Form 23 - Application For Enrollment To Practice Before The Internal Revenue Service 2006

Download a blank fillable Form 23 - Application For Enrollment To Practice Before The Internal Revenue Service 2006 in PDF format just by clicking the "DOWNLOAD PDF" button.

Open the file in any PDF-viewing software. Adobe Reader or any alternative for Windows or MacOS are required to access and complete fillable content.

Complete Form 23 - Application For Enrollment To Practice Before The Internal Revenue Service 2006 with your personal data - all interactive fields are highlighted in places where you should type, access drop-down lists or select multiple-choice options.

Some fillable PDF-files have the option of saving the completed form that contains your own data for later use or sending it out straight away.

OMB Clearance Number 1545-0950

For IRS Use Only

Department of the Treasury - Internal Revenue Service

Date

Enrollment Number

Form

Application for Enrollment to Practice

Please Provide Your:

(Rev. October 2006)

PTIN or Candidate Number

Before the Internal Revenue Service

Exam Passing DATE

Instructions

(General)

Type (or print legibly using ink) and sign the form.

• Attach a check or money order for $125, payable to the Internal Revenue Service. The Fee is non-refundable.

• Attach copies of all Passing Examination Results. Certain Former IRS Employees with technical expertise may be exempt from this requirement.

• Mail to: U.S. Treasury/IRS Enrollment, P.O. Box 894191, Los Angeles, CA 90189-4191.

• Send mail by courier to: Internal Revenue Service, Attn: Box 4191, 5860 Uplander Way, Culver City, CA 90230

2. Other Names Used and Dates Used

1. Full Legal Name

(Last, First, Middle)

3. Telephone/E-mail

(including maiden name)

(

)

Home

(

)

Office

Email:

Instructions for Question 4:

•

Enter enrollment mailing address (number and street, apartment, suite, or P.O. Box number, city, state, and ZIP code).

•

The address you enter will be the address under which you are enrolled; it is the address where we send your correspondence concerning

your enrollment.

•

If your enrollment mailing address changes, you must promptly send us a written change of address. Your written change of address must include: your

name; your old address; your new address; your social security number; the date; and your signature.

•

Send your change of address to: IRS—Enterprise Computing Center, P.O. Box 33968 Detroit, MI 48232, Attn: EPP Unit

•

Sending Form 8822, Change of Address, to the address specified on that form will change your address for tax purposes but will not change your

enrollment mailing address (nor will sending Form 8822 to us change your address for tax purposes). However, you may, if you choose, send Form 8822

(original or copy) to us as your written change of address.

•

Your enrollment mailing address is protected as confidential under the Privacy Act. If you choose to sign the Optional Privacy Act Consent to Public

Disclosure of Enrollment Mailing Address, we may disclose your enrollment mailing address, with your name, to the general public by print or electronic

media. Disclosures to the general public may include: mailing lists requested by individuals or organizations seeking to offer you goods or services;

telephone contacts or correspondence with individual members of the public; and Websites.

•

If you do not sign the Optional Privacy Act Consent to Public Disclosure of Enrollment Mailing Address, your enrollment mailing address will remain

confidential. However, regardless of whether you sign such consent, if your are censured, suspended, disbarred or enjoined in connection with IRS

practices, etc., the fact of such sanction is public information, and we may disclose the fact of suspension, or disbarment, with your name, city, and state

(but not your street address) to the general public by print or electronic media.

4. Enrollment Mailing Address

5a. Date of Birth

(MM/DD/YY)

Optional Privacy Act Consent to Public Disclosure of Enrollment Mailing Address—See instructions above.

5b. Place of Birth

(City and State/Country)

By my signature in this block, I,

, hereby submit my written consent

(sign your name)

under the Privacy Act for the Office of Professional Responsibility to disclose my enrollment mailing address to the general

public.

6. Social Security Number

As part of the enrollment procedures, we verify that you timely filed your Federal tax returns. So that we can locate your returns without delay, we ask that

you provide us your social security number. If you filed jointly with your spouse, we also need the social security number of your spouse. Disclosure is

voluntary; no law requires this disclosure, but not giving the social security number(s) may result in delayed processing of this application.

EMPLOYER IDENTIFICATION NUMBER :

YOUR SOCIAL SECURITY NUMBER:

SPOUSE'S SOCIAL SECURITY NUMBER:

SPOUSE'S NAME:

7. Eligibility Information

YES

a. Are you a successful Special Enrollment Examination candidate?

(If "Yes,'' attach copy of letter advising you of this.)

b. Are you a former Internal Revenue Service employee seeking enrollment

under section 10.4(b) of Treasury Department Circular No. 230?

(If "Yes," complete Schedule A.)