Tax Information Authorization
FORM 8821
1 Taxpayer information. Taxpayer must sign and date this form on line 6.
Taxpayer name and address
Taxpayer identification number(s)
Daytime telephone number
Format: (000) 000-0000.
Plan number (if applicable)
2 Designee(s). If you wish to name more than two designees, attach a list to this form. Check here if a list of additional designees is attached.
Check here if a list of additional designees is attached.
Name and address
CAF No.
PTIN
Telephone No.
Format: (000) 000-0000.
Fax No.
Format: (000) 000-0000.
Check if to be sent copies of notices and communications
Check if new: Address
Check if new: Telephone No.
Check if new: Fax No.
Name and address
CAF No.
PTIN
Telephone No.
Format: (000) 000-0000.
Fax No.
Format: (000) 000-0000.
Check if to be sent copies of notices and communications
Check if new: Address
Check if new: Telephone No.
Check if new: Fax No.
3 Tax information. Each designee is authorized to inspect and/or receive confidential tax information for the type of tax, forms, periods, and specific matters you list below. See the line 3 instructions.
By checking here, I authorize access to my IRS records via an Intermediate Service Provider.
Rows
(a) Type of Tax Information (Income, Employment, Payroll, Excise, Estate, Gift, Civil Penalty, Sec. 4980H Payments, etc.)
(b) Tax Form Number (1040, 941, 720, etc.)
(c) Year(s) or Period(s)
(d) Specific Tax Matters
1
2
3
4 Specific use not recorded on the Centralized Authorization File (CAF). If the tax information authorization is for a specific use not recorded on CAF, check this box. See the instructions. If you check this box, skip line 5.
If the tax information authorization is for a specific use not recorded on CAF, check this box.
5 Retention/revocation of prior tax information authorizations. If the line 4 box is checked, skip this line. If the line 4 box isn't checked, the IRS will automatically revoke all prior tax information authorizations on file unless you check the line 5 box and attach a copy of the tax information authorization(s) that you want to retain.
Unless you check the line 5 box and attach a copy of the tax information authorization(s) that you want to retain, the IRS will automatically revoke all prior tax information authorizations on file.
6 Taxpayer signature. If signed by a corporate officer, partner, guardian, partnership representative (or designated individual, if applicable), executor, receiver, administrator, trustee, or individual other than the taxpayer, I certify that I have the legal authority to execute this form with respect to the tax matters and tax periods shown on line 3 above.
►IF NOT COMPLETED, SIGNED, AND DATED, THIS TAX INFORMATION AUTHORIZATION WILL BE RETURNED.
► DON'T SIGN THIS FORM IF IT IS BLANK OR INCOMPLETE.
Signature
Date
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Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Print Name
Title (if applicable)
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