Tax Information Authorization Form 1995 printable pdf download

Tax Information Authorization Form 1995

Form Approved: OMB No. 1512-0033(04/30/98)

DEPARTMENT OF THE TREASURY

BUREAU OF ALCOHOL TOBACCO FIREARMS

TAX INFORMATION AUTHORIZATION

(PURSUANT TO TITLE 26 OFTHE UNITED STATES CODE AND THE FEDERAL ALCOHOL ADMINISTRATION ACT)

IMPORTANT-Please Read Instructions on Reverse Before CompletingThis Form

(Prepare in duplicate - See instructions on back)

PART I - AUTHORIZATION

PRINCIPAL

2. ADDRESS (Number, Street, City, State, ZiP Code)

3. BUSINESS IN WHICH ENGAGED

4. NAME OF REPRESENTATIVE (Attorney, Certified Public

5. ADDRESS (Number Street, City, State, ZIP Code)

Accountant, or Agent)

6. THE ABOVE-NAMED REPRESENTATIVE IS HEREBY AUTHORIZED TO: (See Instruction 3)

Receive from, or inspect in, the office of the District Director, Chief, Technical Services, Chief, Tax Processing Center and/or the

office of the Director, Bureau of Alcohol, Tobacco and Firearms, any confidential information on behalf of the principal.

Receive from, or inspect in, such office(s) confidential information with respect to:

Receive copies of notices and other written communications addressed to the principal involving confidential tax matters.

SIGNATURE

TITLE (If applicable)

DATE

I am a member in good standing of the bar of the highest court of

I am qualified to practice as a certified public accountant in

and that I am authorized to represent

DATE

SIGNATURE

ATF F 5000.19 (4-95) PREVIOUS EDITIONS ARE OBSOLETE

Tax Information Authorization Form 1995