Taxpayer Consent to Use Tax Return Information
Pursuant to Treasury Regulation §301.7216-3(a)
Internal Revenue Code §7216 generally prohibits any person who is engaged in the business of preparing U.S. income tax
returns from using information furnished to that individual for the preparation of any such return. Treasury Reg. §301.7216-
3(a)(1) provides that such tax return information can be used if written consent of the taxpayer is obtained. This document is
intended to provide written consent to use your tax return information for purposes other than the preparation and filing of your
return.
I/We, _________________________________________, do hereby give consent to Loggins Kern & McCombs CPAs PC
to release the following financial information:
Individual Tax Return (Form 1040 & accompanying state forms)
Corporate Tax Return (Form 1120 or 1120S & a ccompanying state forms)
Partnership Tax Return (Form 1065 & accompanying state forms)
Personal Financial Statement
Other ________________________________________________________________________________________
for the tax year(s)_______________________________________, to:
Name:
Co m pany:
Email Address:
This consent is valid through ____________________.
Fed eral Law requires this consent form be provided to you. Unless authorized by law , w e cannot use, without
your consent, your tax return information or personal financial statements to third parties for purposes other
than the preparation and filing of your tax return. Federal law may not protect your tax return information from
further use or distribution.
You are not required to complete this form. If we obtain your signature on this form by conditioning our services
on your consent, your consent will not be valid. If you agree to the disclosure of your tax return information and
personal financial statements, your consent is valid for the amount of time that you specify. If you do not
specify the duration of your consent, your consent is valid for one ye ar.
If you believe your tax return information has been disclosed or used improperly in a manner unauthorized by
law or without your permission, you may contact the Treasury Inspector General for Tax Administration (TIGTA)
by telephone at 1-800-366-4484, or by email at
complaints@tigta.treas.gov.
_______________________________________ __________________
Signature Date
_______________________________________ __________________
Signature Date
