Fillable Form Wv-Ari-001 - Authorization To Release Information

5. Reason(s) why information is to be released:

_________________________________________________________________________________________________

This waiver will be effective only to the extent explained above and any other release of information is not permitted

without additional authorization. Additionally, information will be released only to the extent the Tax Commissioner believes

disclosure is necessary to comply with this Authorization to disclose information, and will not be disclosed to the extent the

Tax Commissioner determines that disclosure would seriously impair administration of this State’s tax laws.

This authorization must be signed by the taxpayer, or taxpayer’s authorized representative, and the signature of the person

signing the authorization must be notarized. Documentation of fiduciary relationships (e.g. Guardianship, POA, Trustee,

Executrix) must be attached. Please note that original signatures are required. Faxed, photocopied or stamped signatures

are unacceptable.

Authorization is for:

•

release of personal income tax return(s); if jointly filed personal income tax return is requested, the authorization

must be signed by either the husband or the wife.

•

release of a return filed by a business that is a sole proprietorship, the authorization must be signed by the owner

of the business or by an employee of the business, or other person, who is authorized to sign the authorization.

•

a corporation, the authorization must be signed by its president, vice president, treasurer, assistant treasurer, chief

accounting officer or other person duly authorized to sign the authorization.

•

release of a return filed by a partnership, as defined for federal income tax purposes, the authorization must

be signed by the managing partner, or tax matters partner, or any other partner or employee of the partnership

authorized to sign the authorization.

•

release of a return filed by a limited liability company, the authorization must be signed by the managing member,

tax matters member, or any other member or employee of the limited liability company authorized to sign the

authorization.

•

a return filed by an estate or trust, the authorization must be signed by the executor or executrix of the estate, or

the trustee of the trust.

•

for information other than a tax return, the authorization must be signed by a person who could authorize release

of taxpayer’s tax return.

Print Name

Signature

Capacity

Date

State of _________________________________

County of ______________________ , to-wit,

This day appeared before me, the undersigned notary public, ____________________________________________ who

acknowledge under oath the signature above.

Print Taxpayer’s Name

Notary Public

Date

My commission expires ________________________________________________________

Form Wv-Ari-001 - Authorization To Release Information - 2014 Page 2

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