IF NOT SIGNED AND DATED, THIS TAX INFORMATION AUTHORIZATION WILL BE RETURNED.

Signature

Date

Signature

Date

Print Name

Title (if applicable)

Print Name

Title (if applicable)

PIN number for electronic signature

8821

For Privacy Act and Paperwork Reduction Act Notice, see page 4.

Cat. No. 11596P

Form

(Rev. 4-2004)

Form 8821 - Tax Information Authorization

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