Arizona Form 285-I - Individual Income Tax Disclosure/representation Authorization Form
Download a blank fillable Arizona Form 285-I - Individual Income Tax Disclosure/representation Authorization Form in PDF format just by clicking the "DOWNLOAD PDF" button.
Open the file in any PDF-viewing software. Adobe Reader or any alternative for Windows or MacOS are required to access and complete fillable content.
Complete Arizona Form 285-I - Individual Income Tax Disclosure/representation Authorization Form with your personal data - all interactive fields are highlighted in places where you should type, access drop-down lists or select multiple-choice options.
Some fillable PDF-files have the option of saving the completed form that contains your own data for later use or sending it out straight away.
ADVERTISEMENT
1ARIZONA FORM
Individual Income Tax Disclosure/Representation
285-I
Authorization Form
ARIZONA DEPARTMENT OF REVENUE • 1600 WEST MONROE, PHOENIX, AZ 85007
1. TAXPAYER INFORMATION: Please print or type.
Taxpayer Name(s)
Social Security Number(s)
Present Address - number and street, rural route
Apartment/Suite No.
Daytime Telephone Number (with area code)
City, Town or Post Offi ce
State
Zip Code
2. APPOINTEE INFORMATION
Provide one of the following identifi cation numbers:
Name (List additional appointees on supplemental sheet.)
State and State Bar Number
|
Present Address - number and street, rural route
Apartment/Suite No.
State and Certifi ed Public Accountant Number
|
City, Town or Post Offi ce
State
Zip Code
Internal Revenue Service Enrolled Agent Number
Daytime Telephone Number (with area code)
Social Security or Other ID No. Type
|
3. TAX MATTERS:
The appointee is authorized to receive confi dential information relating to individual income tax for the following tax years:
By signing this form, I authorize the department to release confi dential information of the Taxpayer(s) named above to the appointee named above
for the tax year(s) specifi ed. To grant a Power of Attorney, check the box in Section 4.
4.
POWER OF ATTORNEY: By checking box 4, the taxpayer grants the above-named appointee a Power of Attorney to perform any and all acts
that the taxpayer can perform with regard to the above-mentioned tax matters and tax year(s). The use of a Power of Attorney must be in
accordance with Arizona Supreme Court Rule 31. Please specify any limitation to the Power of Attorney:
5.
REVOCATION OF EARLIER AUTHORIZATION(S): This authorization does not revoke any earlier authorizations or Powers of Attorney on fi le
with the Arizona Department of Revenue. If you want to revoke all prior authorizations or Powers of Attorney on fi le with the Arizona Department
of Revenue, please check box 5. If you wish to revoke only some prior authorizations and/or Powers of Attorney, please check box 5 and list below
those authorizations and Powers of Attorney that you wish to remain in effect.
If box 5 is checked, the revocation will be effective as to all earlier authorizations and Powers of Attorney on fi le with the Department of
Revenue except for the following persons (please specify):
6. SIGNATURE OF OR FOR TAXPAYER: I hereby certify that the Arizona Department of Revenue is authorized to release any and all confi dential
information concerning the above-mentioned Taxpayer. I understand that to knowingly prepare or present a document which is fraudulent or false is
a Class 5 felony pursuant to A.R.S. §42-1127(B)(2).
SIGNATURE
DATE
SIGNATURE
DATE
PRINT NAME
PRINT NAME
7. DECLARATION OF APPOINTEE: Complete if Appointee has been given authority under Section 4 or is otherwise authorized to practice law as
defi ned in Rule 31(a) of Arizona Rules of the Supreme Court. Under penalties of perjury, I declare that I am one of the following:
a Attorney - an active member of the State Bar of Arizona.
b Certifi ed Public Accountant - duly qualifi ed to practice as a Certifi ed Public Accountant in Arizona.
c Federally Authorized Tax Practitioner within the meaning of A.R.S. § 42-2069(D)(1). If appointee is engaged in practice with a federally
authorized tax practitioner, provide the practitioner’s name and CAF number below:
PRACTITIONER’S NAME
CAF NUMBER
d Other - This may be any individual, providing the total amount in dispute, including tax, penalties, and interest is less than $5,000.00.
If this Declaration of Appointee is not signed and dated, the representation authorization will be returned.
DESIGNATION
JURISDICTION
Enter a letter (a, b, c or d).
(State)
SIGNATURE
DATE
ADOR 03-0033f (1/10)
Print Form
Reset Form
ADVERTISEMENT
0 votes
Related Articles
Related forms
Form Ri 4868 - Application For Automatic Extension Of Time To File R.i. Individual Income Tax Return - 1998
Financial
Form Ri 4868 - Application For Automatic Extension Of Time To File R.i. Individual Income Tax Return - 1999
Financial
Form Ri-4868 Application For Automatic Extension Of Time To File R.i. Individual Income Tax Return - 1999
Financial
Related Categories
Parent category: Financial