Form 8633 - Application To Participate In The Irs E-File Program - 1998 Page 2

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Form 8633 (Rev. 5-98)
Page
8 Principals of Your Firm or Organization. You may use continuation sheets. (Continued) Complete if line 1d is “No”
Unless you marked the box in 1l, or your only “Yes” response in Section 3 is to question b., you must provide a completed fingerprint card for each corporate officer, owner, or
partner listed below. If a corporate officer, owner, or partner changes, a completed fingerprint card must be provided for each new corporate officer, owner, or partner. If the corporate
officer, owner, or partner is an attorney, banking official who is bonded and has been fingerprinted in the last two years, CPA, enrolled agent, or an officer of a publicly owned corporation,
evidence of current professional status may be submitted in lieu of the fingerprint card (see revenue procedure). Your application will not be processed if you do not provide
the completed fingerprint card or evidence of professional status and a signature for each corporate officer, partner or owner.
Is the individual licensed or
Type or print name (first, middle, last)
U.S. citizenship?
Is the individual:
bonded in accordance with
Legal
an enrolled agent
an attorney
state or local requirements?
resident
an officer of a
Title:
Yes
No
alien
a banking official
Yes
No
publicly owned
Home address
Social security number
a C.P.A.
corporation
Not applicable
Signature
Date of birth (Month, day, year)
Type or print name (first, middle, last)
Is the individual licensed or
U.S. citizenship?
Is the individual:
bonded in accordance with
Legal
an attorney
an enrolled agent
resident
state or local requirements?
an officer of a
Title:
Yes
No
alien
a banking official
Yes
No
publicly owned
Home address
Social security number
a C.P.A.
corporation
Not applicable
Signature
Date of birth (Month, day, year)
Is the individual licensed or
Type or print name (first, middle, last)
U.S. citizenship?
Is the individual:
bonded in accordance with
Legal
an enrolled agent
an attorney
state or local requirements?
resident
an officer of a
Title:
Yes
No
alien
a banking official
Yes
No
publicly owned
Home address
Social security number
Not applicable
a C.P.A.
corporation
Signature
Date of birth (Month, day, year)
9 Responsible Official
The responsible official is the person who oversees the daily operations of the office listed on line 1r and 11. A responsible official may be responsible for
more than one office (see instructions, page 3). A principal listed in Section 8 may also be a responsible official.
Is the individual licensed or
Name of responsible official (first, middle, last)
U.S. citizenship?
Is the individual:
bonded in accordance with
Legal
an enrolled agent
an attorney
state or local requirements?
resident
an officer of a
Title:
Yes
No
alien
a banking official
Yes
No
publicly owned
Not applicable
Home address
Social security number
a C.P.A.
corporation
Signature
Date of birth (Month, day, year)
10 Drop-off Collection Points - complete this section as specified on page 3. (You may use continuation sheets.)
Name and address of Drop-off Collection Point
Name of principal contact
Telephone number (include area code)
(FOR OFFICIAL USE ONLY) CPIN
Does this office operate 12 months?
Yes
No
Name and address of Drop-off Collection Point
Name of principal contact
Telephone number (include area code)
(FOR OFFICIAL USE ONLY) CPIN
Does this office operate 12 months?
Yes
No
11 Foreign Filer (please provide all information)
a Name of contact representative (first, middle, last)
c Telephone number of Foreign location (do not include international access codes,
country codes, or city codes)
b Mailing address (including city, country and postal codes, if applicable)
d Business address (of Foreign location including city, country and postal codes if applicable)
Applicant Agreement
Under the penalties of perjury, I declare that I have examined this application and any accompanying information, and to the best of my knowledge and belief
it is true, correct, and complete. This firm and its employees will comply with all the provisions of the Revenue Procedure for Electronic Filing of Form 1040,
U.S. Individual Income Tax Return, and related publications, for all years of participation.
Acceptance for participation is not transferable. I understand that if this firm is sold or its organizational structure is changed, a new application must be filed.
I further understand that noncompliance will result in the firm and/or the individuals listed on this application no longer being allowed to participate in the
program. I am authorized to make and sign this statement on behalf of the firm.
12. Name and title of firm official and/or principal owner (type or print)
13. Signature of firm official and/or principal owner
14. Date

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