Form 2678 - Employer/payer Appointment Of Agent

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2678
Employer/Payer Appointment of Agent
Form
OMB No. 1545-0748
(Rev. October 2012)
Department of the Treasury — Internal Revenue Service
Use this form if you want to request approval to have an agent file returns and make
For IRS use:
deposits or payments of employment or other withholding taxes or if you want to
revoke an existing appointment.
• If you are an employer or payer who wants to request approval, complete Parts 1
and 2 and sign Part 2. Then give it to the agent. Have the agent complete Part 3 and
sign it.
Note. This appointment is not effective until we approve your request. See the
instructions for filing Form 2678 on page 3.
• If you are an employer, payer, or agent who wants to revoke an existing appointment,
complete all three parts. In this case, only one signature is required.
Part 1:
Why you are filing this form...
(Check one)
You want to appoint an agent for tax reporting, depositing, and paying.
You want to revoke an existing appointment.
Part 2:
Employer or Payer Information: Complete this part if you want to appoint an agent or revoke an appointment.
1 Employer identification number (EIN)
2 Employer’s or payer’s name
(not your trade name)
3 Trade name (if any)
4 Address
Number
Street
Suite or room number
City
State
ZIP code
For ALL
For SOME
employees/
employees/
5 Forms for which you want to appoint an agent or revoke the agent’s appointment to file.
payees
payees
(Check all that apply.)
Form 940, 940-PR (Employer's Annual Federal Unemployment (FUTA) Tax Return)*
Form 941, 941-PR, 941-SS (Employer’s QUARTERLY Federal Tax Return)
Form 943, 943-PR (Employer’s Annual Federal Tax Return for Agricultural Employees)
Form 944, 944(SP) (Employer’s ANNUAL Federal Tax Return)
Form 945 (Annual Return of Withheld Federal Income Tax)
Form CT-1 (Employer’s Annual Railroad Retirement Tax Return)
Form CT-2 (Employee Representative's Quarterly Railroad Tax Return)
*Generally you cannot appoint an agent to report, deposit, and pay taxes reported on Form 940, Employer's Annual Federal
Unemployment (FUTA) Tax Return, unless you are a home care service recipient.
Check here if you are a home care service recipient, and you want to appoint the agent to report, deposit, and pay FUTA
taxes for you. See the instructions.
I am authorizing the IRS to disclose otherwise confidential tax information to the agent relating to the authority granted under
this appointment, including disclosures required to process Form 2678. The agent may contract with a third party, such as a
reporting agent or certified public accountant, to prepare or file the returns covered by this appointment, or to make any
required deposits and payments. Such contract may authorize the IRS to disclose confidential tax information of the
employer/payer and agent to such third party. If a third party fails to file the returns or make the deposits and payments, the
agent and employer/payer remain liable.
Print your name here
Sign your
name here
Print your title here
/
/
Date
Best daytime phone
Now give this form to the agent to complete.
2678
Form
(Rev. 10-2012)
For Paperwork Reduction Act Notice, see the instructions.
IRS.gov/form2678
Cat. No. 18770D

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