Form Rd-1062 - Disclosure Authorization Form - Georgia Department Of Revenue Page 2
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RD1062
Disclosure Authorization Form
Purpose of Form
A taxpayer may use Form RD1062 to authorize the Georgi
a Department of Revenue to disclose and/or discuss
confidential tax information for such taxpayer with an appointee for a specific tax type(s) and period(s). Form RD1062
cannot be used as a Power of Attorney and thus does not grant the appointee any powers of representation.
Filing Instructions
Taxpayers should submit Form RD1062 to the appropriate taxing division. Taxpayers should only use this form when
submitting a specific request for information.
Specific Instructions
Section 1 - Taxpayer Information
Individuals - Enter your name, address, and any applicable identification numbers.
Section 2 - Appointee
Enter the appointee's name, address, and any applicable identification numbers.
Section 3 - Authorization
Enter the tax type(s) and specific period(s) or year(s) for which the authorization is granted. A general reference to "all
years" or "all periods" is not acceptable.
Section 4 - Retention/Revocation of Prior Disclosure Authorization Forms
All existing disclosure authorization forms previously filed by the taxpayer will not be revoked unless the taxpayer checks
the box on this line. If the taxpayer checks off this box but does not want to revoke all existing disclosure authorization
forms, the taxpayer should either specify the forms that the department should retain or attach a copy of such existing
form(s).
A taxpayer may revoke a disclosure authorization form without authorizing a new appointee by filing with the department
either:
(1) A statement of revocation signed by the taxpayer indicating that the authority of the previous disclosure authorization
form is revoked along with the name and address of each appointee whose authority is revoked; or
(2) A copy of the disclosure authorization form to be revoked clearly marked "REVOKED."
It is important to note that the filing of a Form RD1062 disclosure authorization form will not revoke any Power of Attorney
that is in effect.
Section 5 - Signature of Taxpayer
Taxpayer
Who must sign
Individuals
The individual/sole proprietor must sign.
Corporations
A corporate officer or a person designated by a corporate officer must sign.
Partnerships
A partner having authority to act in the name of the partnership must sign.
Trusts
A Trustee must sign.
Estates
An Executor/Executrix or the personal representative of the estate must sign.
Limited Liability Companies
A member having authority to act in the name of the company must sign.
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