Fill - Free fillable Form 8821: Tax Information Authorization (IRS) PDF form

Form 8821

(Rev. October 2011)

Department of the Treasury

Internal Revenue Service

Tax Information Authorization

▶

Do not sign this form unless all applicable lines have been completed.

▶

Do not use this form to request a copy or transcript of your tax return.

Instead, use Form 4506 or Form 4506-T.

OMB No. 1545-1165

For IRS Use Only

Received by:

Name

Telephone

Function

Date

1 Taxpayer information. Taxpayer(s) must sign and date this form on line 7.

Taxpayer name(s) and address (type or print) Taxpayer identification number

Daytime telephone number

Plan number (if applicable)

Appointee. If you wish to name more than one appointee, attach a list to this form.

Name and address

CAF No.

PTIN

Telephone No.

Fax No.

Check if new: Address Telephone No. Fax No.

3 Tax matters. The appointee is authorized to inspect and/or receive confidential tax information in any office of the IRS for the

tax matters listed on this line. Do not use Form 8821 to request copies of tax returns.

(a)

Type of Tax

(Income, Employment, Excise, etc.)

or Civil Penalty

(b)

Tax Form Number

(1040, 941, 720, etc.)

(c)

Year(s) or Period(s)

(see the instructions for line 3)

(d)

Specific Tax Matters (see instr.)

Specific use not recorded on Centralized Authorization File (CAF). If the tax information authorization is for a specific

use not recorded on CAF, check this box. See the instructions on page 4. If you check this box, skip lines 5 and 6 . .

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5 Disclosure of tax information (you must check a box on line 5a or 5b unless the box on line 4 is checked):

a If you want copies of tax information, notices, and other written communications sent to the appointee on an ongoing

basis, check this box . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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Note. Appointees will no longer receive forms, publications and other related materials with the notices.

b If you do not want any copies of notices or communications sent to your appointee, check this box . . . . . . .

▶

Retention/revocation of tax information authorizations. This tax information authorization automatically revokes all prior

authorizations for the same tax matters you listed on line 3 above unless you checked the box on line 4. If you do not want

to revoke a prior tax information authorization, you must attach a copy of any authorizations you want to remain in effect

and check this box . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

▶

To revoke this tax information authorization, see the instructions on page 4.

7 Signature of taxpayer(s). If a tax matter applies to a joint return, either husband or wife must sign. If signed by a

corporate officer, partner, guardian, executor, receiver, administrator, trustee, or party other than the taxpayer, I certify

that I have the authority to execute this form with respect to the tax matters/periods on line 3 above.

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IF NOT SIGNED AND DATED, THIS TAX INFORMATION AUTHORIZATION WILL BE RETURNED.

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DO NOT SIGN THIS FORM IF IT IS BLANK OR INCOMPLETE.

Signature Date

Print Name Title (if applicable)

PIN number for electronic signature

Signature Date

Print Name Title (if applicable)

PIN number for electronic signature

For Privacy Act and Paperwork Reduction Act Notice, see page 4.

Cat. No. 11596P

Form 8821 (Rev. 10-2011)

Page 2

General Instructions

Section references are to the Internal Revenue Code unless

otherwise noted.

What's New

• Each individual and/or entity must now file and sign a

separate Form 8821.

• Appointees will no longer receive inserts, such as forms,

publications, and other related materials, with notices.

• The IRS has created a page on IRS.gov for information

about Form 8821 and its instructions at www.irs.gov/

form8821. Information about any future developments

affecting Form 8821 (such as legislation enacted after we

release it) will be posted on this page.

Purpose of Form

Form 8821 authorizes any individual, corporation, firm,

organization, or partnership you designate to inspect and/or

receive your confidential information in any office of the IRS

for the type of tax and the years or periods you list on Form

8821. You may file your own tax information authorization

without using Form 8821, but it must include all the

information that is requested on Form 8821.

Form 8821 does not authorize your appointee to

advocate your position with respect to the federal tax laws;

to execute waivers, consents, or closing agreements; or to

otherwise represent you before the IRS. If you want to

authorize an individual to represent you, use Form 2848,

Power of Attorney and Declaration of Representative.

Use Form 4506, Request for Copy of Tax Return, to get a

copy of your tax return.

Use Form 4506-T, Request for Transcript of Tax Return,

to order: (a) transcript of tax account information and (b)

Form W-2 and Form 1099 series information.

Use Form 56, Notice Concerning Fiduciary Relationship,

to notify the IRS of the existence of a fiduciary relationship.

A fiduciary (trustee, executor, administrator, receiver, or

guardian) stands in the position of a taxpayer and acts as

the taxpayer. Therefore, a fiduciary does not act as an

appointee and should not file Form 8821. If a fiduciary

wishes to authorize an appointee to inspect and/or receive

confidential tax information on behalf of the fiduciary, Form

8821 must be filed and signed by the fiduciary acting in the

position of the taxpayer.

When To File

Form 8821 must be received by the IRS within 120 days of

the date it was signed and dated by the taxpayer.

Where To File Chart

IF you live in . . . THEN use this address . . . Fax Number*

Alabama, Arkansas, Connecticut, Delaware, District

of Columbia, Florida, Georgia, Illinois, Indiana,

Kentucky, Louisiana, Maine, Maryland,

Massachusetts, Michigan, Mississippi, New

Hampshire, New Jersey, New York, North Carolina,

Ohio, Pennsylvania, Rhode Island, South Carolina,

Tennessee, Vermont, Virginia, or West Virginia

Internal Revenue Service

Memphis Accounts Management Center

PO Box 268, Stop 8423

Memphis, TN 38101-0268

901-546-4115

Alaska, Arizona, California, Colorado, Hawaii, Idaho,

Iowa, Kansas, Minnesota, Missouri, Montana,

Nebraska, Nevada, New Mexico, North Dakota,

Oklahoma, Oregon, South Dakota, Texas, Utah,

Washington, Wisconsin, or Wyoming

Internal Revenue Service

1973 N. Rulon White Blvd. MS 6737

Ogden, UT 84404

801-620-4249

All APO and FPO addresses, American Samoa,

nonpermanent residents of Guam or the Virgin

Islands**, Puerto Rico (or if excluding income under

section 933), a foreign country, U.S. citizens and

those filing Form 2555, 2555-EZ, or 4563.

Internal Revenue Service

International CAF

2970 Market St. MS 3-E08.123

Philadelphia, PA 19104

267-941-1017

*These numbers may change without notice.

**Permanent residents of Guam should use Department of Taxation, Government of Guam, P.O. Box 23607, GMF, GU

96921; permanent residents of the Virgin Islands should use: V.I. Bureau of Internal Revenue, 9601 Estate Thomas

Charlotte Amalie, St. Thomas, V.I. 00802.

Form 8821 (Rev. 10-2011)

Page 3

Where To File

Generally, mail or fax Form 8821 directly to the IRS. See the

Where To File Chart, above. Exceptions are listed below.

If Form 8821 is for a specific tax matter, mail or fax it to

the office handling that matter. For more information, see the

instructions for line 4.

Your appointee may be able to file Form 8821

electronically with the IRS from the IRS website. For more

information, go to www.irs.gov. Under the Tax Professionals

tab, click on e-services–Online Tools for Tax Professionals. If

you complete Form 8821 for electronic signature

authorization, do not file a Form 8821 with the IRS. Instead,

give it to your appointee, who will retain the document.

Revocation of an Existing Tax Information

Authorization

If you want to revoke an existing tax information

authorization and do not want to name a new appointee,

send a copy of the previously executed tax information

authorization to the IRS, using the Where To File Chart,

above. The copy of the tax information authorization must

have a current signature and date of the taxpayer under the

original signature on line 7. Write “REVOKE” across the top

of Form 8821.

If you do not have a copy of the tax information

authorization you want to revoke, send a statement to the

IRS. In the statement, indicate that the authority of the

appointee is revoked, list the name and address of each

recognized appointee whose authority is revoked, list the

tax matters and periods, and sign and date the statement. If

you are completely revoking the authority of the appointee,

state “remove all years/periods” instead of listing the

specific tax matters, years, or periods on the form.

To revoke a specific use tax information authorization,

send the tax information authorization or statement of

revocation to the IRS office handling your case, using the

above instructions.

Taxpayer Identification Numbers (TINs)

TINs are used to identify taxpayer information with

corresponding tax returns. It is important that you furnish

correct names, social security numbers (SSNs), individual

taxpayer identification numbers (ITINs), or employer

identification numbers (EINs) so that the IRS can respond to

your request.

Partnership Items

Sections 6221-6234 authorize a Tax Matters Partner to

perform certain acts on behalf of an affected partnership.

Rules governing the use of Form 8821 do not replace any

provisions of these sections.

Appointee Address Change

If the appointee's address has changed, a new Form 8821

is not required. The appointee can send a written

notification that includes the new information and their

signature to the location where the Form 8821 was filed.

Specific Instructions

Line 1. Taxpayer Information

Individuals. Enter your name, TIN, and your street

address in the space provided. Do not enter your

appointee’s address or post office box. If a return is a joint

return, the appointee(s) identified will only be authorized for

you. Your spouse or former spouse must submit a separate

Form 8821 to designate an appointee.

Corporations, partnerships, or associations. Enter the

name, EIN, and business address.

Employee plan or exempt organization. Enter the name,

address, and EIN or SSN of the plan sponsor or exempt

organization, and the plan name and three-digit plan

number. If the plan's trust is under examination then see the

instructions relating to trust.

Trust. Enter the name, title, and address of the trustee,

and the name and EIN of the trust.

Estate. Enter the name and address of the estate. If the

estate does not have an identification number, enter the

decedent’s SSN or ITIN.

Line 2. Appointee

Enter your appointee’s full name. Use the identical full name

on all submissions and correspondence. Enter the nine-digit

CAF number for each appointee. If an appointee has a CAF

number for any previously filed Form 8821 or power of

attorney (Form 2848), use that number. If a CAF number has

not been assigned, enter “NONE,” and the IRS will issue one

directly to your appointee. The IRS does not assign CAF

numbers to requests for employee plans and exempt

organizations.

If you want to name more than one appointee, indicate so

on this line and attach a list of appointees to Form 8821. If

more than one appointee is listed, notices and

correspondence will only be sent to the first two appointees.

Check the appropriate box to indicate if either the

address, telephone number, or fax number is new since a

CAF number was assigned.

Line 3. Matters

Enter the type of tax, the tax form number, the years or

periods, and the specific matter. Enter “Not applicable,” in

any of the columns that do not apply.

For example, you may list “Income, 1040” for calendar

year “2006” and “Excise, 720” for “2006” (this covers all

quarters in 2006). For multiple years or a series of inclusive

periods, including quarterly periods, you may list 2004

through (thru or a hyphen) 2006. For example, “2004 thru

2006” or “2nd 2005-3rd 2006.” For fiscal years, enter the

ending year and month, using the YYYYMM format. Do not

use a general reference such as “All years,” “All periods,” or

“All taxes.” Any tax information authorization with a general

reference will be returned.

You may list the current year or period and any tax years

or periods that have already ended as of the date you sign

the tax information authorization. However, you may include

on a tax information authorization only future tax periods that

end no later than 3 years after the date the tax information

authorization is received by the IRS. The 3 future periods are

determined starting after December 31 of the year the tax

information authorization is received by the IRS. You must

enter the type of tax, the tax form number, and the future

year(s) or period(s). Only tax forms directly related to the

taxpayer may be listed on Line 3. If the matter relates to

estate tax, enter the date of the decedent’s death instead of

the year or period.

Form 8821 (Rev. 10-2011)

Page 4

In column (d), enter any specific information you want the

IRS to provide. Examples of column (d) information are: lien

information, a balance due amount, a specific tax schedule,

or a tax liability.

For requests regarding Form 8802, Application for United

States Residency Certification, enter “Form 8802” in column

(d) and check the specific use box on line 4. Also, enter the

appointee’s information as instructed on Form 8802.

Note. If the taxpayer is subject to penalties related to an

individual retirement account (IRA) (for example, a penalty

for excess contributions) enter, “IRA civil penalty” on line 3,

column a.

Line 4. Specific Use Not Recorded on CAF

Generally, the IRS records all tax information authorizations

on the CAF system. However, authorizations relating to a

specific issue are not recorded.

Check the box on line 4 if Form 8821 is filed for any of the

following reasons: (a) requests to disclose information to

loan companies or educational institutions, (b) requests to

disclose information to federal or state agency investigators

for background checks, (c) application for EIN, or (d) claims

filed on Form 843, Claim for Refund and Request for

Abatement. If you check the box on line 4, your appointee

should mail or fax Form 8821 to the IRS office handling the

matter. Otherwise, your appointee should bring a copy of

Form 8821 to each appointment to inspect or receive

information. A specific-use tax information authorization will

not revoke any prior tax information authorizations.

Line 6. Retention/Revocation of Tax

Information Authorizations

Check the box on this line and attach a copy of the tax

information authorization you do not want to revoke. The

filing of Form 8821 will not revoke any Form 2848 that is in

effect.

Line 7. Signature of Taxpayer(s)

Individuals. You must sign and date the authorization. If a

joint return has been filed, your spouse must execute his or

her own authorization on a separate Form 8821 to designate

an appointee.

Corporations. Generally, Form 8821 can be signed by: (a)

an officer having legal authority to bind the corporation, (b)

any person designated by the board of directors or other

governing body, (c) any officer or employee on written

request by any principal officer and attested to by the

secretary or other officer, and (d) any other person

authorized to access information under section 6103(e).

Partnerships. Generally, Form 8821 can be signed by any

person who was a member of the partnership during any

part of the tax period covered by Form 8821. See

Partnership Items, above.

Employee Plan. If the plan is listed as the taxpayer on

Line 1, a duly authorized individual having authority to bind

the taxpayer must sign and that individual's exact title must

be entered.

If the trust is the taxpayer, listed on Line 1, a trustee

having the authority to bind the trust must sign with the title

of trustee entered. A Form 56 (Notice Concerning Fiduciary

Relationship) must also be completed to identify the current

trustee.

Estate. If there is more than one executor, only one

co-executor having the authority to bind the estate is

required to sign. See Regulations section 601.503(d).

All others. See section 6103(e) if the taxpayer has died, is

insolvent, is a dissolved corporation, or if a trustee, guardian,

executor, receiver, or administrator is acting for the taxpayer.

Privacy Act and Paperwork Reduction Act

Notice

We ask for the information on this form to carry out the

Internal Revenue laws of the United States. Form 8821

authorizes the IRS to disclose your confidential tax

information to the person you appoint. This form is provided

for your convenience and its use is voluntary. The

information is used by the IRS to determine what confidential

tax information your appointee can inspect and/or receive.

Section 6103(c) and its regulations require you to provide

this information if you want to designate an appointee to

inspect and/or receive your confidential tax information.

Under section 6109, you must disclose your identification

number. If you do not provide all the information requested

on this form, we may not be able to honor the authorization.

Providing false or fraudulent information may subject you to

penalties.

We may disclose this information to the Department of

Justice for civil or criminal litigation, and to cities, states, the

District of Columbia, and U.S. commonwealths and

possessions for use in administering their tax laws. We may

also disclose this information to other countries under a tax

treaty, to federal and state agencies to enforce federal

nontax criminal laws, or to federal law enforcement and

intelligence agencies to combat terrorism.

You are not required to provide the information requested

on a form that is subject to the Paperwork Reduction Act

unless the form displays a valid OMB control number. Books

or records relating to a form or its instructions must be

retained as long as their contents may become material in

the administration of any Internal Revenue law.

The time needed to complete and file this form will vary

depending on individual circumstances. The estimated

average time is: Recordkeeping, 6 min.; Learning about

the law or the form, 12 min.; Preparing the form, 24 min.;

Copying and sending the form to the IRS, 20 min.

If you have comments concerning the accuracy of these

time estimates or suggestions for making Form 8821

simpler, we would be happy to hear from you. You can write

to Internal Revenue Service, Tax Products Coordinating

Committee, SE:W:CAR:MP:T:M:S, 1111 Constitution Ave.

NW, IR-6526, Washington, DC 20224. Do not send Form

8821 to this address. Instead, see the Where To File Chart,

earlier.

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