Form Bank - Authorization For Direct Debit
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Form BANK, Authorization for Direct Debit for
(year)
Complete if you are electronically filing your tax return (Form M1, M2, M3, M4, M4NP, M8, M11, or M11L), and you want to authorize a
transfer 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
Type of Account
Routing Number
Enter the date you want
the amount withdrawn
Checking
from your account.
Account Number
Amount to be Withdrawn
Savings
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
notification of its termination at least 30 days prior to the effective date.
Your Signature
Spouse’s Signature (if filing joint)
Date
Daytime Phone
ERO: Attach 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.
Do NOT mail Form BANK to the Minnesota Department of Revenue unless requested.
Form BANK instructions
Complete Form BANK if you are
If you are the taxpayer
If you are the Electronic
electronically filing your Form
The direct payment option is voluntary and
Return Originator (ERO)
applies only to the electronic return you are
M1, M2, M3, M4, M4NP, M8, M11
Currently, the IRS requires you to keep the
filing.
W‑2, W‑2G and 1099 forms and other docu-
or M11L and you want to have
ments for three years. You should also keep
By signing Form BANK you are authoriz-
your taxes due automatically with-
with these IRS records the signed, original
ing the Department of Revenue to automati-
drawn (direct payment) from your
Form BANK, Minnesota copies of all W‑2,
cally withdraw the taxes due directly from
W‑2G and 1099 forms and any other form
your checking or savings account.
checking or savings account.
that shows Minnesota income tax withheld.
You must sign and date this form. If you are
The Bank Authorization for Direct
If you choose to discard Minnesota records
filing a joint return, your spouse must also
earlier, the minimum length of time you
sign.
Debit (BANK) complies with cur-
must keep these documents on file is until
Your tax preparer is required to keep a
rent ACH rules.
the end of the calendar year in which the
signed Form BANK until the end of the
return was filed electronically.
calendar year in which your return was
If the Department of Revenue requests cop-
electronically filed.
ies of Form BANK and/or W‑2, W‑2G or
If you are preparing your own return, keep
1099 forms, you must provide the informa-
Form BANK with your tax records.
tion within five working days.
Do not mail this form to the Department
Do not mail Form BANK unless re-
of Revenue.
quested to do so by the Department of
Revenue.
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