Form 13-60-A - Certificate Authorizing Disclosure Of Taxpayer Information
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1Form 13-60-A
Revised 4-08
Oklahoma Tax Commission
Certificate Authorizing Disclosure of Taxpayer Information
Purchase Contract Must Be Attached
Part I. To Be Completed by Person Requesting Information
Name: ___________________________________________________ FEIN/SSN: _________________________
Address: _________________________________________________ Phone Number: ______________________
City: _______________________________________________ State: ________ Zip Code: ___________________
Part II. Information of Business Being Purchased
Name of Business: _________________________________________ Sales Tax Permit Number: _____________
Address: _________________________________________________ Phone Number: ______________________
(Physical Location of Address)
City: _______________________________________________ State: ________ Zip Code: ___________________
Part III. Signature
I, the undersigned applicant, declare that I am purchasing the business listed in Part II and am requesting information
relating to any liabilities, delinquencies, assessments, or warrants of the business identified which have not been filed
of record, established, or become final and which relate specifically to this business.
Person Receiving Information:
Name: __________________________________________________________
Signature: _______________________________________________________ Date: _______________________
Part IV. Authorization to Disclose Tax Information
I, the undersigned owner of said business, or if a corporation, a responsible corporate officer, listed in Part II authorize
the disclosure of any and all information in the files and records of the Oklahoma Tax Commission pertaining to said
business, to the extent necessary.
Type or pint Name and Title: _____________________________________________________________________
Signature: _______________________________________________________ Date: _______________________
Oklahoma Tax Commission
Post Office Box 269057
Oklahoma City, OK 73126-9057
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