This form is a Waiver Form for the Release of District Tax Information from the Office of Tax & Revenue, Office of
the District of Columbia Chief Financial Officer.
Trade Name if Different from Business Name
Federal Employee Identification Number
Mailing Address if Different from Property Address
I hereby give the District of Columbia Office of Tax and Revenue ("OTR"), Office of the Chief Financial Officer,
consent to release
tax information, to include real property tax information if applicable, to the
Community Foundation for the National Capital Region (“Community Foundation”).
I understand that the
information released under this consent is limited to whether or not I am in compliance with the District of Columbia's tax
laws and regulations as of January 1, 2016.
is not in compliance, I further consent that the OTR may inform the Community Foundation
whether or not
is maintaining a payment agreement. I understand that this information is merely for
the purpose of determining whether or not
is in compliance with the revenue laws of the District
of Columbia and for verifying
business address; but does not include disclosure of
actual tax returns. I further understand that the information that is received from the OTR
pursuant to this release will be placed in my file that is maintained by the Community Foundation and is not subject to
dissemination to any individual outside of the Community Foundation.
I hereby authorize the Office of the Chief Financial Officer, Office of Tax and Revenue, access to review and
research my taxes for the past three years – tax years 2013, 2014 and 2015.
Signature of Authorized Representative
Print Name of Authorized Representative
c/o The Community Foundation for the National Capital Region
Street NW, Suite 420
Washington, DC 20005
202.955.5890 Main 202.955.8084 Fax