Form 285 - General Disclosure/representation Authorization Form printable pdf download

General Disclosure/Representation

Arizona Form

Authorization Form

285

a Withholding or Transaction Privilege Tax License number if

PURPOSE OF FORM

applicable.

Form 285 enables any individual, sole proprietorship, joint

Section 2 - Appointee Information.

filers, corporation, group of consolidated or combined

corporations, partnership, limited liability company, estate,

Enter the name of the person you are appointing to be

trust, governmental agency, or other organization, association,

authorized to receive Taxpayer’s confidential information

or group thereof (“Taxpayer”) to designate a person

and/or act on Taxpayer’s behalf. The Appointee must be an

(“Appointee”) to whom the Arizona Department of Revenue

individual. Appointee’s Social Security number, CPA number,

can release confidential information, if the release of such

State Bar number, Alternative Preparer Tax Identification

information is not otherwise authorized by A.R.S. § 42-2003.

number or other identification number must be provided.

The disclosure of such confidential information may be

Please attach a supplemental sheet containing the required

necessary to fully discuss tax issues with, or respond to tax

information if Taxpayer(s) desires to authorize more than one

questions by such Appointee.

The form can also grant

Appointee to receive Taxpayer’s confidential information

additional powers to the Appointee, up to and including the

and/or act on Taxpayer’s behalf.

power to represent Taxpayer at any formal administrative tax

Section 3 - Tax Matters.

proceeding.

If Taxpayer grants Appointee the power of

representation, this authorization form shall operate as a Power

You may use this form for more than one tax type. Please

of Attorney.

check applicable boxes and specify the tax year(s) or tax

period(s) for which Appointee is authorized to receive

FILING INSTRUCTIONS

Taxpayer’s confidential information and/or act on Taxpayer’s

behalf. A general reference to “all years”, “all periods”, or

If Taxpayer is working with a specific section/employee of

periods or years “to present” will be accepted as applying only

the Arizona Department of Revenue (“Department”), mail

to tax years (periods) ending prior to the date the form is

Form 285 to such section/employee. Otherwise, mail Form

signed. A general reference to “all future” years or periods

285 to:

will be subject to a four year limitation. Also, check the box

Arizona Department of Revenue

that properly describes the form of ownership of Taxpayer.

Taxpayer Information and Assistance

Section 4 - Scope of Authorization.

P.O. Box 29086

Phoenix, AZ 85038

At minimum, this authorization form authorizes the

Department to release Taxpayer’s confidential information

Taxpayer may file an original, a photocopy, or a facsimile

to Appointee. However, Taxpayer may also grant specific

transmission (Fax) of Form 285.

additional powers in section 4 by checking the applicable

SPECIFIC INSTRUCTIONS

“yes” box(es). A blank box will be treated as a “no”, even if

the Power of Attorney is granted by this form.

Section 1 - Taxpayer(s) Information.

The Appointee must be given the Power of Attorney

(marking “yes” in Box vi of Section 4) in order to

Enter Taxpayer’s name, address, and daytime telephone

represent taxpayer during any administrative tax

number on the lines provided.

Taxpayer may attach a

proceedings. “Administrative tax proceedings” include

supplemental page to the form if section 1 does not provide

proceedings before, and submissions to the Hearing Office

sufficient space for the required information. If Taxpayer is a

or Director of the Department, or the Office of

consolidated or combined group of corporations, Taxpayer

Administrative Hearings. In order to represent Taxpayer

must attach a federal Form 851 or a supplemental sheet, as

in an administrative proceeding, in addition to receiving

applicable, containing the names of each member of the

a Power of Attorney, the Appointee must meet the

consolidated

combined

group

and

indicating

the

requirements of Rule 31(a)(4)(M) of the Arizona Rules of

corporations for which the signator of Form 285 is a principal

the Supreme Court.

The following individuals are

corporate officer. If the principal corporate officer signing

authorized pursuant to Rule 31(a)(4)(M) to represent

the form is not a principal corporate officer of all members

Taxpayers if they have been given a Power of Attorney:

of the consolidated or combined group, this form will only

be effective as to the members of the consolidated or

Any individual, IF the total amount in dispute, including

combined group in which the signator is a principal

tax, penalties, and interest, is less than $5000.00;

corporate officer.

A full-time officer, partner, member or manager of a

An individual taxpayer, sole proprietorship, or joint filer(s)

limited liability company, or employee, IF: (1) taxpayer

must provide a Social Security number(s), Withholding

is a legal entity, such as a corporation, a formal

number, or Transaction Privilege Tax License number, as

partnership, a limited liability company, or a trust; (2)

applicable. Taxpayers which are corporations, partnerships, or

such representation is not the appointee’s primary duty

trusts must provide their Federal Employer Identification

to the legal entity, but secondary or incidental to other

number and a Withholding or Transaction Privilege Tax

duties relating to the management or operation of the

License number if applicable. Taxpayers which are estates

legal entity; and (3) the person is not receiving separate

must provide either the decedent’s Social Security number or

the estate’s Federal Employer Identification number, as well as

Form 285 - General Disclosure/representation Authorization Form

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