Authorization To Receive Confidential Tax Information For Nyc-3a Tax Filers Form - New York Finance

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AUTHORIZATION TO RECEIVE
CONFIDENTIAL TAX INFORMATION
F I N A N C E
FOR NYC-3A TAX FILERS
NEW
YORK
G
Name of corporation authorizing disclosure
Address (number and street)
D D R R A A F F T T
City and State
Zip Code
Business telephone number
Employer Identification Number
of reporting corporation
I, ______________________________________________________, hereby certify that I am the
(
)
PRINT NAME OF THE PERSON AUTHORIZING THE DISCLOSURE
______________________________________________________________ of the above-described
(
,
)
PRESIDENT
CHIEF EXECUTIVE OFFICER
corporation and am authorized to act on its behalf. I hereby notify the New York City Department of Finance that I autho-
rize the employee designated below to discuss and receive confidential tax information related to the New York City
General Corporation Tax for this corporation for each year for which the corporation named above is the reporting cor-
poration filing an NYC-3A (Combined Return). I understand that the employee may discuss and receive confidential tax
information related to this corporation and information related to affiliated corporations included in a combined return.
1.
NAME OF EMPLOYEE: _____________________________________________________________________________
PLEASE PRINT
EMPLOYEE’S SOCIAL SECURITY NUMBER: _____________________
SAME AS PREVIOUS
I I
I I
OPTIONAL
AUTHORIZATION .........YES
NO
2.
BUSINESS ADDRESS: ______________________________________
SAME AS PREVIOUS
I I
I I
AUTHORIZATION .........YES
NO
________________________________________________________
3.
TELEPHONE NUMBER: _____________________________________
SAME AS PREVIOUS
I I
I I
AUTHORIZATION .........YES
NO
4.
FAX NUMBER: ____________________________________________
SAME AS PREVIOUS
I I
I I
AUTHORIZATION .........YES
NO
_______________________________________________________
______________________
Signed
Date

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