Form Nyc-579-Ubti - Signature Authorization For E-Filed Unincorporated Business Tax Return For Individuals - 2017

2017

NYC

NEW YORK CITY DEPARTMENT OF FINANCE

579 UBTI

Signature Authorization for

TM

E-Filed Unincorporated Business Tax Return for Individuals

Department of Finance

ELECTRONIC RETURN ORIGINATORS (ERO): DO NOT MAIL THIS FORM TO THE DEPARTMENT OF FINANCE. KEEP THIS FOR YOUR RECORDS.

:

FIRST NAME AND INITIAL

LAST NAME

SOCIAL SECURITY NUMBER

:

:

n

n

NYC-5UBTI

NYC-EXT

EMAIL ADDRESS

TYPE OF FORM

n

n

NYC-202

NYC-202S

Financial Institution Information - must be included if electronic payment is authorized

:

:

:

AMOUNT OF AUTHORIZED DEBIT

FINANCIAL INSTITUTION ROUTING NUMBER

FINANCIAL INSTITUTION ACCOUNT NUMBER

Part A — Declaration and authorization of Taxpayer for Forms NYC-202, NYC-202S, NYC-EXT or NYC-5UBTI

Under penalty of perjury, I declare that I am the taxpayer and that I have examined the information on its 2017 New York City electronically filed Unincorporated

Business Tax return, including any accompanying schedules, attachments and statements or other report, and to the best of my knowledge and belief, the electron-

ically filed document is true, correct and complete. The ERO has my consent to send the 2017 New York City electronically filed Unincorporated Business Tax

return or other report checked above to the New York City Department of Finance through the Internal Revenue Service. I authorize the ERO to enter my PIN

as my signature on the 2017 New York City electronically filed Unincorporated Business Tax return or other report, as indicated above or I will enter my PIN as

my signature on the document indicated above. If I am paying the New York City Unincorporated Business Tax owed by electronic funds withdrawal, I author-

ize the New York City Department of Finance and its designated financial agents to initiate an electronic funds withdrawal from the financial institution account

indicated on the Unincorporated Business Tax return or other report, and I authorize the financial institution to debit the amount from that account.

n

I authorize ___________________________________________________ to enter my PIN :

ERO FIRM NAME

as my signature on the 2017 Unincorporated Business Tax return or other report, as indicated above

n

As the taxpayer I will enter my PIN as my signature on the 2017 Unincorporated Business Tax return or other report, as indicated above.

_______________________________________________________

_____________________________________

____________________

Signature of Taxpayer

Official title

Date

Part B — Declaration of electronic return originator (ERO) and paid preparer

Under penalty of perjury, I declare that the information contained in the above-named taxpayer’s 2017 New York City electronically filed unincorporated busi-

ness tax return or other report checked above is the information furnished to me by the taxpayer. If the taxpayer furnished me with a completed 2017 New

York City paper unincorporated business tax return or other report signed by a paid preparer, I declare that the information contained in the taxpayer’s 2017

New York City electronically filed unincorporated business tax return or report is identical to that contained in the paper return. If I am the paid preparer, under

penalty of perjury I declare that I have examined this 2017 New York City electronically filed unincorporated business tax return or other report, and, to the

best of my knowledge and belief, the return is true, correct, and complete. I have based this declaration on all information available to me.

ERO EFIN/PIN: Enter your six-digit EFIN followed by your five digit PIN:

_________________________________________

_____________________________________

________________

ERO’s Signature

Print Name

Date

_________________________________________

_____________________________________

________________

Paid Preparer’s Signature

Print Name

Date

PURPOSE - A completed Form NYC-579-UBTI provides documentation that an ERO has been authorized to electronically file the Unincorporated Business Tax return or other

report. The taxpayer may designate the ERO to electronically sign the return or other report by entering the taxpayerʼs personal identification number (PIN). The form also author-

izes payment of tax due on an electronically submitted return or report by an automatic clearing house (ACH) debit from a designated checking or savings account of the taxpayer.

You cannot revoke this authorization.

GENERAL INSTRUCTIONS

Part A - Part A must be completed by the taxpayer before the ERO transmits the electronically filed Form NYC-202 (Unincorporated Business Tax Return for Individ-

uals and Single Member LLC’s); NYC-202S (Unincorporated Business Tax Return for Individuals); NYC-EXT (Application for 6-Month Extension to File Busi-

ness Income Tax Return); or NYC-5UBTI (Declaration of Estimated Unincorporated Business Tax for Individuals, Estates and trusts).

EROs/paid preparers must complete Part B prior to transmitting electronically filed unincorporated business tax returns or reports (Forms NYC-202, NYC-202S, NYC-

EXT or NYC-5UBTI). Both the paid preparer and the ERO are required to sign Part B. However, if an individual performs as both the paid preparer and the ERO, he

or she is only required to sign as the paid preparer. It is not necessary to include the ERO signature in this case.

Do not mail Form NYC-579-UBTI to the Department of Finance. The EROs/paid preparers must keep the completed Form NYC-579-UBTI for three years from

the due date of the return or report or the date the return or report was filed, whichever is later, and must present it to the Department of Finance upon request.

NYC-579-UBTI 2017