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Form Gt-400210 - Registration Information Sharing And Exchange (Rise) Program Level-One Agreement Page 6

GT-400210

R. 01/16

RISE Attachment C for Level-one Agreement

Page 6

Revenue Information Sharing and Exchange (RISE)

Program Participant Certification for

Access to Confidential State Tax Information

I hereby certify that I have read and understand the following:

Section 213.053, F.S., makes state tax information in the possession of the Department confidential

except for official tax administration purposes.

Violation of confidentiality requirements found in s. 213.053(2), F.S., is a first degree misdemeanor,

punishable, as stated in ss. 775.082 and 775.083, F.S.

When in receipt of state tax information from the Department, RISE participants and their authorized

employees, and certified public accountants contracted pursuant to ss. 125.0104 and 212.0305, F.S.,

are subject to the same requirements of confidentiality and the same penalties for violation of those

requirements as the Department.

No federal tax information will be made available.

Confidential state tax information must be kept under lock and key when not being used.

State tax information may be used for official tax administration purposes only.

When no longer needed, this information will be returned to the department, or destroyed according to

the agreement.

Only authorized employees of the RISE participant listed on the attached sheet, or any certified public

accountant contracted pursuant to s. 125.0104 or 212.0305, F.S., with an official need and use, will be

allowed to request, receive, and review state tax information.

______________________________________

________________________________________

(Name)

(Title of Signer)

Signer of RISE Agreement

(Signature)

(Date)

As an authorized employee of the RISE Participant, I hereby certify that I am familiar with the confidentiality

requirements of s. 213.053, F.S., and aware of the criminal penalties for the unauthorized disclosure of state

tax information punishable as stated in ss. 775.082 and 775.083, F.S. I understand that state tax information

received from the Department may be used by listed staff of the Government Entity and for official tax

administration purposes only.

Name (Print or Type)

Official Title

Signature

Date

________________________________________________________________________________________________

(Attach additional sheets if necessary)

Form Gt-400210 - Registration Information Sharing And Exchange (Rise) Program Level-One Agreement Page 6