Liquor Division Authorization To Disclose Tax Information Page 2

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LIQ-AUTH - page 2
4. Signature
If a tax matter concerns a joint return, both husband and wife need to sign and provide applicable identification
numbers. A signature by both is not required in any other circumstance. A signature by a corporate officer, partner,
guardian, executor, receiver, administrator, or trustee on behalf of the taxpayer certifies that the signer has the
authority to execute the form on behalf of the taxpayer.
We cannot honor this authorization of disclosure if it is not signed and dated.
_________________________________________
___________
__________________________________
Signature
Date
Title (if applicable)
_________________________________________
Print Name
_________________________________________
___________
__________________________________
Signature of Spouse (if applicable)
Date
Title (if applicable)
_________________________________________
Print Name of Spouse
Authorization takes effect once the Montana Department of Revenue receives this form. This form applies only to a
liquor division application for licensing.
5. Filing this Form
Please mail or fax this form to the address and number shown below.
Mail to:
Montana Department of Revenue
Attn: Liquor Division Authorization
PO Box 7149
Helena, MT 59604-7149
Fax to:
(406) 444-6642

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