Audit Disclosure Authorization Form Instructions
PURPOSE OF FORM
Form 285A enables any individual, sole proprietorship, joint
filers, corporation, group of consolidated or combined
corporations, partnership, estate, trust, or other organization,
association, or group thereof (“Taxpayer”) to designate a
person (“Appointee”) to whom the Arizona Department of
Revenue can release confidential information, if the release of
such information is not otherwise authorized by A.R.S. § 42-
2003. The disclosure of such confidential information may be
necessary to fully discuss tax issues with, or respond to tax
questions by, such Appointee.
INSTRUCTIONS
Section 1- Taxpayer Information.
Enter Taxpayer’s name, address, and daytime telephone
number on the lines provided. Taxpayer may attach a
supplemental page to the form if section 1 does not provide
sufficient space for the required information. If Taxpayer is a
consolidated or combined group of corporations, Taxpayer
must attach a federal Form 851 or a supplemental sheet, as
applicable, containing the names of each member of the
consolidated or combined group for which the signator of
Form 285A is a principal corporate officer.
An individual taxpayer, sole proprietorship, or joint filers must
provide a Social Security number(s), Withholding number, or
Transaction Privilege Tax License number, as applicable.
Taxpayers which are corporations, partnerships, or trusts must
provide their Federal Employer Identification number and a
Withholding or Transaction Privilege Tax License number, if
applicable. Taxpayers which are estates must provide either
the decedent’s Social Security number or the estate’s Federal
Employer Identification number, as well as a Withholding or
Transaction Privilege Tax License number, if applicable.
Section 2- Appointee Information.
Enter the name of the person you are appointing to be
authorized to receive Taxpayer’s confidential information. The
Appointee must be an individual. For an Appointee
Identification Number, please provide Appointee’s Social
Security number, CPA number, State Bar number, Alternative
Preparer Tax Identification Number, or any other
identification number including one assigned to Appointee by
Taxpayer.
Section 3- Tax Matters.
You may use this form for more than one tax type. Please
check applicable boxes and specify the tax year(s) or tax
period(s) for which Appointee is authorized to receive
Taxpayer’s confidential information. 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 this 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 Taxpayer.
Section 4- Revocation of Earlier Authorizations.
This Disclosure Authorization Form 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
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 5- Signature.
HOW TO FILE FORM
Please submit this form to the specific auditor or audit section
of the Department that Taxpayer is currently working with.
Type of Entity Who must sign
Individuals,
Joint Filers,
and Sole
Proprietorships
Corporations
Partnerships
& Limited
Partnerships
Trusts
The individual/sole proprietor must
sign the authorization. If Taxpayers
are a husband and wife (or former
husband and wife), both spouses (or
former spouses) must sign the
authorization form.
A principal corporate officer within
the meaning of A.R.S. § 42-
2003(A)(2) must sign the
authorization.
A partner having authority to act in
the name of the partnership must
sign the authorization.
A Trustee must sign the
authorization.
Limited
Liability
Companies
A member having authority to act in
the name of the company must sign the
authorization.
Governmental
Agencies
An officer having authority to act on
behalf of the governmental agency
must sign the authorization.
ADOR 03-0030
(4/00)
ADOR 10953 (1/11)
1. TAXPAYER INFORMATION: Please print or type. Enter only those that apply:
Taxpayer Name(s) Employer Identification Number
Present Address - number and street, rural route Apartment/Suite No. Arizona Withholding Number
City, Town or Post Office State Zip Code Arizona Transaction Privilege Tax License Number
Daytime Telephone Number (with area code) Social Security Number(s)
2. APPOINTEE INFORMATION 2nd APPOINTEE INFORMATION (if applicable)
Name Name
Address (if different from taxpayer’s address above) Apartment/Suite No. Address (if different from taxpayer’s address above) Apartment/Suite No.
City, Town or Post Office State Zip Code City, Town or Post Office State Zip Code
Daytime Telephone Number (with area code) Daytime Telephone Number (with area code)
Social Security or Other ID No. Type
|
Social Security or Other ID No. Type
|
3. TAX MATTERS: The appointee is authorized to receive and discuss confidential information for the tax matters listed below.
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. REVOCATION OF EARLIER AUTHORIZATION(S)
Check this box if you wish to revoke any earlier authorizations or Powers of Attorney on file with the Arizona Department of Revenue.
The revocation will be effective as to ALL earlier authorizations and Powers of Attorney (even those relating to a different tax
type) on file with the Department of Revenue except those specified (please specify):
5. SIGNATURE OF OR FOR TAXPAYER
I hereby certify that the Arizona Department of Revenue is authorized to release any and all confidential 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
Audit Disclosure Authorization Form
ARIZONA DEPARTMENT OF REVENUE
ARIZONA FORM
285A
Effective February 29, 2000
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