Bank Authorization For Direct Debit - Minnesota Department Of Revenue

BANK

Bank Authorization for Direct Debit for __________ (year)

To authorize a transfer of funds from your account to pay income tax owed as shown on Form M1.

Your first name and initial

Last name

Social Security number

If a joint return, spouse’s first name and initial

Last name

Social Security number

Current home address (street, apartment number, route)

City

State

Zip code

Type of account:

Routing number

Enter the date you want

the amount withdrawn

Checking

from your account:

Account number

Amount to be withdrawn:

Savings

,

,

I authorize the Minnesota Department of Revenue to initiate debit entries to my account as indicated above. This authority will remain in effect until the department has received

written or faxed (651-296-8222) notification of its termination at least 30 days prior to the effective date.

Your signature

Spouse’s signature (if filing joint)

Date

Daytime phone

(

)

ERO: Attach to this form the Minnesota copies of all W-2, 1099-R and

any other form that shows Minnesota income tax withheld and keep with your records.

10/02

Do NOT mail Form BANK to the Department of Revenue unless requested.

Form BANK instructions

If you are the taxpayer

If you are the Electronic

The Bank Authorization for Direct

If you are electronically filing your return,

Return Originator (ERO)

Debit (BANK) complies with

you may request to have your taxes due

Currently, the IRS requires you to keep

current ACH rules that require a

automatically withdrawn (direct payment)

W-2s, 1099s and other documents for

signature document for automatic

from your checking or savings account.

three years. You should also keep with

Requesting the direct payment option is

withdrawals.

these IRS records the signed, original Form

voluntary and applies only to the electronic

BANK, Minnesota copies of all W-2s,

return you are filing.

1099-R forms and any other form that

shows Minnesota income tax withheld.

By signing the BANK form, you are

authorizing the Department of Revenue to

If you choose to discard Minnesota records

automatically withdraw the taxes due

earlier, the minimum length of time you

directly from your checking or savings

must keep these documents on file is until

account.

the end of the calendar year in which the

return was filed electronically.

You must sign and date this form. If you

are filing a joint return, your spouse must

If the Department of Revenue requests

also sign.

copies of Form BANK and/or W-2 or 1099

forms, you must provide the information

Your tax preparer is required to keep a

within five working days.

signed BANK form until the end of the

calendar year in which your return was

Do not mail Form BANK unless requested

electronically filed.

to do so by the Department of Revenue.

If you are preparing your own return, keep

the BANK form with your tax records. Do

not mail this form to the Department of

Revenue.