Form 23 - Application For Enrollment To Practice Before The Internal Revenue Service - 2017
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1
223
Application for Enrollment to Practice Before
Form
the Internal Revenue Service
OMB Number
(April 2017)
1545-0950
Department of the Treasury
See Instructions on Page 3
Internal Revenue Service
Important things you need to know and do before you file this form:
• Take and pass the Special Enrollment Examination
For IRS use:
• You must obtain a Preparer Tax Identification Number (PTIN) before completing this form
• Read Circular 230
Date Enrolled:
• The application fee is $30.
Visit to file and pay electronically. This fee is non-refundable.
Check here if you are a former Internal Revenue Service Employee, and enter the date you separated
Enrollment Number:
from the Service
.
/
/
Part 1. Tell Us About Yourself
1
Your Social Security Number
If you do not have an SSN, please check this box.
2
Date of Birth
mm/dd/yyyy
3
Your Full Legal Name
Last
First
M
4
Your Current Address
Number
Street
Suite or Apt. Number
City
State
Zip Code
Country
Your email Address:
Your Contact Telephone Number:
5
Enter your PTIN number issued by the IRS:
6
Do you have an Employer Identification Number (EIN)?
Yes
No
If Yes, enter all EINs, business names, and addresses below (attach additional pages, if necessary):
EIN
Business Name
Business Address
23
For Privacy Act and Paperwork Reduction Act Notice, see page 3.
Form
(Rev. 4-2017)
Cat. No. 16233B
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Parent category: Legal