Form Acd-31102 - Tax Information Authorization

ACD - 31102

INT.

10/97

State of New Mexico - Taxation and Revenue Department

TAX INFORMATION AUTHORIZATION

Business Name

New Mexico ID Number

Social Security Number

Name

Telephone Number

Address

Hereby authorizes ___________________________________________________________________________________

Address:

______________________________________

Telephone Number: ______________________________

______________________________________

______________________________________

to represent me and/or my business pertaining to taxes administered by the New Mexico Taxation and Revenue

Department.*

IF IRS INFORMATION IS INVOLVED, BE SURE TO OBTAIN FORM 2848 OR FORM 8821, AS APPLICABLE.

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CHECK ALL ITEMS THAT APPLY

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q

q

all state taxes

FOR

any year

q

CRS taxes

OR

q

q

income taxes

specify specific year(s) __________

q

specify others _________________

_____________________________

_____________________________

I certify that I have the authority to execute this tax information authorization.**

_______________________________________________________________________________________________________

Signature

Title

Date

_______________________________________________________________________________________________________

Signature

Title

Date

*

The taxpayer may limit the scope of this authorization by specifying the particular information or tax types to be handled

by the authorized person.

** For joint returns, both taxpayers must sign. If not signed by the taxpayer, signature must be that of a corporate officer,

partner, or fiduciary on behalf of the taxpayer.