AUTHORIZATION FOR THE RELEASE OF
I hereby authorize the Comptroller of Maryland to release the confidential Maryland tax records and information of:
*Also known as
SOCIAL SECURITY NUMBER
DATE OF BIRTH
The information is to be released to:
Any and all tax records and/or information (including liabilities, delinquencies, liens, etc.) for the following years:
The purpose for such disclosure is:
At my request
This authorization will expire one year from the date it is signed unless a shorter period of time is indicated here:
Authorization For The Release of Tax Records
• This authorization is voluntary.
• I may receive a copy of this form.
• I may inspect my confidential tax information without signing this form.
• This authorization to disclose information may be revoked by me at any time, except to the extent that action has been taken
prior to receipt of revocation. To revoke the authorization, I understand that I must notify the Comptroller of Maryland in writing.
Taxpayer or Personal Representative’s Signature
Printed Name of Taxpayer or Personal Representative
If the signature is other than the taxpayer’s, explain your authority to act for the taxpayer, and attach the appropriate documentation
(Power of Attorney, Letter of Administration, etc.):
Signature of Witness
Printed Name of Witness
Comptroller of Maryland
Revenue Administration Division
110 Carroll Street
Annapolis, Maryland 21411
OFFICE USE ONLY
Taxpayer’s Signature(s) verified by
Date Copies/Info Released