General Disclosure/Representation Arizona Form
Authorization Form 285
PURPOSE OF FORM
A taxpayer may use Form 285 to authorize the department to
release confidential information to the taxpayer’s appointee.
The department may have to disclose confidential information
to fully discuss tax issues with, or respond to tax questions by,
the appointee.
A taxpayer may also use Form 285 to grant additional powers
to the appointee, up to and including a power of attorney.
Who Can Use Form 285?
Any of the following may file Form 285.
An individual
Individuals that file joint returns
A sole proprietorship
A corporation
A group of consolidated or combined corporations
A partnership
A limited liability company
An estate
A trust
A governmental agency
Any other organization, association, or group
NOTE: A fiduciary (trustee, executor, administrator,
receiver, or guardian) stands in the position of a taxpayer
and acts as the taxpayer. A fiduciary does not act as a
representative and should not file Form 285. If a fiduciary
wants to authorize an individual to represent or perform
certain acts on behalf of the entity, the fiduciary must file a
signed power of attorney naming that person to act in the
position of the taxpayer.
Filing Instructions
If the taxpayer is working with a specific section or
employee of the department, the taxpayer should mail Form
285 to that section or employee. Otherwise, the taxpayer
should mail Form 285 to:
Arizona Department of Revenue
Taxpayer Information and Assistance
P.O. Box 29086
Phoenix, AZ 85038
The taxpayer may file an original, a photocopy, or a facsimile
transmission (Fax) of Form 285. If the taxpayer is filing a
facsimile, and is working with a specific person, the taxpayer
should Fax Form 285 to that person. Otherwise, the taxpayer
should Fax Form 285 to (602) 542-2072.
Specific Instructions
Section 1 - Taxpayer Information.
Enter the taxpayer’s name, address, and daytime telephone
number on the lines provided. If more space is needed, attach
an additional page.
For income tax purposes, each individual signing this form
must enter his or her SSN. A corporation, partnership, trust or
estate must enter its Employer Identification number (EIN).
For withholding tax purposes, an individual, corporation,
partnership, trust or estate must enter the EIN.
For transaction privilege tax (TPT) purposes, an individual
must enter the TPT license number. A corporation, partnership,
or trust must enter its EIN and its TPT license number. An
estate must enter the decedent’s Social Security number, the
estate’s EIN and the estate’s TPT license number.
Section 2 - Appointee Information.
Enter the name of the person the taxpayer is appointing to
receive confidential information and/or to act on the taxpayer’s
behalf. The appointee must be an individual. Enter the
appointee’s ID number. This may be an SSN, CPA number,
State Bar number, Alternative Preparer Tax ID number or
other ID number. If the taxpayer wants to name more than one
appointee, please attach an additional sheet that contains the
required information.
Section 3 - Tax Matters.
You may use this form for more than one tax type. Please
check the box or boxes to specify the tax type covered by this
authorization. Also enter the tax year(s) or tax period(s). A
general reference to “all years”, “all periods”, or periods or
years “to present” will be accepted as applying only to tax
years (periods) ending prior to the date the form is signed. A
general reference to “all future” years or periods will be
subject to a four year limitation. Also, check the box that
properly describes the form of ownership of the taxpayer.
NOTE: When you sign this form, you are authorizing the
department to release confidential information to the named
appointee. If you would like to grant additional authority to the
appointee, complete section 4 of this form. If you want to grant
a power of attorney, skip section 4 and complete section 5.
Section 4 - Additional Authorization.
Items 4a through 4h allow the taxpayer to grant additional
authorization to the appointee. Please check all boxes that
apply.
The items specified in Items 4a through 4f are administrative
matters with the department. Any other authorization that
involves negotiating legal rights or responsibilities or filing
documents on the taxpayer’s behalf is also an administrative
matter. In order to represent taxpayer in an administrative
matter, the appointee must be an Arizona attorney or must
meet the requirements of Rule 31(c)(13) of the Arizona
Rules of the Supreme Court. The following individuals are
authorized pursuant to Rule 31(c)(13) to represent taxpayers
in administrative matters if the taxpayer authorizes.
1. Any individual, IF the total amount in dispute, including
tax, penalties, and interest, is less than $5,000.00;
2. A full-time officer, partner, member or manager of a
limited liability company, or employee, if all of the
following apply:
Form 285
2
The taxpayer is a legal entity, such as a corporation,
a formal partnership, a limited liability company, or
a trust.
Representation of the entity is not the appointee’s
primary duty to the legal entity, but secondary or
incidental to other duties relating to the
management or operation of the legal entity.
The person is not receiving separate or additional
compensation (other than reimbursement for costs)
for representation.
If either 1 or 2 above do not apply, then only the following
individuals can represent a taxpayer when the taxpayer
authorizes:
1. An active member of the State Bar of Arizona;
2. An Arizona Certified Public Accountant; or
3. A “Federally Authorized Tax Practitioner” within the
meaning of Arizona Revised Statutes § 42-2069(D)(1).
This includes:
An enrolled agent authorized to practice before the IRS.
An out-of-state attorney or out-of-state certified
public accountant, if the person is not currently
under suspension or disbarment from practice
before the IRS and if the person has filed with the
IRS a written declaration that he or she is currently
qualified as an attorney or a CPA.
An individual practicing with a federally authorized
tax practitioner and who is subject to the same
standards of practice and ethics requirements of that
person.
Section 5 - Power of Attorney.
By checking the box on line 5, the taxpayer grants the
appointee power of attorney. A power of attorney authorizes
the appointee to perform any and all acts that the taxpayer
can perform with regard to the tax matters and tax year(s) or
period(s) specified. This includes, but is not limited to, the
powers listed in items 4a through 4h. Any limitation to this
power of attorney must be specified. The use of a power of
attorney must be in accordance with Rule 31 of the Arizona
Rules of the Supreme Court. (See Section 4.)
Section 6 - Revocation of Earlier
Authorizations.
This authorization does not revoke any earlier
authorizations or powers of attorney on file with the Arizona
Department of Revenue. If you want to revoke all prior
authorizations and powers of attorney, please check the
revocation box. If you wish to revoke only some prior
authorizations and/or powers of attorney, please check the
box and list those authorizations and powers of attorney that
you wish to remain in effect.
Section 7 - Corporations Having
Controlled Subsidiaries
The department may disclose confidential information
relating to a corporate taxpayer 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 wants to
designate a person to receive confidential information
regarding the corporation’s controlled subsidiaries must
either:
(1) Attach a list of each controlled subsidiary that the
parent wants to include in the disclosure authorization
(federal Form 851 may be used for this purpose) or (2)
complete Section 7 of Form 285.
Section 8 - Signature.
Type of Entity Who must sign
Individuals,
Joint Filers and
Sole
Proprietorships
The individual/sole proprietor or a joint
filer must sign. In the case of a joint
return, if both husband and wife (or
former husband and wife) want to
authorize the same appointee, both
spouses (or former spouses) must sign.
Corporations A principal corporate officer within the
meaning of A.R.S. § 42-2003(A)(2) or
any person designated by a principal
corporate officer or any person
designated in a resolution by the
corporate board of directors or other
similar governing body must sign.
Partnerships &
Limited
Partnerships
A partner having authority to act in the
name of the partnership must sign.
Trusts A trustee must sign.
Estates An Executor/Executrix or the personal
representative of the estate must sign.
Limited
Liability
Companies
A member having authority to act in the
name of the company must sign.
Governmental
Agencies
An officer having authority to act on
behalf of the governmental agency must
sign.
Section 9 - Declaration of Appointee
If appointee has been given authority under any of Section
4(a) through 4(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, the appointee must sign and date this
declaration and enter a designation from 9a through d. The
persons who are authorized to practice law before the
Department of Revenue include active Arizona attorneys and
those authorized under Rule 31(d)(13) of the Arizona Rules
of the Supreme Court. An appointee indicating
authorization under 9d who is engaged in practice with a
federally authorized tax practitioner, must provide the name
of the practitioner with whom he or she works and that
person's CAF number in the place provided.
ADOR 10952 (9/10)
Previous ADOR 03-0029
General Disclosure/Representation Authorization Form
ARIZONA DEPARTMENT OF REVENUE
ARIZONA FORM
285
Effective July 3, 2003
1. TAXPAYER INFORMATION: Please print or type.
Enter only those that apply:
Taxpayer Name(s) Employer Identi cation Number
Present Address - number and street, rural route Apartment/Suite No. Social Security Number(s)
City, Town or Post Of ce State Zip Code Arizona Transaction Privilege Tax License Number
Daytime Telephone Number (with area code)
2. APPOINTEE INFORMATION
Provide one of the following identi cation numbers:
Name State and State Bar Number
|
Present Address - number and street, rural route Apartment/Suite No. State and Certi ed Public Accountant Number
|
City, Town or Post Of ce State Zip Code Internal Revenue Service Enrolled Agent Number
Daytime Telephone Number (with area code) Social Security or Other ID No. Type
|
3. TAX MATTERS: The appointee is authorized to receive con dential information for the tax matters listed below. By signing this form, I authorize the
Department to release con dential information of the taxpayer(s) named above to the appointee named above for the tax type and tax year(s)/period(s)
speci ed below. To grant additional powers, please see section 4. To grant a Power of Attorney, please skip section 4 and go to section 5.
TAX TYPE YEAR(S) OR PERIOD(S) TYPE OF RETURN/OWNERSHIP
Income Tax
Individual Joint Return
Partnership
Individual Single Return
Fiduciary-Trust
Corporation
Fiduciary-Estate
Transaction Privilege
and Use Tax
Individual/Sole Proprietorship
Limited Liability Company
Partnership
Corporation
Limited Liability Partnership
Trust
Estate
Withholding Tax
Other (specify tax type): Specify type of return(s)/ownership:
4. ADDITIONAL AUTHORIZATION: Items 4a through 4h allow the taxpayer(s) to grant additional authorization to the appointee named
above. Please check the boxes accordingly. An additional authorization must be in accordance with Arizona Supreme Court Rule 31.
See instructions.
4a Appointee shall have the power to sign a statute of limitations waiver on Taxpayer’s behalf.
4b Appointee shall have the power to execute a protest of a de ciency assessment or a denied refund claim or to execute an
agreement on Taxpayer’s behalf.
4c Appointee shall have the power to request a formal hearing on Taxpayer’s behalf.
4d Appointee shall have the power to represent the taxpayer in any administrative tax proceeding.
4e Appointee shall have the power to execute a closing agreement on Taxpayer’s behalf.
4f Appointee shall have the power to represent the taxpayer in any collection matter including an Offer-In-Compromise.
4g Appointee shall have the authority to delegate to others any or all authority granted to appointee by this document.
4h Other (please specify):
5. POWER OF ATTORNEY: By checking the box on line 5, the taxpayer grants the above-named appointee a Power of Attorney to perform any
and all acts that the taxpayer can perform with regard to the above-mentioned tax matters and tax year(s) or period(s). This Power of Attorney
includes, but is not limited to, the powers listed in items 4a through 4h. The use of a Power of Attorney must be in accordance with Arizona
Supreme Court Rule 31. Please specify any limitation to the Power of Attorney:
6. REVOCATION OF EARLIER AUTHORIZATION(S): This authorization does not revoke any earlier authorizations or Powers of
Attorney on le with the Arizona Department of Revenue unless the revocation box to the left is checked. The revocation
will be effective as to all earlier authorizations and Powers of Attorney on le with the Department of Revenue except
those speci ed (please specify):
Continues on Page 2 Î
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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 con dential 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 of cer of a parent
corporation may execute a written authorization for a controlled subsidiary. A principal corporate of cer of a parent corporation that desires to designate
a person to receive con dential 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
speci c 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 de ned as more than 50% ownership or control.
Include all controlled subsidiaries except the subsidiaries named below. The following controlled subsidiaries are speci cally excluded:
NAME EMPLOYER I.D. NO. TAX YEARS IF NOT ALL YEARS
7a
7b
7c
7d
7e
7f
8. SIGNATURE OF OR FOR TAXPAYER: I hereby certify that the Arizona Department of Revenue is authorized to release any and all con dential
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).
Î Î
SIGNATURE DATE SIGNATURE DATE
PRINT NAME PRINT NAME
TITLE 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 de ned 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:
a A full-time of cer, partner, member or manager of a limited liability company, or employee if the individual quali es under Rule 31(d)13 of the
Arizona Rules of the Supreme Court.
b Attorney - an active member of the State Bar of Arizona.
c Certi ed Public Accountant - duly quali ed to practice as a Certi ed Public Accountant in Arizona.
d Federally Authorized Tax Practitioner within the meaning of A.R.S. § 42-2069(D)(1). If appointee is engaged in practice with a federally authorized
tax practitioner, provide the practitioner’s name and CAF number below:
PRACTITIONER’S NAME CAF NUMBER
e Other - This may be any individual, providing the total amount in dispute, including tax, penalties, and interest is less than $5,000.00.
If this Declaration of Appointee is not signed and dated, the representation authorization will be returned.
DESIGNATION
Enter a letter (a, b, c d or e).
JURISDICTION
(State) SIGNATURE DATE
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