Form 12339 - Internal Revenue Service Advisory Council-Membership Application

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Department of the Treasury - Internal Revenue Service
OMB Number
Internal Revenue Service Advisory Council
(April 2017)
Membership Application
June 16, 2017.
Complete this application and return it to the address below no later than Close of Business on
You may also FAX your application to: 855-811-8021.
Anna Millikan
IRS National Public Liaison Office
CL:NPL:P - Room 7559
1111 Constitution Ave, NW
Washington, DC 20224
PART I – Applicant Information (Some of the information requested in Part I is required to perform an FBI background check)
Maiden name or other name
names were used
Home street address
Home telephone number
ZIP Code
Date of birth
City of birth
State of birth
Business name
Business address
Job title
ZIP Code
Business telephone number
Business FAX number
Email address
PART II – Applicant must complete and submit
Form 13775, Tax Check
Waiver, with this form
PART III – Desired Skills and Qualifications
Submit a brief statement addressing your past or current affiliations and dealings with a particular organization or group that you
represent and how such dealings will allow you to know the views or position of that particular organization or group. Also include in the
statement which of the following subgroups (select only one) your skill set best fits: Digital Services, Large Business & International,
Office of Professional Responsibility, or Small Business/Self-Employed and Wage and Investment.
In addition, submit a short (one or two page) statement, including recent examples, addressing your specific skills and qualifications as
they relate to the following:
● Applying tax law knowledge in the resolution of complex tax issues
● Experience working in a multi-cultural/multi-lingual environment
● Experience establishing successful strategic partnerships
● Digital industry experience to include online services for tax professionals, financial applications, software development, user
experience design
● Experience working with third parties (i.e., individuals or organizations who interact with the IRS on behalf of taxpayers)
● Experience working with Software Developers on tax-related applications, understanding their needs, and using and/or implementing
relevant Application Program Interfaces (APIs)
● Ability to examine issues from a ''macro'' viewpoint, and effectively communicate your views and recommendations regarding issues
Catalog Number 28320P
(Rev. 4-2017)


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