Form 74 - Taxpayer Information Release Form

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Michigan Department of Treasury
74, Formerly C-1036 (Rev. 5-90)
TAXPAYER INFORMATION RELEASE
Taxpayer Information
Name
Address (Street)
City
State
ZIP
Social Security Number
Telephone Number
Release Information To:
Name
ZIP
Address (Street)
City
State
Type of Tax
This Authorization Expires On: (Date)
Authorizing Signature
Date

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