Form 2678 - Employer/payer Appointment Of Agent printable pdf download

2678

Employer/Payer Appointment of Agent

Form

OMB No. 1545-0748

Department of the Treasury — Internal Revenue Service

(Rev. August 2014)

Use this form if you want to request approval to have an agent file returns and make

For IRS use:

deposits or payments of employment or other withholding taxes or if you want to

revoke an existing appointment.

• If you are an employer or payer who wants to request approval, complete Parts 1

and 2 and sign Part 2. Then give it to the agent. Have the agent complete Part 3 and

sign it.

Note. This appointment is not effective until we approve your request. See the instructions

for filing Form 2678 on page 3.

• If you are an employer, payer, or agent who wants to revoke an existing appointment,

complete all three parts. In this case, only one signature is required.

Part 1:

Why you are filing this form...

(Check one)

You want to appoint an agent for tax reporting, depositing, and paying.

You want to revoke an existing appointment.

Part 2:

Employer or Payer Information: Complete this part if you want to appoint an agent or revoke an appointment.

1 Employer identification number (EIN)

—

2 Employer’s or payer’s name

(not your trade name)

3 Trade name (if any)

4 Address

Number

Street

Suite or room number

City

State

ZIP code

Foreign postal code

Foreign country name

Foreign province/county

5 Forms for which you want to appoint an agent or revoke the agent’s

For ALL

For SOME

employees/

appointment to file.

(Check all that apply.)

payees/payments

Form 940, 940-PR (Employer's Annual Federal Unemployment (FUTA) Tax Return)*

Form 941, 941-PR, 941-SS (Employer’s QUARTERLY Federal Tax Return)

Form 943, 943-PR (Employer’s Annual Federal Tax Return for Agricultural Employees)

Form 944, 944(SP) (Employer’s ANNUAL Federal Tax Return)

Form 945 (Annual Return of Withheld Federal Income Tax)

Form CT-1 (Employer’s Annual Railroad Retirement Tax Return)

Form CT-2 (Employee Representative's Quarterly Railroad Tax Return)

*Generally you cannot appoint an agent to report, deposit, and pay tax reported on Form 940, Employer's Annual Federal

Unemployment (FUTA) Tax Return, unless you are a home care service recipient.

Check here if you are a home care service recipient, and you want to appoint the agent to report, deposit, and pay FUTA

tax for you. See the instructions.

I am authorizing the IRS to disclose otherwise confidential tax information to the agent relating to the authority granted under this

appointment, including disclosures required to process Form 2678. The agent may contract with a third party, such as a

reporting agent or certified public accountant, to prepare or file the returns covered by this appointment, or to make any required

deposits and payments. Such contract may authorize the IRS to disclose confidential tax information of the employer/payer and

agent to such third party. If a third party fails to file the returns or make the deposits and payments, the agent and employer/

payer remain liable.

Print your name here

✗

Sign your

name here

Print your title here

Date

Best daytime phone

Now give this form to the agent to complete.

▶

2678

Form

(Rev. 8-2014)

For Privacy Act and Paperwork Reduction Act Notice, see the instructions.

IRS.gov/form2678

Cat. No. 18770D

Form 2678 - Employer/payer Appointment Of Agent

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