Form 8821de - Authorization To Release Tax Information

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STATE OF DELAWARE
FORM 8821DE
DIVISION OF REVENUE
(March 2006)
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Authorization to Release Tax Information
Completion and submission of this form authorizes the Delaware Division of Revenue to release confidential information of the Taxpayer(s)
named below to the authorized person(s) or organization named below for the tax type(s) specified below. This form does not give Power
of Attorney and does not grant the authorized person(s) or organization any powers of representation. Unauthorized disclosure of tax
information is a criminal offense.
Read the instructions below before completing this form.
Your name or name of entity
Social Security or Federal Employer ID number
Spouse’s name, if joint (or corporate officer, partner or fiduciary if a business) Spouse’s Social Security number (if a joint return)
Street address
City
State
Zip code
I authorize the following person or organization to inspect and/or receive private and non-public information in regard
to the tax types and periods provided below.
Name of person or organization to receive tax information
Name of firm (if applicable)
Street address
City
State
Zip code
Phone Number
Fax Number
(
)
(
)
The above person or organization is authorized to receive the following tax information (check all that apply):
Type of Tax
Year(s) or Period(s)
Type of Tax
Year(s) or Period(s)
Individual Income
Gross Receipts
Corporate Income
Withholding
Pass-through Return
Other (please specify)
The authorization to release tax information is not valid until it is signed and dated. It will expire 60 days after the
information is released. By signing this form, I hereby certify that the Delaware Division of Revenue is authorized to
release any and all confidential information concerning the above mentioned Taxpayer under penalty of law. A copy of this
form will be mailed to the individual(s) authorizing the release.
Your Signature or that of Corporate Officer, Partner of Fiduciary Print Name (and Title, if applicable)
Date
Phone
(
)
Spouse’s signature (if joint)
Print Spouse’s name (if joint)
Date
Phone
(
)
Mail to: Delaware Division of Revenue, 820 North French Street, Wilmington, DE 19801
Form 8821DE Instructions
Purpose of this form
Your Signature
Questions?
You must complete, sign and return this
The authorization to release tax information
If you have questions on how to complete this
form if you want to authorize a person or
is not valid until it is signed and dated. Your
form or to fax this form, call (302) 577-8200
organization to inspect and/or receive
spouse must also sign if joint returns are listed.
for a staff contact who will provide you with a
certain private or nonpublic information
Your signature at the bottom of this form
fax number. You must include a Division
concerning your state taxes.
authorizes the individual or organization you
of Revenue contact name on all faxed
By completing and signing this form, you
designate to only be able to inspect and/or
authorization forms.
are authorizing the Division of Revenue
receive confidential tax information on your
to release tax information to the person
behalf.
or organization you have indicated.
Revenue will accept copies of the form,
including those from a FAX machine.
This authorization will expire 60 days after
the information is released to the person
or organization you have indicated.

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