General Disclosure Representation Authorization Form Page 2

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AZ Form 285

Page 2 of 2

7. CORPORATIONS HAVING CONTROLLED SUBSIDIARIES: A.R.S. §42-2003(A)(1) provides that confidential information relating to a corporate

taxpayer may be disclosed to a designee of the taxpayer who is authorized in writing by the taxpayer. A principal corporate officer of a parent

corporation may execute a written authorization for a controlled subsidiary. A principal corporate officer of a parent corporation that desires to

designate a person to receive confidential information regarding the corporation’s controlled subsidiaries must either attach a list containing the names

of each controlled subsidiary that the parent company wants included in the disclosure authorization (a federal Form 851 may be used for this purpose)

or taxpayer may complete the following to include all controlled subsidiaries in the disclosure authorization. In addition, there is space provided to

exclude specific controlled subsidiaries from the disclosure authorization.

Please check one of the following:

Include all controlled subsidiaries. A controlled subsidiary, for purposes of A.R.S. §42-2003, is defined as more than 50% ownership or control.

Include all controlled subsidiaries except the subsidiaries named below. The following controlled subsidiaries are specifically excluded:

NAME

EMPLOYER I.D. NO.

TAX YEARS (if not all years)

8. SIGNATURE OF OR FOR TAXPAYER: I hereby certify that the Arizona Department of Revenue is authorized to release any and all confidential

information concerning the above-mentioned taxpayer. By signing this form, I certify that I have the authority, within the meaning of A.R.S. §42-2003(A),

to execute this authorization form on behalf of the above-mentioned corporation(s), limited liability company(ies), trust(s), estate(s), partnership(s),

and/or individual(s). I understand that to knowingly prepare or present a document which is fraudulent or false is a Class 5 felony pursuant to A.R.S.

§42-1127(B)(2).

SIGNATURE

DATE

SIGNATURE

DATE

PRINT NAME

TITLE

9. DECLARATION OF APPOINTEE: Complete if Appointee has been given authority under any Section 4a through h or Section 5 or is otherwise

authorized to practice law as defined in Rule 31(a) of the Arizona Rules of the Supreme Court.

Under penalties of perjury, I declare that I am one of the following:

9a A full-time officer, partner, member or manager of a limited liability company, or employee if the individual qualifies under Rule 31(d)13 of the

Arizona Rules of the Supreme Court.