Offer In Compromise Application - Tennessee Department Of Revenue Page 22
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25STATE OF TENNESSEE
DEPARTMENT OF REVENUE
ANDREW JACKSON STATE OFFICE BUILDING
NASHVILLE, TENNESSEE 37242
TO WHOM IT MAY CONCERN:
You have my authorization to release any financial data that pertains to me or my company to the Tennessee Department of
Revenue.
Signature
Date
SOCIAL SECURITY #
Sworn to and subscribed before me on the date of first above written.
(Notary Public)
My commission expires:
RV-F0200501
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