Form 10301 - Cd Encryption Code Authorization For Cp2100 972cg Notices Page 2

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Page 2

Instructions for Form 10301, CD Encryption Code Authorization For CP2100/972CG Notices

General Instructions

Block 6 - Enter a self-assigned ten digit PIN. The PIN must be

ten alphanumeric characters. Special characters are not allowed.

Use Form 10301 to authorize a contact person to receive an

This PIN is used to authorize the contact to receive the

encryption code required to read a compact disk (CD) containing:

encryption code. Retain the PIN for future reference. The

• Notice CP2100, Please check your Backup Withholding List

encryption code will not be provided prior to PIN verification.

• Notice 972CG, A Penalty is proposed for your Information

Returns

Block 7 - Affidavit. This application must be completed and

submitted by: (a) the owner, if the applicant is a sole

Revise Form 10301 Information - Check the box located at the

proprietorship, (b) the president, vice president, or other principal

top of the form and complete form with current company

officer, if the applicant is a corporation, (c) a responsible and

information.

duly authorized member or officer having knowledge of its

Timeframe - Allow 5 business days from the date IRS receives

affairs, if the applicant is a partnership, government entity, or

this form.

other unincorporated organization, or (d) the fiduciary, if the

applicant is a trust or an estate. Check the box to confirm that

Specific Instructions

you have read the affidavit and are authorized to sign on behalf

Complete this form with black ink.

of the company.

All fields marked with an asterisk (*) are required fields.

Block 8 - Form 10301 must be signed and dated by an official of

the company or organization. If you have a power of attorney,

Block 1 - Check the box for Original or Revised.

attach a copy to this form.

Block 2 - Enter the legal name and complete street address of

Note: This Form 10301 automatically revokes all prior

the company (payer) receiving the CD containing CP2100/

authorizations.

972CG Notices.

Where to file

Block 3 - Enter the nine-digit Taxpayer Identification Number

Internal Revenue Service

(TIN) [Employer Identification Number (EIN) or the Social

230 Murall Drive, Mail Stop 4360

Security Number (SSN)] of the payer.

Kearneysville, WV 25430

Block 4 - Enter the name and telephone number of the primary

Fax:

contact person authorized to receive the encryption code. It is

(877) 477-0572 (within the U.S)

the responsibility of the contact person to know company's PIN.

(304) 579-4105 (International)

Block 5 - Enter the name and telephone number of the

Please either fax or mail, do not do both.

secondary contact person authorized to receive the encryption

code. It is the responsibility the contact person to know

Upon receipt of the CD, the primary or secondary contact is

company's PIN.

required to call the IRS to receive the encryption code.

Assistance is available Monday through Friday at:

• (866) 455-7438 (Toll Free)

• (304) 263-8700 (International)

Paperwork Reduction Act Notice

We ask for the information on these forms to carry out the Internal Revenue Laws of the United States. You are not required to provide the information

requested on a form that is subject to the Paperwork Reduction Act unless the form displays a valid OMB control number. Books or records relating to a

form must be retained as long as their contents may become material in the administration of any Internal Revenue law. Generally, tax returns and

return information are confidential, as required by Code section 6103. The time needed to provide this information would vary depending on individual

circumstances. The estimated average time is: Preparing Form 10301 is 15 minutes.

If you have comments concerning the accuracy of this time estimate or suggestions for making this form simpler, we would be happy to hear from you.

Write to the Tax Forms Committee, Western Area Distribution Center, Rancho Cordova, CA 95743-0001. Do not send Form 10301 to this address.

10301

Catalog Number 33392H

Form

(Rev. 1-2017)