Form Arfi - Authorization For Release Of Financial Information
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AUTHORIZATION FOR RELEASE OF FINANCIAL INFORMATION
(Including account status of a taxfiler)
CITY OF PORTLAND BUSINESS LICENSE TAX
& MULTNOMAH COUNTY BUSINESS INCOME TAX
111 SW COLUMBIA, SUITE 600, PORTLAND OR 97201
FAX: 503-823-5192 ~ Office: 503-823-5157 ~ TDD: 503-823-6868
Web:
Taxfiler Information
(* Required)
* Name of taxfiler as reported on Federal Form 1040, 1120S, Oregon Form 20, etc.
1*
DBA (Doing Business As) of taxfiler
2
Revenue Bureau Business Tax Account Number
* Federal Tax ID (FEIN) or Social Security Number
3
4*
5*
Requestor Information
(all information in this section is required)
* Name of individual making this request (must be someone who is currently authorized to sign the federal tax return of 1 above)
* City
* State/Prov
* Zip Code
* Address (address to which this information can be released)
OR
* Phone Number
Fax Number (optional)
6
Party to whom financial information will be released
(if different from 5 above)
Name (e.g., non-officer employee of 1 above, lending institution, etc.)
State/Prov
Zip Code
Address (address to which this information can be released)
City
OR
Phone Number
Fax Number (optional)
7*
Description of information to be released
Taxfiler account status (Is the account current according to Bureau records?)
Prepayments per Bureau records for the tax year ending ___ / ___ / ______
Other (explain)
8*
Requestor signature
(individual from 5 above)
I declare that I am either the taxpayer whose name is shown on 1 above or an individual currently authorized to sign the federal tax returns
for 1 above or a paid preparer (including employees of the paid preparer) currently authorized to sign the federal tax returns for 1 above.
Title
Date
Signature
TO BE COMPLETED BY THE REVENUE BUREAU
The taxfiler on 1 above is currently in full compliance with the City of Portland Business License Law and Multnomah County
Business Income Tax Law.
For the tax year ended ___ / ___ / ______, the prepayments for the taxfiler on 1 are as follows:
Line 13 (County) = $_______________
Line 23 (City) = $_______________.
Other:
Date
Revenue Bureau Signature
Title
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FORM ARFI (Rev 7/30/2013)
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Parent category: Financial