Form 500 - Authorization To Disclose Tax Information & Designation Of Representative Page 2
Download a blank fillable Form 500 - Authorization To Disclose Tax Information & Designation Of Representative in PDF format just by clicking the "DOWNLOAD PDF" button.
Open the file in any PDF-viewing software. Adobe Reader or any alternative for Windows or MacOS are required to access and complete fillable content.
Complete Form 500 - Authorization To Disclose Tax Information & Designation Of Representative with your personal data - all interactive fields are highlighted in places where you should type, access drop-down lists or select multiple-choice options.
Some fillable PDF-files have the option of saving the completed form that contains your own data for later use or sending it out straight away.
ADVERTISEMENT
1
2Instructions For Form 500
General Information
Form 500 may be used by a taxpayer to Either:
A disclosure authorized by this form may take place by
telephone, letter, facsimile, or e-mail (if that information is
1. Authorize the Offi ce of State Tax Commissioner to disclose
provided and Box C is also checked).
confi dential tax information with respect to the taxpayer
to another individual or fi rm not otherwise entitled to the
To change a Form 500 previously fi led, a taxpayer must complete
information; or
and fi le a new Form 500. The fi ling of a new Form 500 will
automatically revoke all authorizations and designations
2. Provide a limited power of attorney by designating another
previously made.
individual or fi rm to represent or act on behalf of the
taxpayer and authorize the Offi ce of State Tax Commissioner
Mail the completed Form 500 to: Offi ce of State Tax
to disclose confi dential tax information to the designated
Commissioner, 600 E. Boulevard Ave., Dept. 127, Bismarck, ND
representative.
58505-0599.
Completing Form 500
Taxpayer Information
Box C - Check this box to authorize the Offi ce of State Tax
For an individual - Enter the individual’s name, telephone
Commissioner to use facsimile or e-mail to disclose
number, social security number, and mailing address.
confi dential tax information to the designated individual
or fi rm.
For a corporation, partnership, LLP, or LLC - Enter the name,
telephone number, federal identifi cation number, and business
Box D - Check this box if Form 500 is being fi led to revoke all
address.
previously made authorization(s).
For a trust - Enter the name, telephone number, and federal
Note:
If a separate sheet is being attached to identify additional
identifi cation number of the trust, and the name and address of
designated individuals or fi rms, indicate the authority
the fi duciary.
being given by entering “Box A” or “Box B,” and
“Box C”, if desired, next to each one listed.
For an estate - Enter the name and social security number or
federal identifi cation number of the decedent, and the name,
Type of Tax, Form Number, Tax Year or Period
telephone number, and address of the decedent’s personal
If limiting authorization or designation to a certain tax type, form,
or taxable year or period, enter the type of tax (e.g., Individual
representative or fi duciary for the estate.
Income Tax or Corporation Income Tax), the form number (e.g.,
Designated Individual or Firm
Form ND-1 of Form 40), and tax year(s) or period(s) (e.g., 2002
Enter the name, title, telephone number, social security number
or Tax period ending June 30, 2002). If more space is needed,
attach an additional sheet.
or federal identifi cation number, and mailing address of the
designated individual or fi rm. To authorize the disclosure of
confi dential tax information by facsimile or e-mail, enter the
Signature of Taxpayer(s)
facsimile number or e-mail address, or both, and check Box C
For a partnership - One of the general partners must sign.
on the form. If designating more than one individual or fi rm,
identify on a separate sheet and attach it to Form 500.
For a corporation - An offi cer having authority to bind the
corporation must sign.
Which Box To Check
For an LLC or LLP - A governor, manager, responsible member
Box A - Check this box if Form 500 is being fi led to Only
authorize the Offi ce of State Tax Commissioner to
or partner must sign.
disclose confi dential tax information to an individual or
fi rm other than the taxpayer.
For an estate, trust, or any other situation where there is a
fi duciary relationship - The personal representative, trustee,
Box B - Check this box if Form 500 is being fi led to designate
guardian, conservator, or other fi duciary must sign.
another individual or fi rm to represent or act on
behalf of the taxpayer. Checking this box also
Privacy Act Notifi cation. In compliance with the Privacy
Act of 1974, disclosure of a social security number or Federal
authorizes the Offi ce of State Tax Commissioner to
disclose confi dential tax information to the designated
Employer Identifi cation Number (FEIN) on this form is required
representative.
under N.D.C.C. §§ 57-01-15, and will be used for tax reporting,
identifi cation, and administration of North Dakota tax laws.
Disclosure is voluntary/mandatory. Failure to provide the social
security number or FEIN may delay or prevent the processing of
this form.
ADVERTISEMENT
0 votes
Related Articles
Related forms
Related Categories
Parent category: Financial