Form 20a100 - Declaration Of Representative
Download a blank fillable Form 20a100 - Declaration Of Representative 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 20a100 - Declaration Of Representative 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.
ADVERTISEMENT
1
2
320A100
DECLARATION OF REPRESENTATIVE
Commonwealth of Kentucky
Department of Revenue
1. TAXPAYER INFORMATION: Please type or print.
Enter only those that apply.
Taxpayer Name
Federal Taxpayer Identification Number
Mailing Address - Number and Street
Apartment/Suite No.
E-mail Address
City
State
Zip Code
Daytime Phone
2. REPRESENTATIVE(S) INFORMATION
Enter applicable identification number.
Name
State and State Bar Number
Mailing Address - Number and Street
Apartment/Suite No.
State and CPA License Number
City
State
Zip Code
Daytime Phone
IRS Enrolled Agent Number
Name
State and State Bar Number
Mailing Address - Number and Street
Apartment/Suite No.
State and CPA License Number
City
State
Zip Code
Daytime Phone
IRS Enrolled Agent Number
Name
State and State Bar Number
Mailing Address - Number and Street
Apartment/Suite No.
State and CPA License Number
City
State
Zip Code
Daytime Phone
IRS Enrolled Agent Number
3. TAX MATTERS: The taxpayer appoints the above representative(s) for purposes of duly authorized representation
in any proceeding with the Kentucky Department of Revenue with respect to the tax matters indicated below. If no tax
form number or tax year is provided this form will be valid for all tax types and authorized acts selected until revoked.
TAX FORM NUMBER
TAX TYPE
ACCOUNT NUMBER
TAX YEAR(S) OR PERIOD(S)
(740, 720, 51A205, etc.)
Corporation Income/Limited Liability
¨
Entity Tax
¨
Individual Income Tax
¨
Sales and Use Tax
¨
Property Tax
¨
Other (Please Specify)
4. AUTHORIZED ACTS: The representative listed above is authorized to receive, inspect, and discuss the taxpayer’s
confidential tax information. The taxpayer also authorizes the following acts:
¨
Representative has the authority to sign a statute of limitations waiver on Taxpayer’s behalf.
¨
Representative has the authority to execute a protest on Taxpayer’s behalf.
¨
Representative has the authority to represent Taxpayer in any administrative tax proceeding, including conferences.
¨
Representative has the authority to receive notices and communications (unless system generated) from the Department of
Revenue.
¨
Representative has the authority to represent Taxpayer in any collection matter, including an Offer-in-Settlement.
¨
Representative may obtain Taxpayer’s CBI number and execute changes to Taxpayer’s account.
¨
Other acts. (Please specify) ________________________________________________________________________________________
20A100 (8-17)
Page 1 of 3
ADVERTISEMENT
0 votes
Related Articles
Related forms
Related Categories
Parent category: Financial