Form Et007 - Authorization For Release Of Tax Information printable pdf download

Form Et007 - Authorization For Release Of Tax Information

AUTHORIZATION FOR RELEASE OF TAX INFORMATION

Excise Tax Administration, Room 217

Arkansas Department of Finance and Administration

P. O. Box 8054

Little Rock, Arkansas 72203-8054

Telephone: (501) 682-7200

Fax: (501) 682-7900

*Company Name: _________________________________________________________________

Address: _________________________________________________________________________

_________________________________________________________________________________

*F.E.I.N.: __________________________________

S.S.N.: _____________________________

Do you have employees in Arkansas? _____

Taxable Corporation? ___ Sub-S? ___ Partnership? ___

Sole Proprietorship? ____

*If a subsidiary of a parent corporation filing a consolidated return with Arkansas, give the name of parent

and parent federal employer identification number (F.E.I.N.). If business is a Sole Proprietorship enter the

social security number (SSN) of the owner in addition to the FEIN of the business.

AUTHORIZATION FOR RELEASE

The taxpayer indicated above hereby authorizes the release of tax information maintained by the

Arkansas Department of Finance and Administration to:

_________________________________________________________________________________

This authorization is: (check one)

_______ limited to this one request.

________ continuous until withdrawn in writing by taxpayer.

Signature of Taxpayer:

__________________________________________

Title:

______________________________________________________

Subscribed and Sworn to before me this ________ day of _______________________, 19______.

Notary Public ____________________________________

(Seal)

Form ET007

Form Et007 - Authorization For Release Of Tax Information