Form Bank - Bank Authorization For Direct Debit
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1BANK
Bank Authorization for Direct Debit for
(year)
Complete if you are electronically filing your tax return (Form M1, M2, M3, M4, M4NP or M8), and you want to authorize a trans-
fer of funds from your account to pay tax owed as shown on your return. Do not complete if filing a paper return.
Your name or name of entity
Social Security or Minnesota tax ID number
Spouse’s name, if filing joint (or partner if a partnership)
Spouse’s Social Security number (if filing joint)
Street address
City
State
Zip code
Routing number
Type of account
Enter the date you want
the amount withdrawn
Checking
from your account.
Account number
Savings
Amount to be withdrawn
I authorize the Minnesota Department of Revenue to initiate debit entries to my account as indicated above. This authority will remain in effect until the department has received
written or faxed (651-556-5130 or 651-556-3130) notification of its termination at least 30 days prior to the effective date.
Your signature or signature of partner
Spouse’s signature (if filing joint)
Date
Daytime phone
ERO: Attach to this form the Minnesota copies of all W-2, W-2G and 1099-R forms and
any other form that shows Minnesota income tax withheld and keep with your records.
9/10
Do NOT mail Form BANK to the Department of Revenue unless requested.
Form BANK instructions
If you are the taxpayer
If you are the Electronic
If you are electronically filing your
Return Originator (ERO)
Requesting the direct payment option is
Form M1, M2, M3, M4, M4NP
voluntary and applies only to the electronic
Currently, the IRS requires you to keep
or M8, and you want to have your
return you are filing.
the W‑2, W‑2G and 1099 forms and other
taxes due automatically withdrawn
documents for three years. You should also
By signing the BANK form, you are autho‑
(direct payment) from your check-
keep with these IRS records the signed,
rizing the Department of Revenue to auto‑
original Form BANK, Minnesota copies
matically withdraw the taxes due directly
ing or savings account, complete
of all W‑2, W‑2G and 1099 forms and any
from your checking or savings account.
Form BANK.
other form that shows Minnesota income
You must sign and date this form. If you are
tax withheld.
The Bank Authorization for Direct
filing a joint return, your spouse must also
If you choose to discard Minnesota records
sign.
Debit (BANK) complies with cur-
earlier, the minimum length of time you
Your tax preparer is required to keep a
rent ACH rules.
must keep these documents on file is until
signed BANK form until the end of the
the end of the calendar year in which the
calendar year in which your return was
return was filed electronically.
electronically filed.
If the Department of Revenue requests cop‑
If you are preparing your own return, keep
ies of Form BANK and/or W‑2, W‑2G or
the BANK form with your tax records.
1099 forms, you must provide the informa‑
tion within five working days.
Do not mail this form to the Department
of Revenue.
Do not mail Form BANK unless requested
to do so by the Department of Revenue.
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