Form Gao-09 - Assessment Report - Pennsylvania Public Utility Commission Page 5
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5SECTION 4
AUTHORIZATION FOR RELEASE OF STATE TAX RECORDS
In accordance with Sections 505 and 506 of the Public Utility Code, as a means to verify the
accuracy of financial information supplied to the Public Utility Commission, I hereby authorize the
Pennsylvania Department of Revenue to release to the Public Utility Commission, any tax records filed or
compiled with regard to the below-listed utility and/or individual.
____________________________________________________
Utility Name
X __________________________________________________
Signature
Date:______________
____________________________________________________
Name (Printed)
Title
GAO-09
Page 4 of 4
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